Dentists’ Diaries on Everyday Clinic Work
today,a girl,about 20s came to the dental hospitle
frankly speaking,i don't think she is too ugly to accept.but she is determined to receive an orthognathic surgery for her protrusive mandible.
unfortunately,her periodontal condition is so poor that my boss told her that she was insuitable for the surgery,especially that her teeth may become removable or even off during the presurgery orthodontic tx.
when she heard this,she was so disappointed that i can't stand seeing her heartbreaking face.
beauty,how important for a young girl like her!i wish someday she can realize her dream and turn a very good-looking woman.

the second consultation with an orthodontic patient
Because of an appointment with an American boy this afternoon, i had been busy with preparing all the document these days，such as model analysis，cephalo tracing，consulting with senior orthodontists etc。However，as a young dentist，I was still nervous when facing the parents of my patients’，especially the western ones。Usually，I have to strugle for some words during the consultation 。It's much more difficult
than speaking my mother tongue。
Therefore，I had writen down the outline before they came。I told the parents the boy‘s mouth breathing habit was due to his enlarged adenoid vegetation，which blocked the upper pharynx。They agreed to go to some ENT doctor for operation，meanwhile we fabricated orthodontic appliance here。
I was very pleased with thier cooperation。But unfortunately，I found I had forgotten to take the wax bite as soon as they left！

a relapse case from Singapore
This afternoon, a college girl from Singapore came for regular check-up.When greeting to me, she showed too many and too long teeth,so that the word"protrusion"jumped out promptly in my mind.
As soon as putting a mirror into her mouth,I found she got severe overjet and over bite in spite of missing four first premolars.Moreover,she suffered moderate periodontal problem,with 1/3 gum recession,two degree mobility in lower incisors and diastema among the upper ones.I was told that her teeth had become longer and longer in recent
years.That's why she came up.
Her teeth were relatively clean ,flossed everyday and no bleeding.But her occlusion was really terrible,cusp to cusp relation and second molars tilted.She got orthodontic treatment ten years ago in Singapore.After a long time (from10y to 13y) wearing fixed appliance,she was fed up with any braces.When we discussed the tx plan,she definitely refused retreatment.What should I do to prevent her condition from getting worse?

hard nut!
1.what do you mean by saying "with 1/3 gum recession"?does she have alveolar bone loss about 1/3 in x films and the roots are exposed about 1/3?
2.in my humble opinion,a periodontist ,instead of an orthodontist is the 1st man she should turn to ,after all, the "longer and longer teeth" is caused by on-going gingival recession rather than the extrusion of teeth in most cases
3.since her 4s are missing ,i don't think there is much room left for us to correct herDB and excessive OJ,except that her 8s are in right places.