Those of you with messed up bites and smiles will understand this.  When we smile, whether it be with family, or friend, at a job interview, or people we just met, or your husband or wife with whom you hold nothing back from, we always try to alter or control our smile.  Always.  Some people with underbites get in the habit of pulling their lower jaw back and smiling, and the same when somebody with an overbite or overjet pulls back their top teeth to line up with their bottom.  For me, I have to catch and stop myself from laughing too hard uncontrollably because I show ssssoooo much gum and my overjet/overbite sticks wwwaaayyyy out.  But, there are times when I'm not thinking about it, or don't catch myself doing it in time before a photo is snapped.  I guess it's not a bad thing.  I mean, comon'..... we're talking about laughing and smiling uncontrollably.  This is usually a good thing!  Everybody can use a little unadulterated laughter and smiles every now and then!  I was looking through some recent pictures, and this was one of those times:

And for good reason, 1.) I'm having the best freakin time ever that I can't even think about controlling this grin, and 2.) I have other things to worry about on a skydive.  My situational awareness does not include making sure my buck teeth are tucked away. 

3 weeks away from the appointment with the surgeon, and I have to remind myself sometimes that anything gained cosmetically from this surgery will be just an added bonus.  But I have to admit.... it will be nice to have pictures, especially likes ones on a skydive where I don't control my smile, where I'm not sporting a horse face.  BUT.... I have been wearing a full face helmet recently, so you can't really tell anymore anyway!

I feel like thinking about this whole surgery and braces thing is consuming my life.  All I do is read blogs, and websites, and online forums for people going through this stuff.  But, I think I'd be crazy if I wasn't thinking about it a lot.  It's a huge decision!  And I feel like every day I feel differently.  One day I read a blog that outlines an experience that was as easy as walking on a cloud of unicorn farts, and I think, "Hey!  Sign me up for this crap now.... like, how about yesterday?!"  And then I read about people who have tough times and/or are left with permanent issues or side effects, and it makes me want to punch myself in the throat and say, "Self, why are you even thinking about doing this?!"  Regardless, everything I read is informative and worth so much to me in this whole decision process, so big shout out to all my other jaw surgery and braces blog peeps out there on the interwebs.  Keep on keepin on!

