Could this be the culprit?

Below is a picture of me from high school.  It's a pretty good shot of my oboe embouchure.  I started playing oboe when I was eleven.  From ages eleven to fourteen, I practiced about one hour a day plus one hour of band class.  For four years in high school, I practiced about three hours a day plus one hour of band class and even more time in other rehearsals and concerts.  In college, I played for about two hours a day, but pretty much stopped playing my junior year except for every once in awhile.  So, basically, during the years when my jaw was growing the most and I was having my first round of orthodontic treatment, I held my jaw in this position for several hours a week.  I haven't discussed this too much with my OS or OD, but I'd be curious to hear if they think this had anything to do with my bite problems.  Then again, other people play musical instruments and have normal bites.  Who knows?

I have loose teeth!

Seriously, this can't be good, right?  Or is it normal?  I haven't had this problem with my lower braces.  I've had these top ones for nearly two weeks.  I noticed right away that there was a very strong pressure, particularly on my right lateral incisor and my right canine.  I had pressure with a wire change on the lower braces too, but it usually has gone away after, at most, three or four days.  This pressure has been steady nigh on two weeks now, and that's with that ultra-flexible wire they give you first.  Also, the gums by the two teeth are red and sore.  I thought, well, suck it up, you have braces.  But I decided to see if the teeth could wiggle, and they can wiggle a lot.  None of my other teeth wiggle.  These two wiggle like baby teeth, and I am seriously worried.  I don't have good gum coverage on these teeth due to clenching.  I don't think they're necessarily going to pop out of my mouth overnight, but I really wish it were not a long weekend so that I could call my ortho on Monday...

And, of course, I keep wiggling these two teeth with my tongue like I'm a first-grader waiting for the tooth fairy...  AAARGH!!

Time machine.

I was looking through some old photos of myself.  I was not feeling particularly nostalgic.  I just wanted to see if my bite had changed since I was a kid.

This is fourth grade.  There is no gummy smile.  The "buck teeth" are not looking too bad yet.

This is fifth grade.  Those front teeth are sticking out more, jaw is clearly crooked, but no gum showing.

This is seventh grade, just before the braces went on.  I had worn several appliances that were supposed to widen my upper palate and help my jaws grow together in proper alignment.  I was not very cooperative (the one to keep my jaws growing together fit over both the top and bottom teeth in one piece, so I could not open my mouth to speak while wearing it and thus would have been forced to learn ventriloquism, except that I refused to wear it).  My jaw is clearly crooked.

Eighth grade.  Braces are on!  Things have straightened out fairly quickly.  Gummy smile begins to appear on right side of mouth only.  Jaw is still crooked.  I can't tell how much overjet I had.

Ninth grade.  Serious gum has appeared on right side only.  After some head gear, jaw seems less crooked, but still noticeably "off."  Braces came off a few months after this picture.  My orthodontist (unknown to me at the time), purposely gave me this crooked smile so that my teeth would have the appearance of a proper bite.




I will admit that I did not give 100% compliance to this first ortho's treatment.  I asked my OD if this affected my need for surgery now (as in, had I been good, could I have avoided this surgery).  He said that there was nothing that my first OD could have done.  I was a surgery case from the beginning, but back then, they thought they were doing the right thing by using those appliances.  My current OD said that if I had been compliant, those appliances could have caused even more joint damage.  So, "yay" for non-compliance???

**disclaimer: I believe in compliance now, 100%!!

Update on being splint free.

I've been without my splint for ten days now.  At first, I had no problems being without it.  But now, I'm clenching AND grinding at night and breathing with my mouth open a lot more.  I'm not too happy about any of these things.  I'm worried about damage to my teeth.  I've already had significant gum damage from clenching, and that was even with having a night guard.  A fellow blogger (thanks, Tina!) sent me a link for a night guard that can be worn while you have braces.  I'll be checking into this for sure with my OD.

I've also noticed a lot more joint tension and muscles tension in my face, particularly in my cheek area and near my ears.  I haven't had a major migraine yet, so I'm happy about that.  My jaw is totally confused about where to go without the splint to guide it.  I find myself "posturing" a lot, and not being able to find really any comfortable position.  I expect I won't have that until after the surgery.  Here's hoping!

