Beginning Braces

Just tweaking the blog a bit. If you're bored, my "other" website geek-girl.ca just got a bit of an overhaul, so I've put back the link on the right as well. I god rid of Lisa over there in the corner, too. I need a new pic; I was tired of that one. Plus, for some reason, it started screwing with the site layout.

In therms of ortho news, I've got nothing. I've postponed making any major life decisions until I can get the job situation worked out. It's so frustrating to finally make the big decision only to have everything get screwed up, but what can ya do?

A couple days ago, I finally had my consultation with my oral surgeon. He was great, actually. Yeah, he came off as a bit of an arrogant ass at first, but in surgeons, I think that's a good quality. My diagnosis is pretty cut-and-dried; my lower jaw is too short, and needs to be lengthened. He explained the procedure, explained the benefits and risks, answered all my questions... yadda yadda yadda. We discussed how I'm a good candidate, psychologically (ok, that may be debatable... I'm a tad nuts) and physically okay. He explained that since I sit at a computer all day, I'll only need to be off work for at most 2 weeks, and should be virtually pain free after only 4 or 5 days, with the swelling gone in a week. We even discussed medical politics across the country (don't ask) and he told me how much he wanted to do this surgery, because he feels the impact on my self confidence will be even greater than the impact on my appearance. And for an added bonus, the actual cost of the surgery will actually be less than I thought it would. After months of waffling on the topic, I walked out of his clinic convinced that this was the right thing to do.

It's amazing what a day can do. I was totally psyched at the possibility of finally starting the process of fixing my mouth, which is pretty much the bane of my existence. I get downright giddy when I hear the words "perfect bite" because frankly, I can't even imagine that. I don't even want a perfect bite or smile - I just want to be able to open my mouth and not be completely humiliated.

The next morning, I get a phone call. All of a sudden, my job and income is not nearly as secure as it was just last week. I'm not out of a job... yet... but I'm looking. It's time to move on. And with this hanging over my head, I simply cannot in good faith take on another $15,000 in debt. It's different than when I was making car payments and not working, because I knew that if I had to, I could always sell my car. I can't sell 3 years of orthodontic treatment!

So now I don't know what to do. I'm debating pushing things back to the new year, when I can re-assess the situation. I really don't want to do that, but I don't think I have much of a choice.

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Coming back from the dentist, the end result was just one little itty bitty cavity. In all honesty, my dentist probably wouldn't even have bothered to tell me about it if I wasn't going for braces. Instead, it would have been on her "watch" list and would be filled if/when it got bigger. But because it's located right where a bracket will be, she's filling it now. It'll even be done before my oral surgury consult, as well. 18 days to go.

A small cavity on an upper premolar I can handle. My upper jaw freezes much better than my lower, and it's not very deep. I hope. So hopefully this cavity will not cause me the problems the others have. *fingers crossed*

Yesterday I called my dentist, hoping to bump up my regularly scheduled cleaning a bit so I could be sure I'd be cavity free for all this ortho work. I'm pretty sure I still have a cavity or two lurking in there somewhere. When I use my electric toothbrush, there's a bit of pain up in the top right, and I swear I can also see decay on the bottom right premolar. Considering it'll most likely take a couple weeks to months to get the appointments to get these filled, I should probably schedule them sooner than later if they are necessary. The end result was I could either have an appointment for a cleaning this morning, or 3 weeks from now. I chose the former, and have about 20 minutes before I have to leave!

Up until now, the only people I'd told about all this work I'm having done are my parents and a particularly special guy in my life (that's another whole story I won't get into here). He's been amazing and really supportive, but is getting tired of hearing me obsess. My mom's been really supportive about my choice to get braced, but she is not at all happy about the prospect of surgery. I ended up getting the "its your money and your body, so do what you want" routine. Sometimes, no matter how old you get, parents just don't ever stop being parents.

