Ready for surgery?!

I have a lot to update on since my last post...

On 6/3/14 I went to the orthodontist to get a new wire placed.  He also took molds of my teeth to see how my teeth are lining up.  These are the first molds I have had in this process (pics below).  Other than that, he told me to come back in 10 weeks.... He didn't really say what was going to happen in 10 weeks, so the next day I called to ask what was going on.  I talked to one of the assistants and she said I'd be getting a new wire in Aug, then ANOTHER new wire in Oct, then final wires and I could look at scheduling surgery after that, which puts us at December.  I was pretty disappointed because I thought surgery was going to be sooner than that.  The initial estimate from the ortho had been 6 - 9 months, and I am in the 9th month now.

Fast forward to 6/25/14.  I had a cleaning scheduled with my regular dentist and stopped in at the ortho first so they could remove my wire to make it easier for the cleaning.  (I highly recommend this.  If the wire is not removed they can't get your teeth very clean).  Anyway, I go in to have the wire taken out, figuring I will be in and out in less than 10 mins. So the Dr. comes over as soon as I get there and is like "Hey, guess what, I have your molds and your teeth line up.  You're ready for surgery."

This was pretty shocking to hear.  First of all because after my last appointment I was under the impression it was going to be towards the end of the year.  Second of all just because there has been so much waiting around for the braces to do their thing it just always felt like surgery was so far away.  Surprisingly, I am not totally freaking out. I was caught off guard by this initially, but I am ok with it now and kind of excited actually.

I had already planned a summer vacation in August when I thought surgery wasn't happening until later.  I told my ortho about this and he was totally cool about it.  He said there's no rush, that I can do it whenever I want and to enjoy my vacation.  So that was a relief to hear.

So next steps are: I'm going back to the ortho next week to get the surgical wires put on.  Apparently these are just a heavier wire.  I also scheduled an appointment with my surgeon.

Also, I am still going to my orofacial myologist and working on all kinds of stuff like keeping my mouth closed, breathing through my nose and all of my tongue/swallowing exercises.  She says I am making excellent progress.

Here is a pic of my progress since I've started in braces.  In the collage below the top left is the date I got the braces put on and then every 3 months since then.  It's really amazing to see how much my teeth have changed.

Below are pics of my molds.  It is so cool to actually see my teeth fit together!!! I think the purpose of the molds is just to see if my teeth are straight enough to fit together once my structure (jaw) is fixed.

OROFACIAL MYOLOGY FOR TONGUE THRUST

"Orofacial myology is the study of normal and abnormal patterns of use of the mouth and face and their relationships with dentition, speech and vegetative functions."

The most common oral myofunctional disorder is the tongue thrust. 

I stumbled across the term "orofacial myology" while doing research on my open bite surgery.  I found a journal article that stated treatment for anterior open bite should include orthodontics, surgery and orofacial myofunctional therapy.  

So then I started researching orofacial myology.  Basically it is therapy to help treat your tongue thrust.  I am currently working with a therapist who is teaching me to correct my tongue resting posture, swallowing and mouth breathing.   It is really important to know that these issues CAN BE CORRECTED.  It is all about learning the new, right way to do things and then making it a habit.

I think this is a really important thing for anyone having this type of surgery to know about.  I did not hear about this through my ortho or surgeon, i had to find out about it by myself.

A really good resource is the International Association of Orofacial Myology (IAOM).  You can search for a certified myologist in your area and read about the field. Here is their website: http://www.iaom.com/IAOM/

See picture below.  The pic on the left is from 12/2/13, before I started myofunctional therapy.  The pic on the right is from 3/18/14, after having 4 sessions with my therapist and doing daily practice on my own.

You can see on the right that my lips are closing easier and my chin is less strained.  More relaxed/natural.  I absolutely recommend this type a treatment from a certified orofacial myologist!!!

New Wire

I had an ortho appointment this morning.  They ended up repositioning 4 brackets and putting in a new bigger wire.  This wire has squared off edges, my previous wires were round.  So he said to come back in 8  weeks and then he should put me in the surgical wire and take initial molds.  That was kind of scary.  I am not sure how long I will have to stay in the surgical wires before I can schedule surgery. 

Anyway, my teeth are really sore right now. I have been taking ibuprofen all day... 

Bite Opening more on right side

About 2 weeks ago I noticed that my bite had opened up on the right side.  I could no longer feel my molars touching when I bit down.  I tested this by trying to bite down on a piece of paper,  I was able to pull it right out when biting on my right side, but when biting on my left side I was still touching and could hold the paper in place while pulling.  I know that my bite would be changing and it is possible for it to get "worse" before surgery, but I still called my orthodontist to let him know. He wanted me to come in so he could take a look.  So I went in today and he confirmed that I was no longer touching on my right side.  He said there was about 1mm of space between those molars.  He said the brackets on my LEFT molars were really close to the bite-line and he was going to move them to allow the teeth on my RIGHT side to come back together.  I don't totally understand this.  But he removed/ repositioned the 3 brackets on my upper LEFT molars.