An expert weighs in on Palin.

Okay.  So this article is over ten days old, but I hadn't seen it yet.  I know some of you guys posted Bristol's "coming out" news sensation.  Now it seems that an expert has confirmed *our* expert opinion.  It appears to be cosmetic...

Now to be fair to Bristol, I know a lot of us hear "it's just cosmetic" when we know darn well that it's medically necessary.  But again, this doc is an expert, right?  I dunno.  I sure would hate to have my whole personal life examined and scrutinized like she does.

And to be fair to us, it would be nice if those in the public spotlight could be honest about their cosmetic surgeries rather than claiming something to be "corrective" when it's not.

First impressions.

(no, I'm not talking about the gooey kind...)

It used to be, when I first met someone, that I'd notice their hair, their eyes, maybe their shoes.  Now?  There's one thing, and one thing only.  You bet I'm checking out that bite.  And comparing.  And wondering.  And diagnosing.

Sometimes I want to ask them, "Do you get headaches?  Has your dentist noticed that?  Do you know what 'orthognathic' means?"  But I hold back.  Usually my clients want me to analyze their financial statements, not their occlusion.

What is this obsession?

In my analyses, I notice that most people don't have a perfect bite.  I would guess a lot of people suffer from TMJD symptoms and don't even know it.  It was several years before either I, or any dentist I saw, put the whole puzzle together.  When I realize how many people have to go through life just dealing with it, I realize that I am incredibly lucky.  I'm incredibly lucky to have a great ortho team who understands my problem.  I'm incredibly lucky to have a good job so that I can afford to have this done.  The family situation could be better, but...meh....overall I have it pretty good.

Then I see the beautiful people who already have the perfect bite, and do everything seemingly without effort.  They can eat anything they want.  Their confidence is palpable.  Sometimes I hate me in that moment.  But then I have to remember: this can be fixed; this CAN be better.  What's three years of dental torture compared to a lifetime of healthy functioning?  

And I have to remember too---those beautiful people, the ones who can already "bite a piece of lettuce out of their sandwich"...they have their ugly moments.  That's life.  A perfect bite will not solve the world's problems, but, boy, am I looking forward to that bite!

Ceramic vs. metal braces.

Before getting my braces, I spent a lot of time exploring my options.  I figured that if I had to have these things for three years, I wanted what would give me the best result, what I would be happy "wearing" for that long, and what I could actually afford.

I searched on the Internet a lot, and "decided" that I wanted the Damon brackets, because they sounded like they would be the best.  What I didn't realize at first is that my options would be pretty much limited to what my orthodontist offered.  I wasn't about to switch orthodontists just to get the bracket I wanted.  The orthodontist I have works regularly with my OS and preps about 70 surgery cases a year.  My OS says he's the best in the area.

So....then my choices basically came down to metal or clear.  I actually spent some time considering this.  I really wanted the clear for aesthetic reasons, but they were A LOT more expensive (like $1500 more expensive and all my OD work has to be out of pocket).  Also, I wasn't sure if they were the best kind for surgery cases, or if they would stain, all sorts of questions.

I talked with one of the OD's assistants who also had braces as an adult.  She said that for the assistants, the metal ones are easier for them to work with.  The metal brackets are smaller and can be somewhat more comfortable against the lips.  Also, the clear brackets themselves don't actually stain.  Clear ligatures (if you have them) can stain, and the bonding can stain from coffee and pop.  She personally went with clear on the top, though, because they looked better.

That is what I decided doing, and I don't really regret it.  Sure, there are times when I wish I had gone all clear, but braces are braces.  People do notice them.  But, whatever.  I'm doing this for me.

My ortho uses In-Ovation brackets.  They are a self-ligating bracket very similar to the Damon bracket.  They don't require rubber or metal ties (ligatures) because they have a little door that closes over the archwire to hold it in.  This system is supposed to work a little bit faster than traditional brackets.  Also, my appointments for adjustments are about 6-8 weeks apart.  Changing the wires goes very quickly because there are no ligatures to take off or put on.