So I finally told my two closest girlfriends about my plans last nite. I really wasn't going to tell anyone else until I could no longer hide the fact I had railroad tracks on my teeth, but I felt I needed the support. They were so wonderful! I love my girlies so much. They both offered to "take care of me" if need be, and Lora has volunteered to find me (and make me) all sorts of yummy smoothie recipes. She's a kick ass cook, and I'm almost looking forward to that!

In another vein, I found this article about the Psychological considerations in orthognathic surgery. It's a little technical and doesn't contain as much info as I would have hoped, but it might be a decent read if you're considering the surgery as well.

That's it for now... I'm off to brush my teeth again and make my way to the dentist! Isn't the journey fun!?! (That was sarcasm, in case you missed it!)

Peridontally boring, that is.

As per usual with potential adult orthodontic patients, I had to have a periodontist check me out before I could go through with everything. I was a little bit freaked out about it, to be honest. I was envisioning even more problems that would have to be fixed, needing even more money and time.

Thank god I was wrong! At the request of my ortho's office, the peridontist squeezed me in yesterday when they had a cancellation, which was nice. (My scheduled appointment wasn't until late November). I wish the peridontist was my orthodontist. He was totally cool, had an awesome & friendly chairside manner, and took the time to explain a lot of things to me. I really, really appreciate that. And as far as he's concerned, peridonatally i'm fine. Boring was the term he used. A perfect candidate. In fact, even if I wasn't fine, he told me he would recommend orthodontics anyway. In my particular case, the benefits of getting the ortho done outweigh any risk of tooth loss later.

Apparently, as it stands right now, if my front teeth were to be knocked out due to an accident, I'd be screwed. A partial or implants or any kind of prosthetic device would be almost impossible with my current bone structure. In the future, if I do loose those teeth, naturally or otherwise, orthodontics now will make them much, much easier to replace. Great... now i'm going to spend the next 3 years afraid of baseballs, hockey pucks and falling on my face. But on the other hand, it got my wheels turning. Maybe, just maybe, I could get this whole thing classified as medically necessary? If it is, then maybe my government would pay for it (Gotta love being a canadian, eh?). It's a long shot, but is something I need to look into. Orthodontics in adults are considered cosmetic. And everything but the surgeon's fee is already covered for oral surgery. But that damn fee is the biggest expense!

We also discussed (again) why the surgery option was best. I know it's the best option, it's just a scary, expensive, potentially painful option. He explained that after I saw the oral surgeon, the three of them (orthodontist, peridontist, and oral surgeon) would get together to discuss my case, present the options to me along with their pros and cons, and let me make my own decision. He promised nobody would strong arm me either way. And then promptly changed his mind, telling me yeah, they probably would try to strong arm me into surgery. Lovely...

My consult with the oral surgeon is Oct 18. That'll cost me even more money. It's going to end up costing me a grand just to get a treatment plan, and I wouldn't have had a single thing done yet. But it's for a good cause, right? Can you really put a price tag on self esteem?

As previously mentioned, yesterday I had my "pre-treatment" appointment with the patient coordinator. She had all sorts of pictures, my impressions, and we were going to discuss my options now that the ortho had taken a look at all the data. (See the previous post for some of the pictures and an xray.)

She said so much, and tried to explain so many things to me, I'm sure I'm going to forget 75% of it.

The problems, on the surface, are obvious. There's the huge overjet. There's the spacing problems. And then there's the problems with my lower jaw: it's much too short.

I was given three options. The first was to try and fix things with orthodontia alone. It would involve an appliance on the roof of my mouth for the entire treatment plan. It would be attached to molar bands, and would serve two purposes; it would keep my lower teeth from touching the roof of my mouth, and would provide some anchorage for moving my front teeth back. I've seen pictures of this device on archwired, unfortunately, i cannot remember it's exact name.

I was warned - ortho alone will not be able to fix everything. At best, it could fix the spaces, and maybe reduce the overjet by half.