Bracket Repositioning

On 1/29/14 I had my second ortho appt since my braces were put on in September.  During this visit they took off some brackets and repositioned them.  I'm not really sure how many he actually did.  I would say at least 4 or 5, maybe more.  I thought it was going to hurt really bad, but I couldn't even feel most of them.  He did try to take off one on my upper second tooth and that one hurt BAD.  It felt like my tooth was loose and he was ripping it out.  So he didn't end up doing that one.

I'm just starting to feel back to normal after that appointment.  My teeth were really sore for about a week.  It was like I just had my braces put on.  So I was eating soft foods all week and taking ibuprofen or tylenol as needed.

Anyway he put my current wire back in after he was done (I'm in Damon Clear braces and still in the light round wire).  I will have this wire for another 10 weeks.  Then I'll get my wire changed to a heaver wire and 10 weeks after that they will take my initial molds to see if I'm ready for surgery.  So that should be around June.  He also said i might only need upper jaw surgery.  That is kind of exciting because that would probably mean a quicker surgery, less trauma and faster healing.  But I'll try not to get my hopes up yet...

PS. Next time I go to get my regular dental cleaning I'm going to stop at my ortho first to have them remove the wire.  That way the hygienist is able to clean my teeth easier.  Just a tip for anyone else in braces because I had a cleaning last month with the wire in (didn't even know it was possible to have it taken out for cleaning) and they didn't use the scaler on my teeth to scrape the tartar off on the bottom front teeth.  She just used a high pressure water jet and that really didn't remove much.

First Wire Change

I got a little behind on posting...my first wire change was actually on 11/20/13 which was 9 weeks after my braces were put on.  I have Damon braces so they just had to slide the doors open, take the wire out, put the new wire in and shut the doors.  I was surprised that the actual process didn't hurt at all.  It did feel very tight once they put the new wire in and my teeth were sore for a few days.  I am still in a light round wire.  Last week (3 weeks after wire change) the wire started sticking out of the back of my last bracket and poking me in the cheek.  Now this was very painful.  It tore up my tissue and it hurt to eat.  I had to go in for them to trim the wire.

This is a pic of my new wire.  Not sure if you can tell, but it is a little thicker than the first wire.

 Here is the first wire for comparison:

X-ray from the day braces were put on

I just saw this email from my ortho's office, it landed in my Spam email folder.  I requested a copy of my x-ray and this is what they sent.  It is a picture of the x-ray.  Not the greatest.

Anyway, this is from 9.18.13 before I got my braces put on.

Week 4 with Braces

Yesterday was officially my 4th week in braces, although I feel like I have had them forever already.  I am pretty much totally used to them at this point.  They no longer feel "weird." However, I do feel like I have to concentrate when I'm speaking and talk more slowly because they kind of give me a lisp. 

The only thing I am noticing is that a different tooth is sore every few days.  Last week when bit into my toaster strudel for breakfast my front top right tooth wiggled like it was loose and it hurt! Same thing happened at lunch when I bit into an already cut, bite-sized piece of sandwich - loose/wiggly and sore.  The loose sensation freaked me out, I have felt soreness/pressure before, but never this loose feeling.  I called my ortho's office and they said it was normal and should firm up within a few days.  She said to watch for red/inflammed gums or a bad taste in my mouth.  

So that front tooth did get better after a few days, next it was my lower right-side molars and a few days later it was my lower left-side molars.  Currently my upper left-side molars are sore.  It sucks because it's making me go back to a softer diet and I am hungry all the time but it hurts to chew.  

On the bright side of things I have noticed movement in my teeth.  

This pic is Day 1 with braces.  You can see the wire is bent a lot along my top teeth.  Also, my second teeth are much higher than my first and third teeth. 

This picture is from yesterday, Day 28 with braces.  You can see the wire has really straightened out and those second teeth have moved down a lot!

Also wanted to add some pics of my face/profile:

This is me forcing my lips closed. You can see there is still even a little hole in my lips.  And its kind of hard to tell in this pic, but my chin is puckered from pushing my lips closed.

This is at rest, my mouth hangs open due to my bite

Left side profile forced closed

Left side profile at rest

  Right side profile forced closed

Right side profile at rest

Smiling :-)

And this is just a closer look at my mouth.  That little opening is still there even when I'm trying to keep my lips shut.