You can see from the pictures I've posted that the metal brackets are a bit smaller.  I don't find the slightly larger ceramic brackets to be all that uncomfortable, though.  I'm very happy with the look.  They're not completely clear, as you can slightly see the "door" and the archwire itself is not clear, but they're not immediately noticeable.  I think that's what I like best about them.  I just feel a little more confident in professional situations having the clear.  I have to be honest, though: it's not like people don't notice them at all.  When I smile, I can tell people look at me a bit like, "something's different about that smile, but I'm not sure what," and then they see BRACES, and it's okay after that. :-)

I've only had the ceramic brackets for a week now.  There are eight clear brackets on top, four metal brackets on top (on the teeth you can't see so much), and two metal bands on top.  So far, so good.  No staining issues so far (I <3 coffee).

Waterpik, my new best friend (maybe).

I bought a portable Waterpik a few weeks ago.  I wasn't totally sold on it at first.  My hygienist recommended it as a way to keep things cleaner around the braces, and I had read in a couple places that it can replace flossing. That sounded pretty good, since flossing takes *forever*.

Here's my take on the Waterpik deal.  It does make my mouth feel cleaner when I'm done.  It feels like it's doing something good, and there are bits of food that come out even after I've brushed very thoroughly (and I have quite the pre-floss routine).  However, I'm really messy with it!  Water squirts everywhere.  I thought maybe it's a learning curve and that it would get better.  It did get better, but it's still pretty messy.  It's the nature of the beast.

The downside--I still floss.  I floss after I pik, and I still find stuff.  Not a lot, but it's there, and I'm not taking any chances.  I thought maybe that I just had to get better at it.  Well, flossing still finds stuff, and I think I am better at the Waterpik thing.

I considered returning the Waterpik since I still have to floss, but decided against it.  First, I've *used* it, and it just seemed gross to return it.  Second, it does get stuff out that's stuck in the brackets, so I decided it's worth it, even though I still have to floss.  Maybe others don't have to floss still, but I'd test it out for yourself before making that decision.

I got the Waterpik Waterflosser Cordless PLUS.  I chose the cordless because I don't have a lot of counter space.  If you have the counter space, I've read that the Waterpik Ultra Flosser may be a better choice.  With the cordless one, I use about one tank for the bottom, and another tank for the top.  I pik for a little less than two minutes.  It's not a big deal to fill it the second time.  Warm water makes it more comfortable!  I use the low setting, but may work myself up to the high...maybe then I won't have to floss...Oh, joy.

How much is too much?

I am guessing I consume about 1/2 of those small sticks of wax a day.  Is this bad for me?

The problem is, I put it on in the morning before I go to work.  Sometimes I forget about it.  When I have lunch or pick up a snack in the break room, inevitably the wax comes loose.  When I'm with my colleagues, I'm not about to start picking it out of my teeth in front of them, so I just swallow it.  I assume the wax is safe, because it's safe to put it in your mouth, right?

Still trying to get used to brushing my teeth in public, too.  I'm really self-conscious about it!  But it's really terrible to go around with food stuck in your braces all day.

Ah, the life of braces!

Braces application.

For anyone out there getting ready for braces, I thought I'd give a quick run-down of the process I had at my orthodontist's office.  I had my top and bottom braces put on at different times (almost 6 months apart!).  Everyone is different -- some have the top put on first, some have both put on at the same time.  I highly recommend having your teeth cleaned at your dentist's office before getting the braces.

My two appointments were about 1 hour and 15 minutes each.  A week before the braces went on, I had spacers put in.  They were the little metal kind.  They were sort of uncomfortable, but not too painful.  The spacers were needed to make room for the bands on my back molars.  I have only fours bands (placed on the four molars furthest back -- my wisdom teeth are already out).

An hour before the braces appointment, I had to take a medication that dried up the saliva in my mouth so that it would be easier to put the braces on.  I only did this for the bottom braces appointment.  It made me go to the bathroom A LOT (like, I seriously had to go about five times during the appointment, which made it a lot more uncomfortable).  I didn't think it helped too much with the saliva anyway.  For the second appointment, they forgot to give me the pills, and I did not remind them.  I noticed that saliva pooled up a little in the back of my throat, and I had to swallow a lot, which was slightly uncomfortable, but not as bad as that first appointment.  Of course, you should follow whatever your OD tells you.  That was just my own experience.

