Orthodontics against the odds
At last year’s British Orthodontic Conference in Edinburgh, I was presented with a commendation certificate in the ‘Against the Odds’ competition 2009 to mark the successful treatment of my patient, Kayleigh Wilson. This competition, run by the British Orthodontic Society (BOS), seeks to raise awareness of the impact of orthodontics on patient’s lives and is open to patients who have recently completed treatment.
‘Against the Odds’ was judged by a panel of orthodontic specialists from the BOS, along with a professor of psychology and a journalist from The Sunday Times newspaper. A record number of cases were assessed (double the previous year’s) and were judged for their poignancy and the aesthetic results of their treatment.
I’d like to share with you the details of my winning patient’s journey through treatment, which transformed her life completely.
Kayleigh was 14-years-old at presentation and was seen by myself, on referral from her dentist in West Lothian, in October 2005 for an orthodontic assessment. When she was two-years-old a bookcase fell on her, smashing her skull bones and leaving bone fragments embedded in her frontal lobe. She was left in a coma for three weeks.
Despite life saving surgery, she was left with brain damage to the frontal lobe. She said that she was very much concerned about her teeth and agreed to the orthodontic treatment with reluctance.
In her letter to the competition, Kayleigh describes her childhood as: “a dark place inside my head”. Targeted as the freak by her school-mates, Kayleigh had to endure the painful taunts of “Brain Buck”.
Every time she heard those words, she “died a little more inside”. Kayleigh was told by her bullies that if she cut herself with a piece of glass, she could be accepted into their gang. She graphically describes how “my face, neck and wrists were slashed that day”. After this Kayleigh also developed anorexia. She said: “I couldn’t bear to be fat on top of everything else.” She also developed an aversion to going outside, fearful that everyone would think she was ugly. As she put it “I hated myself, so I hid myself away”. She admits that she was fearful of visiting the orthodontist, knowing that the orthodontist would have to look at her.
She presented with a class II division I malocclusion on a skeletal II base with slightly increased lower facial height and an incompetent lips (Fig. 1 & 2). The overjet measured at 7mm while there was an anterior open bite measuring 2-3mm, affecting her labial segments (Fig 3, 4 & 5). The upper and lower arches exhibited moderate crowding. There was no history of any soft-tissue habits. There was a 1mm diastema between her upper central incisors. Her oral hygiene was fair with obvious staining/calculus on her teeth surface.
The treatment plan involved extraction of her upper 1st and lower 2nd premolars, with the use of upper and lower fixed appliances with rigid intra-oral anchorage reinforcement. She did have problems with the extraction of these teeth under local anaesthesia and it was only in February 2006 that her fixed appliances were fitted.
After her fixed appliances were fitted, Kayleigh suffered from frequent oro-mucosal ulcerations during her treatment – her medical practitioner said that it could be due to her ‘sensitive mucosa’ due to her anorexia. Kayleigh said: “My gums and my mouth burst open and bled. I have never been so scared. Every day I woke with countless cuts and sores.” She needed the plastic tubing over some areas of the arch wires to make it comfortable and needed to use the ‘wax’ to relieve any sharpness on her braces.
As she moved up the arch wires, her teeth started to align nicely and become straight. The spaces between her teeth were closed with the use of elastomeric chains. To close her anterior open bite, Kayleigh needed to wear vertical inter-maxillary elastics. Even though, she experienced numerous difficulties with these elastics, Kayleigh persisted, with the encouragement and support of her mother, who was a source of many comforting words and moments for Kayleigh. She wrote: “When my elastics were put in, I kept choking and my teeth hurt so bad.”
End of treatment
After two years and nine months of active treatment, Kayleigh’s braces were removed in November 2008. The expression of joy on Kayleigh’s face and in her smile not to mention the change in her confidence are illustrated eloquently in the photographs taken at the end of her orthodontic treatment (Fig 6 & 10). Her teeth were straight and her occlusion was perfect, with the open bite closed (Fig 7, 8, & 9). For retention, she was fitted with bonded fixed retainer on the lingual surface of her upper and lower anterior segments. She was also given a removable vacuum-formed retainer for night-time wear.
The first time Kayleigh saw her new teeth unveiled on the removal of her braces, she was lost for words. She was so overjoyed that she actually broke into tears. She said: “No words can explain how I felt when Mr. Mahesh took my braces out. In the mirror he held out was my reflection. I’m perfect now; I’m Kayleigh the girl who was lost. I’m the girl I dreamed about. I’m not ugly anymore, I’m Kayleigh with an amazing smile.”
Finally, she felt pretty and the proud owner of an amazing smile she had always dreamed of. Kayleigh says that this is the beginning of an amazing new life, which has transformed her confidence as much as it has her smile.
Orthodontics comes from the Greek words ‘orthos’, meaning correct or straight and ‘dontos’, meaning teeth. It is a specialized branch of dentistry concerned with the development and management of irregularities of the teeth, jaws and face (malocclusions). Orthodontic treatment can improve the function and appearance of the mouth and face.
The aim of orthodontic care is to produce a healthy, functional bite, creating greater resistance to disease and improving personal appearance. This contributes to the mental as well as the physical wellbeing of the individual. The benefits of orthodontic treatment include an improvement in dental health, function, appearance and self-esteem.
Improvement in dental/facial aesthetics as a result of orthodontic treatment is often associated with improved self-esteem and other psychosocial aspects of the individual. A number of studies over the years have confirmed that a severe malocclusion can be a social handicap. Social responses, conditioned by appearance of the teeth, can severely affect an individual’s whole adaptation to life. This can lead to the concept of a patient’s malocclusion being ‘handicapping’.
The case report of Kayleigh Wilson illustrates the psychological benefits of orthodontic treatment. Even though case reports are low in the hierarchy of scientific evidences, such cases markedly illustrate the obvious benefits from orthodontic treatment to the wider audience. As an orthodontist, it is very gratifying to see such appreciation of one’s work, both from the patient and the assessment panel of Against the Odds 2009 competition. I am really grateful to my patient for her kind words and for putting me forward for the award.
Her compliments included: “Mr. Mahesh is my guardian angel. Mr. Mahesh has given me a brand new, perfect life. I will never forget Mr. Mahesh or what he has done for me. He heard my wish, without me telling him and he makes wishes come true.” She concludes her letter with: “From the bottom of my heart, thank you!”
The countless possibilities for making a difference in another person’s life, as illustrated be
autifully in this case, is what makes it all the more worthwhile of being an orthodontist and providing the best possible care for all my patients.
Raja Mahesh is the principal orthodontist at M-Brace Orthodontics in Bathgate, West Lothian and Glenrothes, Fife. He would like to acknowledge the use of ‘The Justification for Orthodontic Treatment’ which was published by the British Orthodontic Society (BOS). The literature can be accessed by visiting the BOS website at ww.bos.org.uk
(For all the pictures referred to in this article please see the digital version, page 56)