Frequently Asked Questions
In the smiling pictures, do the patients have to force the smile or is it better if they smile naturally?
When taking the smile photos, try to get a natural, but full smile, not a forced smile. We are noticing that this is one of the better trends to monitor before and after, we really notice a difference in the smile window and the overall uplift effect on the facial aging triangle in this picture.
How long do the patients use the appliance for, and what is the long term regime?
The schedule is 4 months wear initially, then 4 months rest. The next wear period is only for 2 months, and then again 4 months rest, and so on after this is always 2 months wear, 4 months rest. If you get a patient who is coming regularly to you for Oralift checks (that is over a period of one to two years), you can then start to play with the variables a little to see if you can get a better result in specific areas, e.g. the bigger the appliance the better the effect on the eyes, if you want a more lengthening effect on the face, it is better to wear it for longer periods. But remember, initially, the idea is to get the patient to wear the appliance and get used to it, and achieve an overall result before looking at specific areas of the face.
Could I trouble you for clarification and guidelines on how long the patients should wear the clear appliance before moving on the next height and for how many days should the patient persist with each 15 minute, 45 minute etc. wear period before moving up to the next extended time and do you recommend particular time increments?
On the first day, the patient should wear the appliance for 2×15 minute sessions. These should be at a time when the patient is able to give 100% attention, as I recommend that they keep a note in the little memo book as to how many times the top teeth are touching the appliance, with the lips kept together. This exercise will establish the new freeway space very quickly and will cause muscle relaxation to take place. The next day when the patient starts to wear the appliance, they will find it much easier to maintain the new freeway space and the teeth will touch the appliance much less. They can now start increasing the amount they are wearing the appliance by amounts they feel comfortable with. A patient who had been suffering from frequent headaches and neck pain when she started wearing the appliance, found that after 15 minutes of wearing it, the muscles would ache. She therefore only used to wear the appliance for 5 to 10 minutes at a time to start with. The average person should have no problems wearing it for up to 2 hours by the end of the first 7-10 days; however this will differ for some patients and they will need to progress slower.
When the patients wear the Oralift again after the rest period, do they have to re-introduce back from the clear with the same initial regime?
Usually no. When the patient starts again after the 4 month break, most will be able to go straight back into using the pearl appliance as they were before the rest period. This will only change if they experience pain/soreness in the jaw when they commence the active period again. If this is the case, it is best to use the clear appliance and slowly re-introduce the pearl appliance at a gradual rate as they did the first time.
To get better results, can I always suggest to also use the white appliance if they have no problems in wearing the pearl and they do less than 5 ticks? And which scheme can I use to introduce its wearing?
If you are getting good results with just the clear or the pearl appliance, it doesn’t always follow that you will get better results with the white. If you are monitoring the patient closely, that is the deluxe or premier packages you can check if they tolerate the white appliance and if the results improve. Normally nowadays I wouldn’t do this until the second time they start wearing the appliances (after the first 4 month rest period). If the patient only purchased an introductory package (which only includes the clear and pearl) they can just purchase the white appliance at an extra cost.
Do you have to pay the Daily Express or the Daily Mail to write an article, or is it sufficient to tempt them with an Oralift?
To get an article published, we use a PR company and do free trials for journalists. Once you get more experience, this may be the route to take, but you need to have treated about 10-15 patients and let me see the results before you do this.
I would like to ask some specific questions about TMD disorders, which patients I should not treat, as you told us your headaches almost completely disappeared with the appliance, as your muscles relaxed!
Can I treat patients with:
– clicking and no pain
– clicking and pain
– some episodes of locking (I don’t think I should)
– headaches and muscular pain, tinnitus etc…
– Patients with clicking and no pain, don’t treat (they can still use the Oralift for anti-aging purposes, but in terms of treating the clicking joint, don’t treat for this purpose).
– Clicking with pain, treat.
– A mandible that gets locked in front of the disc – patients usually have learnt how to unlock the mandible, that is, get it back on the disc, I think we could safely treat these patients because I think the Oralift appliance helps to heal the tissues in the joint.
– Headaches and muscular pain, tinnitus etc, treat.
When treating patients with TMD symptoms, as with any condition where the aetiology is multi-factorial, one should not give any guarantees to the patient. But you must approach the patient with calm confidence and explain that you will try and do the best for them as possible. This is where the therapeutic effect of good communication skills and relationship building comes to the forefront.
When you do the full mouth rehab, do you make a permanent appliance or do you try a stock Oralift.? Do they go straight to full time wear, and for how long?
Nowadays I always start with the Oralift appliances for at least a couple of months, convert to a permanent appliance, then go on to full time use (for 2-3 weeks), and then do the full mouth rehab. This way I get to know the patient better and find out exactly what they are looking for, and hopefully achieve a better end result.
You remember I stopped clenching my teeth after the 10 min tick test treatment? How did that happen, was it just drawing my attention to how often I clenched or did that treatment already change the condylar position?
As far as your clenching is concerned, the reasons why I think we got such a good result are that the muscles adapt very quickly when you first use the Oralift appliance and therefore the increased freeway space made you realise that tooth contact was not necessary and helped to stop your habit. I remember a similar case, but in this instance I had made the patient new dentures at the increased vertical dimension, but she kept on clenching. Suddenly, one day she stopped at red traffic lights and found herself clenching and for some reason that triggered her to stop clenching from that day onwards. To break a habit, sometimes you just need one little trigger to set you off on the right path. Remember clenching is only a habit. The position of the condyle and the disc at resting vertical dimension probably does alter.
How rigidly do you suggest I hang on to the 2 x 1h every third day if the patient feels there is not much happening and if the patient is keen to do more. You were suggesting that going over the top will reverse the effects but if there does not appear to be too much effect I suppose it is difficult to over-do it?
The reason why I have the rigid protocol is because sometimes patients do all sorts of funny things with the appliance. If they do start wearing it at night time and clenching and getting symptoms of TMD, at least we can then say they didn’t follow the procedure. If you can monitor the patient, than obviously you can change the protocol as you wish. This exercise becomes very time consuming and is alright if you are treating friends/family, but when treating patients on a commercial basis it’s a bit of a luxury. However, if the patients are on the more expensive packages (£1650 or £2500), then you have the freedom to be able to do this.
In your opinion, is wearing the device 2h equivalent to 2x 1h? In other words, do you value the time gap in between the 2 separate hourly sessions for recovery for example?
Yes, I do believe the time gap is important, for instance Lauren couldn’t wear the appliance for half an hour at a time, but could easily wear it for 2 x 15 min sessions. There will be patients who can wear it for much longer sessions without any problems, and without any signs of overuse. People with busy lifestyles who can’t manage 2 sessions in the day, I normally would suggest just one 1 hour session, rather than one 2 hour session. Less seems to give sometimes better results. If in 4 months they haven’t shown much improvement, then you can review the amount they have been wearing the appliance and start changing the variables. At least you have a baseline to work with.