So here is the rundown:

• The OA first polished my teeth with something gritty.  It was not minty toothpaste, but it was supposed to make sure that the areas that would be covered with braces would be free from bacteria. 
• I brushed and rinsed the grit away, and then back to the chair.
• I was fitted for bands.  Apparently, my teeth are small, so it took a few tries to find ones that fit.
• The bands were tapped and squeezed on using special pliers.  I felt pressure, but not pain.
• I was able to brush and rinse after this.
• Then, they put in a plastic piece that kept my mouth open while putting on the brackets.
• "Glue" (bonding material) was applied to each tooth.  This part tasted pretty nasty.
• Then, each bracket was applied.  The OD did this part to be sure they were exactly in the right position.
• Brush and rinse again (thank goodness!).
• Then the wire was put in (a thin flexible wire for the first one) and the "doors" of my brackets were closed.   (I have self-ligating brackets; if you have the other kind, they will put either rubber or metal ties around each bracket to hold the wire on.)
• Mirror time!  (aaahhhhh!)

That's it!  Not much pain the first day...  That came the second day, with a feeling of pressure and tightness.  That went away after about a week (at least for the bottom ones; my top ones are still a little sore, but not too, too bad).  The most pain I has was from having to keep my jaw open for so long.  Take Advil or something before you go in if you have jaw problems!

First night of freedom.

I have worn a night guard since 1998.  For four months in 2009, I wore a removable palatal expander and then went back to a night guard.  For nearly 10 months, I wore a special splint for my jaw.  Now that I have braces, I am splint/night guard free for the first time in 13 years!  I was a little nervous about sleeping without any sort of "protection." (heh...)  But let me tell you, it was wonderful!  I didn't wake up with any more tension than I did with the splint, and it was soooooo nice to not have a huge chunk of plastic stuck in my mouth.  To give you an idea of how awful that splint was, I am incredibly relieved to finally have braces.  My mouth feels so free.  Yay!

And they're on!

The dreaded bite splint.

Let me start out by saying that I absolutely HATE these pictures.  This splint is absolutely one of the most unattractive things ever.  And I have worn it for 271 days.  That's nine months of 24/7 torture.  And today is the LAST DAY!

I wanted to write about it, even though the pics are embarrassing, because the splint is not something I could find a lot of information on through Google.  Apparently, it's not all that common.  So, I hope this post helps out anyone else who has to go through this.

The splint has a fancy name.  It is a maxillary anterior guided orthotic, or "MAGO."  It's an "active" splint, which makes it a bit different from a regular night guard.  It's purpose is to give you a simulated correct bite so that your muscles can relax, allowing your TMJ to move into it's most stable position.  It's supposed to help relieve headaches and muscle tension.  In order for it to work properly, you have to wear it ALL the time, even while eating.  You should only take it out to brush.  It has to be adjusted about every week to accommodate your constantly changing bite as your joint moves into position.  It's a huge commitment.

Once your TMJ is stable, it helps the orthodontist and oral surgeon know the best position for your jaw placement, because your joint head is in its most natural position (i.e., it's not being dislocated by your muscles in trying to chew, find your bite, etc.).

Well, that's the basic goal/hope.  Let's just say it did not work that way for me.  I never had true relief of my joint tension.  Everyone involved in the splint treatment seemed genuinely surprised by this.  But, they insisted that this was the way to go, before I could get top braces, even knowing that once I had braces everything would just shift around again anyway.

Well, FINALLY, it will be over.  Tomorrow, I get my top braces.  I am so freaking excited to be rid of this awful thing.

271 days.  Over.

My smile with splint in...not too bad.

                            Lips "relaxed."                             Lips closed.  Ugghhh.

More bite pics.

Nobody touches....

Can braces fix this?

I'm biting down all the way!!

Tomo report.