The second option was oral surgery. This would bring the lower jaw forward, which would allow the upper teeth to be returned to their normal position. As it stands currently, the movement of the upper teeth is limited by the bone growth, which protrudes outwards. It'd be fine if my lower jaw had grown to match, but obviously, it did not. So the lower jaw needs to move forward, to correct my bite and to allow the upper teeth to be moved to align properly with the lower.

The surgery option is the only option that would fix all my problems completely.

The third option is what floored me. I thought I'd done my research, but this was an option I'd never heard of. It would still involve some input from the oral surgeon, but was not "oral surgery", per se. Instead, the surgeon would install a post (or pair of posts) of some sort into my upper jaw, which would be used as leverage (for elastics?) to further correct the overjet. For whatever reason, my jaw alone is not strong enough to be used as leverage to pull the teeth in as far as we'd like. Being able to accomplish that would defy the laws of physics, apparently. The post(s) would be considerably stronger, and would provide some extra leverage. Of course, this is all providing I understood the process correctly. Even the patient coordinator, who'd been doing this for 25 years, seemed a little foggy on the details. The posts were likened to piercings in either the roof of my mouth, or on the sides (the exact location has not been determined yet). Now, I can deal with piercings, currently sporting 8 holes total in my ears and belly button, but the idea of a piercing is that it goes through flesh... not bone! But I digress...

This option, although not providing 100% correction of my problems, would provide considerably more than ortho alone.

Also - both surgery options would require 4 extractions. I thought with all my spacing problems, I'd be spared the extraction route. Apparently not.

The end result of all this? My nice patient coordinator is going to make an appointment for me with the oral surgeon. That'll be another $250. Just figuring out what the treatment should be is sucking me dry, cost wise, between records, a perio consult, and now the surgeon's fee for his consult. Yikes.

I have no idea what I'm going to do.

I've always been leaning away from the idea of surgery. It's a huge expense, doubling the cost of the whole process, especially considering the lost wages from the time i'll have to take off. Plus, it's surgery... I'm not such a fan of hospitals right now. The third option was presented as a compromise, and I am curious to find out more, but a metal post in my jaw, extruding into my mouth? What is this, frankenstein goes to the orthodontist? (ok, that might be a bit extreme, but that's what came to mind.)

Guess I'll have to wait to see what the surgeon says. And the periodontist. Apparently he also has some say on what happens in my mouth. Talk about a team effort, all needed to fix the freak of nature that is me! ;)

Quick update: My ortho's office is going to send me some info regarding the post procedure. I'll post again when I get it, and maybe I can explain things better then.

Because I know how much evey one loves pictures. Even pre-treatment ones. These came from my records and impressions, taken September 7, 2005. The plan (obviously) is to fix the spacing and that huge overjet, which is actually worse than it appears due to the fact my bottom teeth are also tipped forward. Yikes.











And now for the special treat - The scan of the xray of my head, including all the markups my ortho made. Hey, they gave it to me, might as well post it, right?

Just over a week ago, I went in for my orthodontic records and xrays. They scheduled me for a 90 minute appointment, but I was out in 45. The only part that could be classified as unpleasant was the pink goo they use for impressions, but even that wasn't that bad. And of course, they had to take pictures of me and my "smile", which, for someone with a mouth like mine, is an extremely humiliating experience. I honestly do not know how to smile naturally like a normal person.

I've got my records follow up appointment in a couple hours. I have no idea what to expect, but I'll be back to record whatever it is that happens.

Just a quick note - I fixed the majority of typos in the previous posts. I really should learn to proofread my work better. I have a bad habit of reading what I meant, not what I typed, and the end result is something that looks like a typing test gone mad. ;)

I've been meaning to post for a while, bur for whatever reason, I never got around to it.

I did finally get in for a second consultation with a orthodontist close by.

The ortho's clinical findings:
- Lower jaw is too short
- Distance from nose to chin appears long
- Lower teeth are behind the upper teeth. Upper teeth are tipped forward.
- Lower teeth bite into the roof of the mouth
- Lower fron teeth are too far behind upper front teeth
- Upper front teeth are spaced
- Space between upper front teeth is 3mm
- Overjet measures 10mm
- Lower jaw appears asymmetric to the left
- Attrition to upper incisors

Now, I have to choose an orthodontist. I'm torn.

