Hi, Sandra….Hope all is well with you! So, this 14 year old that has done SO WELL with the program is currently in “follow-up” stage with me. She has worked very hard and gone thru all of the stages and has been working diligently to incorporate reminders and associations and has been using and liking the autosuggestion. My question is I am relying heavily right now on self reports, self charting, etc. for her generalization….how do I know when she has truly generalized and is “done”? Well, I guess the word isn’t “generalize” because she is doing that – good swallows w/ different foods in different environments, and same with tongue on spot for rest……habituate may be a better word…..doing it all the time/enough? (I’ve done a post assessment – no longer drooling at night, was “a lot” when we started; lips closed all day,even in silent reading, all objective measurements WNL (within normal limits), freeway space measurement normal, from a “7” to a “2” (tho, of course she knows I’m measuring), etc. One thing: She does still have a lateral open bite (right side only) – I think it has closed some, but it is still open. If that is to close on its own, w/o 2nd round of ortho, how long does that take (or what is reasonable?)
Regarding habituation: I usually tell them the first or second session that I can offer them what they need and guide them. I tell them that the first two phases can be accomplished by working hard on the exercises and activity assignments given to them. “But,” I tell them, “making it a part of your every day life is up to you. Neither your parent nor I can be responsible for that part. We’ll support you all along the way, but making it a habit is your job.” I encourage them to try to start the process early on, long before we actually focus on it in Phase 3 targets. Your measurements and clinical observations are pretty good indicators of success. I also give them 3 months of the Grab Bag Activity right at or near the end of the regular treatment sessions. About the lateral open bite, this is one of those areas that some trainers and therapists are emphasizing, but should not be doing so. For years, therapists showed photos of changes that “we” created. In reality, they selected the particular ones that showed movement, or worse yet, they might have used photos of patients who had also had orthodontic intervention of one type or another that made the teeth “move.” I never make any guesses or promises about whose teeth might “move” into a more desirable position. The more I learn, the less I make any claims about orthodontics. I just today took photos that I am sending to Dr. Bob Mason because I am not sure whether to initiate the orthodontics now or later with a child. Has she previously had orthodontics or is she currently seeing an orthodontist? Sorry to give more questions back, but she needs to see one and if he/she is a good practitioner, he might not have to do anything extreme now that you’ve helped the girl make the oral cavity easier for orthod. to work.
OK, FABulous……I actually did start that “lecture” process from the get go, and this girl’s mom is phenomenal at having fun with it (sending funny texts during the day….do you know where your tongue is? ,etc.) So, yes, she DOES know it is up to her. Whew! THANKS for taking the pressure off re: the pictures and the teeth. One thing I have noticed is that there are about 5 pictures that are used around the whole country!!! ha! Like they all have the same client! Anyway…..yes she has had ortho, and he referred her to me when her teeth opened up after about a month after braces off and he and her dentist noted tongue thrust…..she is due back for follow up with him, but he told me he does want to wait to see if shifting back occurs or not (I was feelin’ the pressure!) OK, I think I am actually in a good place (I get to sleep tonight! yay!)