At rest

Smile

Day #15 with Braces and Before Pics

Well I haven't posted in a while because I got used to my braces after the first week.  The pain is gone, I'm back to eating pretty much normal foods and I almost don't even feel them in my mouth anymore.  Also I feel like my speech is back to normal and I'm less self-conscious about the way they look.  I'd say the worse part at this point is having to brush my teeth in the public bathroom at work after lunch. Gross.

I mentioned before that I have a tongue thrust.  Since I've got the braces I feel like I have been correcting this because my teeth were sore and it hurts to push against my front teeth when swallowing.

Since I have an open bite, I have always had trouble closing my mouth and had to force my lips shut in order to close my mouth. It has become more difficult to force my lips shut now that I have braces, they are in the way.

Here are my "before" pics from 2010...

This is my bite.  I have a huge space in the front an only the back molars touch.

This is my top arch.  My orthodontist says it's in a "V" shape and should be a "U" shape.  Probably a "V" shape from my tongue thrust constantly pushing out my front teeth. Also, I sucked my thumb as a child, you can almost see a thumb print on the top of my mouth...

Bottom arch.  I think this looks pretty good.  Just some crowding on the lower front teeth that needs straightened out.

Bite from the side.  It looks pretty bad from this angle.

Bite from other side.

Day #5 with Braces

I'm gradually getting used to the feeling of braces in my mouth.  It still feels weird when I talk and I'm surprised to say that it still hurts to chew.  I'm still eating soft foods (pancakes are really easy to chew and filling) and taking ibuprofen.  Flossing is a gigantic pain.  I am definitely going to get a waterpik water flosser!

So I'm a little irritated by what happened at the orthodontist's office when I got the braces put on. As soon as I walked in the door, the ortho assistant lady took me into the back, took X-rays and started cleaning my teeth for the braces application.  I need to mention here that I still needed my "before" photos (without braces) taken.  When I went in for my (second) initial consultation in July 2013 (when they are supposed to take the before photos) they told me they would just do everything when I scheduled my first appointment for getting the braces put on.  I think the reason they said this was because they took photos at my first initial consultation in 2010 and then I never made my next appointment to get braces on.  I think they were waiting to make sure I was serious this time before taking more photos again.  If that was their reasoning then fine, I understand.

I never said anything about this at my appt on Wednesday partially because I was having huge anxiety about the whole experience and partially because I figured at some point they would do it.  Never happened. Next thing I know I was checking out and making my follow up appointment.  They desk lady said I was all set to go.  I had to bring it to her attention that I never paid for anything yet and hadn't turned in any of my signed papers (privacy statement, payment agreement, informed consent, etc).  At this point I also explained that I needed updated "before" photos taken as the current "before" photos in my file were from my first initial consultation which was from 2010.  Instead of asking anybody about it right then while I was there, she said she would put a note in my chart.  OK.  So  I left.  10 mins later a get a call from the office telling me sorry but I do need to come back in to get updated "before" photos taken. So now I have to go in again at 7:30am before work to have these done when I was already there and asked about it.  Grrr! 

I just feel like there was an entire step in the process missing.  I should have sat down with my treatment coordinator for 5 mins before everything started and arranged payment (there were multiple payment plans for me to pick from), turn in paperwork and then have time to get these photos taken.  Kind of disappointed by this because now my before pics will be in braces.   

Day #2 with Braces

My teeth are feel very tender and painful, so bad that I have been taking ibuprofen all day. Still hurts to chew so I have been on a soft/liquid diet (soup, juice, yogurt, tuna fish).  I also noticed that the skin is rubbing off on the inside of my cheek (is that an ulcer?) so I had to put some wax on.

This girl's video is brilliant and perfectly describes how I'm feeling right now:
http://www.youtube.com/watch?v=lg_iVDUmfYk

Getting Braces

I couldn't sleep last night.  I wasn't so much worried about the braces themselves, but more that it is the first step towards surgery and I am still afraid of that.

My appointment was at 7:15am and I soon as I walked in the office and sat down, they called me to the back. They took some x-rays then started the process of applying braces.  I got Damon Clear.

Getting the braces put on didn't hurt at all. I was actually a little surprised.  But they feel WEIRD. I have never had braces before but I was really not expecting them to feel so odd.  Since I have an open bite it is hard for me to close my mouth to begin with, but now with the braces in there, it is even harder to force my lips shut around them.  Just a really awkward feeling.  I'm starting to wonder what I got myself into...I already want to take them off... :-/

I didn't really eat today.  I tried to eat some mac n cheese for lunch and it hurt really bad to chew.  It took me so long to finish that they got cold.  I had scrambled eggs for dinner, they were much softer and easier to eat.