I really liked the office, and the staff. I like the fact it's considerably closer to home - running in to get a wire clipped, for instance, will not be a problem.

A lot of things were similar to the first office I visited - general treatment plan, cost, financing.

The one thing I wasn't impressed with overall was the ortho's chairside manner. He was very... abrubt. Very clinical, and he did not seem overly sympathetic. I was almost in tears, mainly because he didn't seem to think he could do all that much without surgery, and he didn't seem to understand why I wouldn't want it. (The patient cordinator did, however, and repeatedly told me it would always be my choice, and that I would still see huge results regardless of my treatment plan).

So... decision time.

I chose the second orthodontist. I'm still not sure that was the right decision, but I think it's worth it, for the convinience factor alone. Add that to the fact that I'll probably only see the actual orthodontist for a grand total of 10 minutes over the whole treatment, and that they use the faster self-ligatating 3M Smart Clips. Plus, I was able to schedule records for next week... err, that would be tomorrow.

I'll let y'all know how that goes. But that's the deciding factor - I'm not about to spend $450 for records & xrays and NOT go through with this.

New school year, new things, right?

Yesterday, I had the last of the cavities filled, which should mean that, if/when I decide to go ahead with braces, I should be ready. I'm cavity free for the first time in YEARS!! There will still have to be a peridontal checkup to make sure that that's all good to go, but I'm not anticipating any problems.

I have a second consult with an orthodontist next monday, so I'll be posting about how that goes shortly.

This time, even though it was a simple cavity, I was given Halcion again to take the edge off. That little wonder drug makes life so much easier, it's almost stupid. Yeah, I'm still hard to freeze, but I'm not all panicy about it... my state of mind during the filling was more along the line of "she's drilling... i feel nothing... still nothing... wow... if i do feel something, then i'll worry about it." As opposed to the non-Halcion-ated me, which does something like "Oh my god... this is gonna hurt... ok, this is gonna hurt... ok... this is gonna hurt... ARGH!!! It hurts, it hurts!!"

It is a pain in the butt that the drug knocks me out for a good 8-10 hours regardless of the length of the dental appointment, but that is a sacrifice I'm willing to make.

I'm excited for the next consult, however. 5 days to go.

I had another dental appointment last week I've been meaning to blog about.

It really shouldn't have been a big deal - it was just another cavity being filled. Due the fact that i'm EXTREMELY prone to decay, I've had dozens filled already. Although I've always been difficult to freeze and sometimes it wears off too early causing my dentist to only do a single cavity per sitting, it's never been this bad.

I simply wouldn't freeze. My tongue was numb. My lips were tingly. Hell, she gave me so much freezing i swear my eyeball was numb. But still, once she hit the deep bits of the cavity, i was jumping and yelping and otherwise in pain. It was easily my worst cavity ever, pain wise, and she had done all she could do. She hit all my "landmarks" with freezing, tried a couple different freezing techniques, and gave me way more than i'm supposed to get (at my request). But still, i was in pain. She had to finish really quickly while i tried to get through the pain (after the tooth is open and half done, there's not much else to do...). It's a weird feeling though, because i was partially frozen.. things will be going fine, i don't feel a thing, then she'll hit a nerve and *whammo*, i'm jumping in pain. When your dentist has a drill in your mouth, jumping is generally *not* recommended.

*sigh*... i give up.

The root canal was easier. It has to be because of the sedatives I was given to relieve the anxiety. It's been shown that severe anxiety has two effects: It blocks the brain from accepting the freezing of the nerves, and can cause what freezing that works to wear off quickly. (Sorry for the crappy description.. i'm probaly the only person with a science degree who has never taken a single biology course...)

Of course, each painful experience in the dentist chair makes the anxiety for the next trip even worse, which I suppose is what is making things get progressively worse and worse.

