Let's See What We Have Here

How about some pictures? Is it sick that those of us in like situations really appreciate these awfully uncomplimentary photographic records of our mouths? Or worse yet, am I the only one? Oh well.

Remember that open bite I was telling you about? Check it out. You could train a lion to jump through that thing.

A view from the left.

And a view from the right. Notice the lack of molar? Let's go to the lower arch for a better look.

There we go. Yup. No tooth there. This is one of the big issues to be dealt with. The second might not be as noticable unless you're a dentistry student. There are actually 5 teeth missing from my mouth. That one gap there and an entire set of molars (number 4s? Just outside of the bicuspids.) I had those taken out when I got braces the first time. What's the issue you say? Well. It's not as noticeable because I've got a set to replace them in quantity. That's right. Look deep and you'll see wisdom teeth. So I don't know if I'll need to have those pulled ultimately or what. We shall see. Oh, I'll tell you about that 5th missing tooth later. It makes for a great story.

Ah the upper arch. It used to be much worse. I'll try to pry some records out of my old orthodontists. That'll be interesting.

Lateral Ceph. The funny thing here is, from this x-ray you'd think I've got a chin pointier than a crescent moon. Such is not the case.

Hi Everyone!

I just wanted to say hello and thank you to those of you who are getting onboard with me here. For those of you in the greater-ortho-blogosphere who are peeking feel free to throw me on your page, I'd be happy to do the same.

Trivia for the day- The first recorded orthodontic-like method of treatment was performed by the Roman writer Celsus (25 B.C.-A.D. 50).

Cheers

All Caught Up

Ok. I've caught us all up to last week now. I hope it hasn't been too confusing up till now.

I got a call from Wonderful Jessica a couple days after I faxed her the info from Dr.Keefe. She had been out of town I guess, but she's back on the case now and the insurance people need more recent x-rays. That's what happens when you have to wait three months to see a specialist. (Which by the way I'm still not convinced is any kind of norm. Has anyone else had this problem?) So I'm scheduled to come in the next day for a quick visit. Wonderful Jessica is ready as soon as I walk in the door and now it begins. She asks if I'm ready to make my down payment. What a wonderful feeling. Now I'm committed. No backing out. Let's roll! I get all set up and she hands me off to one of the technicians, Kari. We do some panographs and make some impressions. That paste tastes way better now than I remember. And within 15 minutes I'm free to go. Now I'm waiting for word from Wonderful Jessica to set up a time with my OS to be.

Rollin rollin rollin.

ENT

Moving right along, the snow has melted (in San DIego) and the birds are singing. It's the end of May and finally time to meet my ENT. I got a notice to report for jury duty the day before my appointment. I can only imagine that with Murphy on my side I'd get chosen and have to wait another three months. So obviously I moved the jury duty back. Way easier than I thought. Dr. Michael Keefe is very nice. I got a weird feeling in his exam room as he clearly make his bread and butter on cosmetic plastic surgery. I've never been a fan of changing your appearance just because you didn't like it. Now we could go into a whole discussion on why I feel this way and how some might say it's because I don't feel happy about my own appearance blah blah blah. But we'll save that for another post.

Anyway, Dr.Keefe seemed to have been down the orthognathic road before and gave me a list of things to send to the insurance people (letter from ortho, x-rays, etc.) In addition, he said, and I quote, that my septum "shanked to the right" and that I have "HUGE turbinates." Very technical stuff here. But it goes along with the not-as-easy-as-it-should-be breathing issue. He said they might be able to take care of that all in one shot along with the jaw surgery but they'd have to see how things pan out. Another little peak into my insurance packet and again, as long as it's "Medically Necessary" nasal surgery also is covered. I'm starting to wonder if by "covered" they really mean "75% covered" or "50% covered" We shall see I guess.

So I gave the list of things Dr.Keefe gave me right to Wonderful Jessica and she's taking care of it. I got people.

Process

Now that I've come to terms with this procedure it's time to get the wheels spinning. Jessica, my wonderful treatment coordinator, told me I have to do three things in order. 1)See my Primary Care Physician to get a referral to an Ear Nose and Throat doctor. 2) See the Ear Nose and Throat doctor to get a referral to an Oral Surgeon. 3) See Oral Surgeon to nail down the details of what I need done. After all that and with a little research of my own I found that as long as it is found "Medically Necessary" my insurance will cover the surgery. Ok go.

Getting an appointment to my PCP was no problem. She's a very nice lady who knew little about orthognathic surgery. With my x-rays and consultation papers in hand she saw I was prepared and was more than happy to give me a referral to one of the network's ENTs. I figured, "Cool, about a week's time from seeing my ortho to seeing my PCP. Between the ENT and the OS I should be in braces by March."