Last summer, I had a tomogram taken of my TMJs.  It's a very interesting experience!  It's not like an MRI or a CT scan (you don't go through a tube or anything), but it does make the magnetic banging noises and it is a HUGE machine.  You sit in a chair in the middle, and around you swing the arms of the x-ray that takes pictures of you jaw.  I sort of laughed to myself, though, as I was sitting there.  Any of you who have undergone the dreaded face bow, or even just the ear rod things from the ceph x-rays will understand.  So, I am sitting in the middle of this enormous, sophisticated equipment, and then they tell me to place my chin on the chin rest and they proceed to swing around a contraption that looks like some sort of medieval torture device.  It's like 1200s meets the 21st century.  Anyway, there were ear-rods and clamps.  It was somewhat uncomfortable, but not too bad considering.  It only took about ten minutes to do both sides.

Here is the report, again in dentist-speak, which I will leave untranslated and to your imagination.

The left condyle was very small.  The reduction in size occured from the superior surface of the left condyle.  The superior surface of the left condyle showed signs of flattening, erosions and sclerosis while the superior surface of the right condyle had a thick cortex.  The superior slope of the left articular eminence showed signs of flattening, sclerosis, and erosions.  When the mandible was in the closed position the consyles were located superior to the center of their fossa and the resultant superior joint spaces were thin.  In the mandibular open position the condyles translated to a point short of the summit of the adjacent eminence.

The structure and morphology of the osseous components of the TMJs were evaluated and the findings noted above were consistent with active degenerative joint disease (DJD) in the left TMJ and remodeling in the right TMJ.  DJD involves the destruction of the articular tissues and occurs when the remodeling capcity of those tissues has been exceeded by the functional demands.  I could not rule out the possibility of active DJD in the left TMJ therefore this joint may be vulnerable to biomechanical forces.  The presence of the DJD increases the probability of a displaced disc in the left TMJ, has reduced the size of the left condyle, may be associated with a change in occlusion and mandibular posture and may predispose the TMJs to dysfunction.  In addition, the narrowed superior joint space increases the probability of displaced discs and/or thinning of the soft tissues separating the superior and inferior joint compartments.  The condyles demonstrated a radiographically subnormal anterior range of motion.

What this boils down to is that surgery is necessary to prevent any further damage, but it can't un-do the damage that has already been done.  My surgeon said that my bite will always have some "wiggle" because the joint is small and this will allow my bite to shift around.  This really increases the chance of relapse, but if I don't have the surgery at all, things would be much worse.  So I am moving forward...  Top braces go on next week!

Diagnosis.

Blogger ate my post (grrr), so here it is again:

I thought it might be helpful if I also posted my diagnosis from my oral surgeon.  It is pretty much in dentist-speak, which I will not attempt to translate....

Assessment of this patient's case is (1) Cranial base to mandible discrepancy. (2) Mandibular asymmetry. (3) Chronic closed-lock. (4) Dysmorphic condylar presentation of left TMJ suggestive of degenerative joint disease. (5) Capsulitis. (6) Myofascial pain dysfunction syndrome. (7) Bite instability with a Class II skeletal malocclusion, absence of anterior coupling and anterior guidance with working and balancing side interferences noted on lateral excursive movements. (8) Maxillary medial lateral asymmetry with maxilla down on the right and up on the left and a mandibular sagittal discrepancy with the mandible asymmetric to the left. (9) Inability to masticate a diet of normal consistency. (10) Speech impediment.

So, that's it in a nutshell.  I will need double jaw surgery to correct the asymmetry and malocclusion (open bite and over bite).  I thought the speech impediment part was real cute (not).  I have a slight lisp with "ch" sounds.  I am hoping this will go away after surgery!

X-rays (part 3).

This is my panoramic x-ray taken in 2009, again before any treatment began.

My dentist told me a few things about it.  First, it's possible to see how the left TMJ (on the right side of the x-ray) is flattened and short compared to the right TMJ.  My dentist said it's fairly significant that you can see that on this type of x-ray, because usually you can't.  He said it shows how severe the deterioration is.  The second thing he explained was about the indentation on the left bottom part of the jaw (again, on the right side of the x-ray).  The indentation is caused by the masseter (chewing) muscle pulling so hard on the bone when I clench.  The clenching has also caused a lot of gum damage (recession), which I'll have to have taken care of once everything else is done.  Thankfully, I am not a grinder, so my teeth themselves are fairly healthy.