I have one more cavity (that we know about). And my dentist, bless her heart, has pretty much refused to fix it unless i try the sedatives again. Which is fine with me, except it's a pain in the butt to have to get a ride, and to otherwise write the whole day off.

This really does suck. I'd kill to have a "normal" mouth. I'm woking on it, but you can't change biology. (Can you?)

To summarize: If you ever have to have some serious dental work done, ask your dentist about sedation dentistry, or if they offer Halcion for you to take before your appointment.

Yesterday was the long dreaded appointment for 2 root canals and some gum work. Because I'm such an anxious, difficult patient, I was given a small pill (Halcion) to take 1 hour before my appointment, with STRICT instructions to arrange a ride to/from the dentist's office.

I took the pill, and had my dad come pick me up. I was grumbling about needing a ride, because I felt fine. I didn't think I needed any help...

As it turns out, we were a few minutes early for my appointment, so I was sitting in the truck waiting for the office to open (I was the first appointment of the day). All of a sudden, it hit me... wow. Apparently I was a tad loopy, but all I can really recall is that I really wanted to have a nap. When it came time to get out of the truck and into the office, I also had trouble... Gravity and I were apparently having a few issues. It almost felt like I was drunk, and very tired.

As I sat in the dentist's chair, I was able to have a coherent conversation with the staff - as long as I was sitting or laying down I was fine, just a tad sleepy. We discussed the orthodontic work, and my root canals, etc, etc. Then my dentist asked me how I was feeling, and if I wanted anything more. Apparently I was a still a little more coherent that she would've liked! So she gave me an Ativan...

I was in the friggin' chair for 4 and a half hours!!!! I was sleepy through the whole thing, and sorta half-out of it, but even severely doped up it's impossible to sleep through root canals. I did close my eyes and try to sleep a few times, but I kept having these odd hallucinations/daydreams. I only asked for more freezing a few times, which must be a new record for me. A lot of the time was spent doing reconstructive work (preparing 2 root-canalled teeth for orthodontics) so it wasn't as if it would've been extremely painful the entire time, but that was the easiest appointment I've had in a long time, with the exception of the length. Getting up and trying to pay for the work was interesting as I was still feeling drunk and was swearing at gravity in general, but I did get through it. Although I should check to see if I remembered to get my credit card back!

When all was said and done, my dad bought me a milkshake, and I went home and slept off the effects of the drugs. My only complaint is that I'm still feeling rather groggy the next morning. I have a feeling it's the Ativan - it spends much longer in your system than Halcion. My jaw is still sore as well, but that's to be excepted after over 4 hours with bite blocks and a dental dam.

Regardless, I'd take those wonderful little pills next time, no questions asked.

They're scheduled for this upcoming Thursday, and I don't think I need to explain how much I'm looking forward to this, do I?

I've always had serious issues at the dentist, mainly related to the fact the freezing doesn't work very well for me. It takes tons of it to be effective, and it wears off extremely quickly. This has caused me to be very anxious in the dentist's chair. And, and I've just learned, this anxiety causes me to be even harder to numb, and for the freezing to wear off even quicker. It's a viscous circle!

I found this article however (Treating Anxious Patients Like Me), and it describes me and my dental situation *perfectly*. I'm what they call a "severely traumatized patient". But my dentist has given me a sedative (Halcion) for this endo treatment, which will hopefully make this dentist appointment almost bearable. I'm hoping to sleep thru it, but I'm probably setting my sights a little high, huh?

I hope it doesn't knock me out to much tho, because I have some orthodontic-related questions for my dentist, and I want to be able to ask them.

I'll post back to document how it goes...

As this blog is mainly a means to allow me to record my orthodontia, I'm going to use it as a note-keeping medium as well. As a bonus, maybe I've thought of something you need to ask your orthondontist as well. But i'm not going to remember the things in 10 weeks I'm thinking of now, so I need to write them down.