Apparently I'm not so good at figuring.

The earliest appointment I could get with the ENT was three months away. Despite bugging their receptionists everyday for a week or two and getting on their "short-notice-will-call-wait-list" I still had to wait it out. Wait. Wait. Wait.

Conflicted

Late January for those of you keeping track. And while I've chosen an ortho I'm still rather conflicted about the entire procedure. In my consultation with Dr.Styrt and some online homework of my own I've found a lot of super positive reasons to go for it. The aesthetic issue of having straight teeth has quickly become a functional issue of so many other things that are wrong with me that I've either 1) compensated for throughout my life, or 2) never knew was "wrong" in the first place. I've read that people sleep better afterwards because of a more open airway. I've always been twitchy when I sleep and I had an ex-girlfriend that constantly hounded me about getting tested for sleep apnea. I've always had trouble breathing though my nose also. Chronically sniffy or stuffed I am. Not really stuffed but when I inhale through my nose it feels like I'm breathing through a filter. I'm getting air, but it feels like I'm working too hard to get it. Like drinking a really thick milkshake through a coffee stir. Maybe not that difficult but you get the idea. Dr.Styrt said my jaw would stick out a bit more when the bite closes and I'd actually have a chin. A chin hunh? That's new. I've worn a goatee since high school and it's only been recently that I've realized it's because it gives me a sort of faux chin. I remember being asked if I ever wanted to change anything about myself (like plastic surgery) what would it be? I had a hard time coming up with anything because for the most part I've really learned to like who I am and what I look like. Ultimately I thought having a facial structure that wasn't so long might be nice. This would do just that. And of course chewing would be much easier. Do you know how hard it is to eat a sandwich with leaf lettuce in it with an open bite? I'll tell you how hard.


It's f***ing impossible.


Pizza, onion rings, and balogna sandwiches can also cause annoyance. To adapt and try not to look like a complete fool while eating I'll use my tongue to push these sorts of food up against the bottom of my top teeth. I thought it was rather clever. So all these things that, while obvious improvements on my current lifestyle, require me to admit that I have these problems and that they need fixing.

Enter cocky, proud, stubbornness. I don't want to say this is a male thing but it is most certainly a male thing in my family. We don't ask for help. We don't take charity. At gift-giving time it's usually only something functional that we ask for. "But this surgery is totally functional. You just said so yourself," you say. Well yeah but it also carries with it a vain reward of aesthetic value. Besides, I'm still alive. I've made it this far. I can eat and breathe and sleep and do a lot of things and a lot of things better than most. So why "fix" something that obviously works fine? This is the connundrum and the conflict. I feel that by admitting I need this work done I am betraying 27 years of perservering and overcoming and "being myself" and being ok, no, more than ok, with who I am. At the exact same time though, I am elated by the knowledge that all these things that have always been an issue are all related and can be solved relatively easily. So I did what any American young man would do in my situation.

I called my mom.

She gave me a little perspective and in the end made me feel pretty certain about my choice to go through with this. She also told me something interesting that I had completely forgotten about. When I had braces the first time they knew I needed surgery. In fact they had actually asked me if I wanted it done. I had completely forgotten! Why wouldn't I have it done before? Not because I was in school. Not because I was young and young people can be terrible and insensitive to each other. Because I was completely misinformed. See, my older brother also has an open bite but also has a large underbite. So when they explained it to him they said his chin would be pushed back. When they explained it to me they explained it as "you need surgery just like your brother." As mentioned, I don't have a chin to begin with! Why would I want you to push it back more!? Needless to say I didn't want it. Then. But after chatting with Mom I'm rearing to go. And now I get to pay for it.

Boy did I get hornswaggled.

Shopping Around #2

It's time to go see the ortho that Dr. Misleh recommended. I'm not going to tell you his name because I don't want anyone to think he's a bad doctor, just wasn't right for me. Let's just call him Dr. Crowe.

Dr. Crowe's office is located in a small medical complex where a lot of doctors have their practice. A Medical Strip Mall of sorts. One could reasonably get their braces tightened, warts lanced, hair permanently removed, and relax for a spot of accupuncture all in an afternoon while only having to park your car once. As wonderfully odd as that visual may be, it didn't bother me as my first ortho in middle school occupied the same sort of facility.

The consultation went very much the same way as with Dr. Styrt with the exception of some details. Dr. Crowe needed to use a measuring device to determine my midline deviation etc. Once or twice he was interrupted to show one of the girls at the desk some paperwork or other. Maybe she was new. I don't rightly know. And lastly his quote had to get worked up and was eventually emailed to me. All in all yes I would have felt fine having the work done there. But I felt that with the surgical ramifications of my treatment Dr.Styrt's office would be able to take care of me better.