That's all the x-rays I have for now!

X-rays (part 2).

So, here is my lateral ceph.

You can only sort of see my overbite.  I'm no expert in reading x-rays, but it doesn't seem particularly noticeable here.  You can see how my front teeth stick out a little (a huge improvement from the buck teeth I had as a thumb-sucking kid!).  Both my maxilla and mandible are retruded, and so both will need to come forward in surgery, the mandible slightly more so that my teeth are in a class I position, instead of being smack on top of each other like they are know.

What's interesting in this x-ray is the curvature in my cervical spine.  This gives me a forward head position, which causes a lot of tension in my neck, back, and shoulders.  An orthopedic doctor I saw told me that my neck curves in this way to compensate for the misalignment of my jaw.  (You can see how the cervical vertebrae bump up against my jaw, pushing it more forward than it would normally sit.)  Unfortunately, the forward head position won't be fixed automatically by the surgery and having the jaw in the right place.  I'll have to have physical therapy to retrain my muscles and my brain to no longer compensate for my jaw.

There's so much to think about!  I'm actually grateful that surgery is at least a year and a half away so that I can prepare myself for it and get used to the idea.

X-rays (part 1).

This x-ray really shows the asymmetry in my jaw.  The x-ray tech kept telling me to hold my head straight, and I kept saying, "I am!"  (I mean, hello--it's pretty hard not to hold your head straight when you have those rod things stuck in your ears...)  The x-ray is from 2009, when I first started investigating treatment options, but before I had anything done.  Some of the asymmetry is a structural problem that I've always had.  It's gotten worse as the stress from my uneven bite has worn down the jaw joint on the left side.  You can see how the top jaw is also tilted.  My sinuses are somewhat caved in too, so I am hoping that the surgery will help me breathe and sleep better.

My crooked smile.

So here is my crooked smile.  It's not actually something that bothers me so much.  People DO notice it, though, and have actually commented on it to me (weird), but I'm not generally upset by it except on bad days or when I'm obsessing about my jaw too much.  My face has pretty much always been asymmetrical (I can see it in photos from when I was a kid), but when I had braces in middle school and high school, instead of treating the actual problem of the asymmetrical jaw bone, my orthodontist just made my teeth straight to each other.  This basically means that he purposefully brought down my teeth on the right side.  This left me with a slightly gummy smile on the right that I did not have before braces.  I remember when I got my senior picture taken, the photographer was, like, "Don't smile so wide on the right!  You're showing too much gum!"  Huh?  That's just how I smile, so how do I make only one half of my face smile differently?  Well, I learned, eventually, I guess...

Here's my usual smile with my attempt at hiding the crooked part.  You can see how my chin slants off to the left a bit (I am holding my head straight in this picture.)

Here it is with a big smile (though somewhat forced to show my bite).

My bite...

So, here is my overbite before treatment began.  I don't know the measurements.  I've tried measuring it myself, but I can't really tell.  I am guessing about 7 mm.  My bite is also lopsided because I have significant joint deterioration of my left condyle.  I have a "gummy" smile--sort of, because it's only on one half of my smile; the other half is normal.  My teeth are fairly straight due to the lovely braces I sported as a teen, but I've still been given a 2-year pre-surgery and 1-year post-surgery time line.  Argh.  I got my lower braces in December and I'm slated to get the uppers this month.  It's hard to tell in this pic, but my teeth touch only in one spot (the back molars on the right).  I have a crossbite and an open bite than can be fixed only with upper and lower jaw surgery.

 I'll post more of my story and some pics in the next few days.

(I apologize that it's fuzzy... It's from my phone.)

First Post!

Welcome to my blog!  I've stumbled across many helpful jaw surgery blogs over the past months.  So, I thought I'd start my own as a way to process my journey, but also to help anyone out there who will be having a similar surgery.  I'll do my best to update and keep it interesting!