1) Get a ballpark figure and time estimate for total treatment. Make sure that includes the cost of surgery.
2) Inquire about the price of records.
3) Ask about payment options.
4) Ask how long it will take to get started (in reference to the fact it took 3 months just to get a consultation).
5) Ask about the crowns, and whether I need them before or after treatment.
6) Ask about my tongue, and whether he anticipates problems due to it's size.
7) Ask about all brace options, including silver/gold, ceramics, and clear. Double check that i'm not a candidate for Invisalign.
8) Make sure that afer a quote is given, that's the maximum I'll have to pay.
9) Ask if there's any guarantees for the treatment, i.e. if things shift back if they'll be fixed free fo charge.
10) Ask about what would happen if i elected not to get surgery. Is the overbite/overjet fixable without worrying so much about the bite?
11) What does he see as a treatment plan? Headgear? (That will be a problem.) Any other applicances?

LOL... forgot about this part. At my consult this afternoon, my orthodontist spent a lot of time looking at my tongue, and then told me it was bigger than usual. He was worried that after my braces, my tongue would re-push my teeth back into an overbite position, despite all the work by the braces. It's not really a tongue thrust problem, just that my tongue was too big! He seemed hopeful that the jaw surgery would create more room in my jaw for my freak-of-nature tongue (:P) and told me he used special retainers for such cases, but that was definitely not something I had thought about.

So now I'm wondering if it's possible to "train" my oversized tongue to stay away from my teeth...

Argh... blogger's being difficult, so here's a post dedicated entirely to the pictures I had taken at my first consult. They're horrible, horrible things, taken while I had some serious plaque buildup, but I'm trying to be very honest about every thing here, so here goes...

I just got back from my first orthodontic consultation in probably 12-13 years.

It is *so* refreshing to hear somebody say that yeah, we can fix that... finally!

As I stated in my original post, this appointment was supposed to be my "second opinion". I'm still waiting to see the highly recommended orthodontist closer to where I live. Regardless, I was definitely impressed with this office I saw today. The support staff was great, and the orthodontist was very helpful, and only slightly hard to understand with his Swedish accent. He told me he's a strong believer in giving me as much information as he can, so I can make an educated decision. I really appreciate that approach.

As this was just a consult and no records were done, everything he's said has to be taken with a grain a salt. But after his initial examination, his recommendations were:
* 18-20 months in braces, to fix the overbite.
* Jaw surgery, to bring my lower jaw forward a bit. This would be done while the braces were still on, but I'm guessing the archwire would be removed?
* 3-6 months to fine-tune my bite.

He guessed the whole process would take 2.5-3 years. Also, with this approach, I don't have to make a final decision regarding the surgery until after the overbite is corrected.

I'm scheduled to do two root canals next week. His recommendation would be to put off the crowns on these teeth until my bite is fixed, such that they can be made for my new bite. This is good news, those crowns are expensive, and the whole reason I started this process was because I hate to spend money on a mouth I loathe.

Financially, he told me in the worst case scenario, the braces would cost about $7400. I'm not sure if that included the $300 for records or not. The surgery would be another $5000-$7000 dollars. I do like the fact that they will let me pay for the brace portion as 25% up front and the rest in monthly installments, interest free. I forgot to ask about the surgery portion of the payment.

Because everybody loves pictures, they'll be above you, in the next post. Ignore the horrible plaque on the molars please; I had to go a while before brushing before visiting the orthodontist, and man does it show up horribly on the pictures.

I can't believe I'll be posting these hideous things....

I've got my very first orthodontist appointment tomorrow, so I thought I should start the blog that I'm hoping will chronicle the journey I'm about to embark on.

My teeth have been my issue my entire life, and I'm both excited and extremely nervous about taking the plunge to finally fix them. I've done all the research I can, but I'm still not entirely sure what to expect.

This first appointment is just a consultation, and is actually my "second opinion". Unfortunately, I'm still waiting for the consultation appointment with my recommended ortho, which is *still* 10 weeks away.