Dr.Styrt is about 30% more expensive than Dr.Crowe, but already they've been handing all the insurance stuff which is well worth it.

Shopping Around #1

It's early January and the time has come to do something about my crooked teeth. Dr. Misleh had given me the card of an ortho he works with a lot so I set up an appointment. I have a friend who is a dental assistant for a doctor that does mostly cosmetic work (veneers and caps and things) so I called her to ask for any recommendations. She said her office had just taken a field trip to a guys office that I should check out. Very tech savvy, but friendly and relaxing at the same time. She knows I get anxiety around dentists (and now you do too) so she had a little insider information and thought we would be a good match. This place could see me sooner so I made an appointment and went in that week.

Dr. Paul Styrt is the ortho and his office is immaculate. It's in a very upscale office complex so instead of getting that nauseous "I'm-going-to-a-clinic" feeling I felt like I was going to a training seminar or conference for work. Which was nice. The office is very open and well designed. Italian marble countertops and a colorful fishtank gave the feeling of a spa rather than a medical office. When you arrive you find your name on a computer screen at the receptionist desk and click to let them know you're here. (I'm not exatly sure why they need a receptionist at all.) They took some pictures and some x-rays and then I got to meet with Dr.Styrt. His examination was quick and knowledgable as if he had seen a thousand people with a mouth just like mine. Rattling off the number of mm's my midline was off, my bite was open, etc. I felt reassured by his confidence that he knew what he was doing.

There was no question in his mind I needed a surgical treatment to fix my bite. While I could just opt for braces alone it would straighten my teeth but the bite would never come together and ultimately the TMJ problems I have would keep getting worse and worse. 12-18 months in braces, surgery, and another 6 before the braces came off. A bit shocking but not unbearable.

Meanwhile, Jessica, the treatment coordinator, had written up my treatment plan with quote and pictures and x-rays and laid it all on me in a cute little pocket folder. She explained to me different payment options which were within my range but it was the surgery that concerned me. I hadn't saved anything for what would inevitably be at least, what, 20k? 30k? "I can't go through with this unless the surgery is covered by my insurance." Which I had no idea if it was or not. But that's why Jessica rules the roost. She asked what kind of insurance I had and immediately called someone and asked what their procedures were for this and in 30 seconds had a detailed list of what I had to do and who I had to see for this to be covered.

I hadn't even signed anything and they knew I was seeing another ortho next week.

So out I went with my cute pocket folder and a plan of attack and smiles and waves from the girls in the office.

How Did it Come to This?

When I finally got out on my own and graduated from college I knew I had to catch up on some dental work. Wait, no. Lemme start over.

When I finally secured some permanency in my job and began receiving dental benefits (which was actually about two years after I graduated college) I figured I should probably start taking advantage of them. Stop. Hold on.

When I finally secured some permanency in my job and began receiving dental benefits it was probably a toothache that made me take advantage of them. I'll be the first to say that despite many spells of dental hygiene mantainence attempts (both obsessive and completely non-existant) I have always had difficulty avoiding more than routine cleanings.

During college I went to the dentist once a year over the summertime when I was home and that's it. After I graduated I was no longer under my parent's insurance and had to wait it out until I got my own. Needless to say those first couple appointments with my newfound dentist (Dr. Anton Misleh) were spent ruthlessly cleaning the years of crap now built up on my teeth and eating my gums away. Eventually things got up to snuff and I was no longer a dental biohazard zone. Throughout my dentist would ask me when and if I planned on getting braces. I'd tell him I already had braces in middle and high school and hadn't thought about getting them again. (I'll tell this story some other time as it really does deserve its own post.) He'd tell me that straighter teeth would obviously look better but he was more interested in the fact that it would make my teeth easier to clean. Hence, less bacteria hiding and causing problems. Over the last year or so things have been good dentally and financially so I started thinking about getting braces again. I have to be honest though, much of the decision was based on getting my dentist to lay of the badgering about when I'd have it done. So "The new year" became my lift-off date. I went home for Christmas this past year and when I got back the search for an orthodontist began.

Baby's First Post

Here you are at the beginning of what will be a considerable, life-changing journey for a young man and his maxillofacial skeleton. For these first couple posts I'm going to rewind a bit to try to capture the entire process for anyone who is interested. If you just wanna see the gory surgery photos (which there will be many I'm sure) come back in 12 months an you shant be disappointed. So again, if the timestamp on these first bunch of posts seem extremely compressed it's because I'm just trying to get caught up. So sit back, grab a cup of tea or a beer, and let me tell you the story of the boy with the skeletal deformity.