Recent Orthodontic Consultation in Detail

Hello!

This is a pretty long post so hang on!

As I stated in my last post, I had an orthodontic consultation on the 10th of this month, my first one in over 20 years. I was really excited to have it because I wanted to hear about the possibility of closing my anterior open bite. I was SO excited, in fact, that I had a nervous tummy!

First, they did the iCat, which consists of 3D x-rays.  The procedure was quick and easy.  Then I was ushered into a consultation room for adults.  I answered questions about my breathing and TMJ issues.  I informed them that I had had a lingual frenectomy (when I met the orthodontist, he showed no interest in this fact).  Then I watched an introductory video of the type of orthodontics they do.  The video highlighted the treatment of a teenage girl who seemed very happy with her treatment.

Too bad she still had a long face, midface deficiency, narrow palate, and a lisp.

I know, I know. Kind of (OK, very) obnoxious of me to say that, but once you recognize these things you see them EVERYWHERE. Because they ARE everywhere.

After the video, the doctor came in and looked me over and declared me to have a "skeletal" open bite.  A skeletal open bite means my bite is due to the structure of my face and jaws.  You could put braces on me until doomsday and it wouldn't close my bite.

See?  The arrow shows the angle of my upper jaw.  Braces move teeth not jaws.

Also, notice how my face sort of scoops inward?  Midface deficiency, baby!

The doctor also pointed out that I have extrusion of my lower front teeth (see photo below).  Normal teeth overlap (to a degree) with the upper front teeth coming down over your lower front teeth.  This provides resistance that keeps the teeth planted firmly in the bone.  Since my teeth never had any resistance, they over-erupted.  That's why my lower teeth appear to have gum erosion: they're sitting too high up out of the bone!!

And all those years I just thought I wasn't flossing enough...

Incidentally, it's hard showing photos of my teeth because they are NOT flattering!  But they don't look this bad in person; I actually have a nice smile. However, I feel it's important to show these things, embarrassing as they are, because whatever flaws my teeth have are almost all due to my tongue tie and having an open bite.

For instance, my teeth have a lot of yellowing here and there (see photo below).  Those aren't stains, however; those yellow spots are where I wore away my tooth enamel down to the dentin through over-brushing, which can happen with tongue-tied people who try to overcompensate for their short tongues.  Remember, one of our tongues' jobs is to sweep food away from our teeth.  A tongue-tied person often cannot do that, so food gets trapped against, or between, the teeth, they get cavities, and brush their teeth longer, or harder, to try and stop getting more!

This is not from bad oral hygiene but from a dysfunctional tongue!

One spot of great news in this consultation came when we looked at my airway.  No airway issues for me!  While I will never know what my airway looked like before my lingual frenectomy, I've no doubt it did not look this good!

My airway area is 932.9mm squared.  The minimum for me to have a healthy airway is 230.1mm squared.  Breathing large!

I did get confirmation of what I've suspected for years: that I have a deviated septum.  In the photo below, you can see my left septum is much more narrow than my right (top arrow).  There's also quite a deviation further in (bottom arrow).

Ha ha! Made you look up my nose!

At this point, I'm not going to worry about my deviated septum because I breathe so well through my nose these days that this is the least of my concerns.  My jaw on the other hand.... oy.

So far, everything I've shown you is relatively cosmetic in regards to how important it is to get fixed.  Technically, I can live with an open bite, although open bites tend to put strain on your jaws because you only bite down on your back teeth.  My real concern now is my jaw.

I really wasn't thinking about my jaw when I saw the orthodontist.  I've had TMD symptoms a long time now but wasn't too concerned.  Until the doctor showed me my right jaw...

The above series of images show 'slices' of my right ("R") and left ("L") jaw joints.  Doesn't look like much, does it?  Everything is fine in the Land of Left Jaw Joint, but the Realm of Right Jaw Joint is not too happy.  Let us take a closer look...

You can see here that my left lower jaw sits nice and centered in my upper jaw socket.  Snug as a bug in a rug!

But now let us look at my right jaw...

It's off-center!  You can see that it is jammed back into the socket (imagine you are looking at my right side profile) and also appears to sit a little low compared to the left jaw.  The result of this is popping and an inability to open my mouth wide without my jaw deviating (moving to the side).  Sometimes, my jaw seems to 'catch' when I try to open my mouth.  Also, when I bite, my left-hand teeth touch more than my right because my right jaw is hanging lower!  While I don't have pain yet, it's still uncomfortable.

And the orthodontist was very concerned.  He told me that I needed surgery to fix my bite, although he could not guarantee that it would fix my TMD.  He talked about how complicated TMD cases can be, but he also told me that I could expect my symptoms to get worse without surgery.  He said what would likely happen is one day I'll bite into something, even something as soft as a banana, and my jaw will lock up and I'll hardly be able to open it.

Did you get that?

I COULD GET LOCKJAW FROM EATING A BANANA.

So there we have it, sports fans!  My concerns just went from aesthetic (I want a nice smile and better speech) to medical (I don't want my jaw to deteriorate or lock up on me).  So now I have to begin the process of consulting with maxillofacial surgeons (and I will be consulting with more than one) but that won't happen until I begin my new job and my insurance kicks in, which will be about a month and a half from now.  Because it's a real medical issue at this point, and not merely cosmetic, insurance will likely cover the surgery.  However, I will still need orthodontics and insurance may not cover that.  Also, I don't even know which surgeons will take my insurance.  Many of the top doctors (in any field) don't accept insurance.

In the end, what is most disheartening about all of this is that it didn't have to be this way.  Had I gotten a lingual frenectomy as an infant I might have avoided a lot of this trouble.  BUT my history as a thumbsucker is what really did my jaw in.  My myofunctional therapist told me that thumbsucking often pushes the jaw backwards into the joint leading to misalignment and TMD.

The other disheartening fact is that I started braces too late when I was a child:

"The American Association of Orthodontists recommends all children get a check-up with an orthodontic specialist no later [italics mine] than age 7." (American Association of Orthodontists, 2012, p. 1)

I didn't start seeing an orthodontist until age ten.  By then, according to the orthodontist I just met with, 90% of my facial structure was done growing.  My jaw was set.  That's why my teeth never came together.  The tongue thrust was the final nail in the coffin.  And what angers me is that I told my first orthodontist, all those years ago, that my right jaw was clicking and he showed no concern.  I left his office with a faulty jaw that spent the next twenty years grinding, popping, and catching.  And it's only going to get worse.

Thanks, doc.

Am I bitter?  I thought about it, and I don't really feel bitter but I do get angry when I think about it.

still, when I look at case studies online of people who have jaw surgery for severe facial deformity's, many of them kids, I realize that it could be a lot worse. But I just hate the fact that for so long I knew something was wrong and the doctors I spoke to dismissed it.  We rely on our doctors to tell us what's what and know what to do, but it can certainly happen that a doctor does NOT know what's what or what to do.  So it is vital you be your own advocate when it comes to any medical concerns.

And that's what I'm doing now.

So I shall try not to dwell on the past and just focus on the journey ahead of me.  And it will be a long journey!  This whole process will take a couple of years or more between needing braces before and after treatment, surgery healing time, and needing to save up money! Egad!!

Anyway, that's where I am right now.  Hope you all enjoyed the post.  I would love to hear from others who have had jaw surgery, especially for TMD.  Are you happy with your results?  Would you do it again?

Happy Trails!