Question:
I went back and looked in the archives on your experiences with
cristen and her expander. if i got it straight, you considered both the
rapid expander (which i think she eventually had, correct?) and the ALF,
which is what she first was fitted with by the dentist in texas?
how long did cristen have the ALF? did she outgrow her use for it? is
this why you went to the rapid palate expander? i know you mentioned the
first dentist in your area was not comfortable doing the adjustments and
you found someone else locally who was - is this who recommended the rapid
palate expander?
Answer:
Actually, in the beginning we didn't know what to do. Our dentist
confirmed that Cristen had all of her adult teeth and that clearly they
weren't going to fit. It was also clear that she had an extremely arched
palate. Initial research indicated that typically orthodontia is not
performed on children with DS for whatever reason. Our dentist was talking
about putting spacers in, but I didn't see how this was going to help. I
know that in my case, I had 4 teeth pulled and braces when I was 12 or so.
It was also pretty clear that although Cristen's articulation was very
good, the facts that her palate was so arched and that her mouth was so
small were either having or going to have a negative impact eventually.
NACD gave me the name of the dentist in Texas, who was known for working
with kids with DS. He recommended the ALF (adjustable lightwire frame?) to
start with rather than an RPE. I did some research on the RPE and while it
was clear that it would help with the space issue, it seemed that it would
not do much with regard to the severity of the arch in the palate.
NACD just recommended the dentist. I liked the dentist o.k., but would
have preferred somebody local. Since then I have learned that there is a
ped. dentist in Gainesville, Virginia that uses the ALF with good success
with kids with DS. I would have gone there had I known. The goals with
the ALF are different than those of the RPE. The ALF has two pieces - one
for the top and one for the bottom. The wireframe design allows for
different areas of the jaw to have pressure applied over time while there
is a bar that fits behind the upper front teeth. This encourages the child
to keep the tongue in the mouth and off of the teeth. While the frame
pushes out and the tongue rests on the palate, the palate becomes more
round. This technique is designed to help compensate for development of
the palate that takes place naturally in most typical children. The ALF
can also be fitted to baby teeth, so theoretically this intervention could
be applied earlier than we used it and I would imagine that the earlier the
better. The question is whether the child would tolerate it. I know that
Cristen probably would as she has never had any negative tactile reponses
to dental treatment.
If I had it to do over again, I probably would have gone after the ALF
earlier. I did have the opportunity to examine before and after casts of
Cristen's mouth and although there was a marked difference, her palate was
still pretty arched.
The RPE was recommended by our new dentist/ortho. as well as the dentist in
Texas. I suppose that if there is more value to be gained, then another
ALF could be fitted. Both dentists concurred that we had gotten the
biggest bang for the buck as far as ALF goes.
Yes, our original family dentist was relatively young and not very good
with manipulating appliances. He was great with our kids, though and I
will always be thankful for the treatment that we got there as it was he
who originally put Cristen in the chair and got her used to the procedures
by lettingride in the chair and count his teeth, etc. He was a really nice
dentist, but he only worked with a certain ortho. in town who is a well-
known jerk. So, the search was on and eventually we found a dentist/ortho.
a couple of towns away that agreed to give Cristen a chance and he has been
wonderful with her too.
Given the same circumstances, probably. Had I known about the ALF when
Cristen was say 5, I probably would have considered it then. Had we had
the dentist that we have now, then we might have taken an altogether
different approach.