Talking is strange.  I feel like I am talking funny, but everyone says I sound normal.  I also feel like everyone is looking at my mouth.  I am very self conscious about these.  It is hard to smile, my lip gets stuck on them when I smile.  Ugh....

I have been taking ibuprofen throughout the day for the pain.  It is sore and tender feeling.

Here's a pic with the braces on.  I'm not totally biting down here, but almost, so it is pretty open.

First Post - History

Ready or not, after 10 years of trying to make a decision, I finally made an appointment to get my braces put on and start the process of correcting my open bite.

My history:  I always thought my teeth were fine since it was all I'd ever known.  I never noticed and open bite, that my teeth didn't touch, never noticed I had trouble biting into food like sandwiches, hamburgers, pizza, etc.  (When eating these foods I either have to rip and tear it off, or use my tongue to press the food against my top teeth to cut it).  I never thought anything of this, it was all normal to me.

When I was in 3rd grade I had an orthodontic device  called a bionator to correct an overbite, I think.  Or maybe it was to stop my thumb sucking habit.  Either way, I remember wearing it for about a year.  No dentist ever mentioned needing additional orthodontics, braces or surgery.

Fast forward to my senior year of high school.  Somehow it was randomly mentioned that I needed braces.  I didn't understand why, I don't think I even asked why.  All I knew was that I was a senior and DID NOT want braces senior year or when starting college!  So I blew the whole thing off for a few years.

Probably my sophomore year of college (don't remember exact dates) I found a general dentist (who I absolutely LOVE, btw) who referred me to an oral surgeon.  This is when I learned that I have an open bite and only my back 2 molars touch when biting.  I learned that I cannot close my mouth, I have to force my lips together in order to get closure which creates puckering in my chin.  This surgeon explained a little about the surgery I would need, Lefort osteotomy.  He also mentioned I would need a cheek augmentation to go with it to make my cheeks fuller for some reason.  I did not like the sounds of this.  So he submitted this to my insurance.  They approved the surgery but denied the cheek implants.  I was totally against the cheek implants anyway, but I didn't realize that I could just do the jaw part and not the cheeks.  The entire idea was horrific, not only did I need my jaw BROKEN apart and fused back together, but some foreign objects were going to be implanted into my face?!?!?  I remember discussing this with my mom, she said "I know you, Sarah, and I can see you looking in the mirror touching your fake cheeks and crying, 'THIS ISN'T ME!'"  She knows me well.  That is exactly what I would do.  I lost all trust in this doctor.

I went to another surgeon for a second opinion.  He told me I did not need cheek implants and that my cheeks would probably be naturally fuller from the surgery.  I liked this guy but he was out of state so no dice.

Then I got hooked up with an orthodontist, don't remember how I found him.  Maybe stupid cheek surgeon referred me to him.  Anyway, this ortho told me that I needed my wisdom teeth out to make room in my mouth, and that I needed a skin graft along my lower front teeth since I had some gum recession there and they would need a study base for braces. OK.  I proceeded to have my wisdom teeth removed and the skin graft.  No problems with either procedure.  Then I decided I didn't like this orthodontist.  He wasn't friendly, I didn't get a good feeling, just not a good fit. So then I put the whole thing down again.

Eventually, I found another ortho.  This guy was much  nicer, but still not right for me.  However, he did refer me to a new and local surgeon, and that is how I found my surgeon, Dr DO. I had 2 separate consults with him and he explained the surgery, confirmed I did NOT need cheek implants and said I would be happy with the results. I really liked him.  Luckily he referred me to my 3rd ortho, said this guy does lots of surgical cases per year, when most orthos only do maybe one.  I met with this new ortho, and I liked him as well.  Now I had my team.

Still being scared by the whole idea of this huge surgery, I decided to meet with my general dentist to get his opinion.  I figured he is the best person to ask because he is impartial and has nothing to gain from my having surgery, plus he is knowledgeable on the subject.  He met with me for an hour, answered all my questions and his final answer was to go for it.  But I got scared. I am so terrified of something going wrong during surgery, that I chickened out again.... for 3 years!

Fast forward again to present.  A few months ago I started having jaw pain.  I realized that things were only going to get worse and I finally found a team of doctors I liked.  The longer I wait, the more could go wrong. Surgery not be covered, one of my doctors retire, etc.  So i started back up again.

Had a 2nd consult with my ortho.  I still like him. Talked to one of his patients who had a similar surgery.  Went back to meet with the surgeon again with my mom. Started the prior auth to make sure surgery is still covered.  My insurance required additional photos, but it was approved. So now I am ready for braces to go on.

This was really long-winded, but I wanted to capture all of the history.  I want to document my journey for myself and hopefully to help others going thru the same thing.