Seriously, if I had a dollar for every type of “ist” I’ve seen this week.  But, this is progress.  This is what all of this is going to take, so I better get used to it.  First “ist” was the orthodontist, who I saw for my second appointment.  Regarding this second appointment, let me first get this out of my system:  HAVING THE MOLDS DONE SUCKS!  Seriously.  Like, not like it tasted awful, but brutal in different ways.  For the bottom, it felt like she was ripping my teeth out when she went to take the tray out.  I guess the mold came out good, because it was really molded and stuck to my teeth.  The top felt like it was choking me to death.  Part of the goo started to slide down my throat and just about close off my nasal passage in the back of my throat, which is what I was mostly breathing through with that tray in my mouth.  I figured just hold my breath and get through it since it’s only 30-60 seconds.  After she took the tray out and saw how much goo was hanging down the back, she said I should have said something.  I guess I’m just that much of a bad ass ;)
Anywho…..I got my xrays transferred over from the other ortho I had my first consult with.  I got to chat up my new ortho for a few minutes during my appointment and I asked him particularly what kind of jaw surgery he thought I needed.  The verdict: Lefort I (upper jaw surgery that basically cuts the top jaw off your face, shaves off some of the bone that helps give me that gummy smile, and it’s attached in its new position with plates/screws).  He said it’s possible the angle they reattach the jaw at will make my lower jaw rotate up more and I won’t need the lower jaw surgery to move that jaw forward, but he wasn’t sure.  Only the oral and maxillofacial surgeon will be able to answer all of those questions for me once he sees my xrays and molds.  I’m wondering if the surgeon will veto the Lefort plan.  It seems like from my research, most people who get this surgery have a bad underbite, so I’m wondering if that is really what I need since I have the opposite problem.
I got to talk to a patient who had double jaw surgery a few months ago to correct her underbite.  She was scheduled in the appointment right before mine, so my ortho allowed us to talk in his office for a few minutes.  She was really shy and hard to chat up, so he had to facilitate the conversation.  About all I got was that she had the surgery, everything is great, he bite is all lined up, and she’s not having any nerve problems.   
I also signed my contracts and paid my first chunk of money down.  $2,000 bucks.  Ouch…. Just ouch.  But, they are allowing me to pay in chunks so I can maximize this year’s FSA, and then next year’s FSA for both Matt and I.  I am thankful for the FSA, but damn…. Still an ouchy.
Next stop was to hop over to the periodontitis’ office (another “ist” in a few days) to have him look over the missing molar that my ortho was worried would need the implant first so I don’t lose anymore bone there.  First of all, the perio was awesome.  Got a good vibe from him, and he told me that my ortho came over to talk to him personally about my case earlier that morning.  Man, I am so glad I went with this group of doctors.  I love that they chatted about all of this face to face!  Lots of good news from the perio—he thinks the bone should be OK to hold out 2 years while I do ortho, and he also said my gums are in pretty good shape.  No signs of inflammation and disease, and the 4-5mm pockets I come up with around my back teeth are probably more so because I have a ton of gum around those teeth, and not because of infection.  This was seriously fantastic news for me since I’m always coming up with 3-5mm pockets on those back teeth and I just felt like it was a losing hygiene battle. 
I have an appointment with the jaw surgeon on April 17th (that was the soonest they could get me in L ).  I still have to make the decision of surgical vs. non surgical before I go back to the ortho office that week to get braces.  I am still doing a ton of research and reading a ton of other blogs, but I guess I’ll have to make that decision by the end of April.  I still don’t know what to do.  Some days I feel like, “great—lets do this!” and then days like today where I read a few not so great experiences on blogs and it really has me wondering why the hell I am even considering this.  I know why—I want my bite to be lined up, I want to bite into a sandwich and be able to cut through the lettuce and tomato in it, and I want my mouth to be in the prime health, which includes getting everything in alignment.  One of the other issues my ortho mentioned was the uneven wear on my teeth.  He noted in my case work up that a few teeth have moderate to severe wear and will eventually need restoration.  I wonder if he means need it as of now, or will need it if I don’t get the surgery to fix the uneven bite which is producing the uneven wear. 

Some new glamor shots. …. Sorry for the flash in the one.  I took these with my phone since I don’t have the digital copies.  This newest pan is after I got the molar out on valentines day.

I met with another orthodontist today for a second opinion on my case, and he basically told me everything I knew he was going to tell me, but I still managed to walk out of his office so overwhelmed...... and honestly, kind of depressed.  I was holding back tears the whole way home, and the only reason I didn't loose it then is because I had an appointment to get my windshield replaced with somebody meeting me at my house, and I didn't want to show up a hot mess-- "sorry, don't mind me.... I'm just crying over my teeth!"  Ugh.

I shouldn't say that this was everything I thought I would hear, because it wasn't.  I feel like the only good news out of the whole deal is that if I go the non-surgical route, he can do invisalign for me.  I've been told in the past I am not a candidate for it since my teeth are so messed up, but this doc is the guy who invented invisalign-- yep, he made it right in his lab that was 2 feet from where we were talking.  So, invisalign would be fantastic since it will be MUCH easier to keep my teeth clean with that!  If that happens, I guess I'll have to change the blog to "confessions of a plastic mouth."  Otherwise, he pretty much said to me what the other orthodontist said to me.  Actually, there was one other difference.  This orthodontist suggested taking care of the hole where #19 back molar was with the bone graft and implant first.  He doesn't want to risk any more bone loss over the next few years, which would worst case scenario prevent me from being able to hold an implant and I would be forced into getting a bridge.  I do NOT want a bridge.  The two teeth around 19 are healthy and it would be stupid to grind those down for a bridge.

I liked this orthodontist.  When I walked in there was a sign up in the office that said "Welcome Ashley!  Congrats!"  I thought that was sweet!  I also liked that he was a weather geek, and even applied for the National Weather Service many years ago.  They turned him away with his biology degree though!  Ha!  He took a lot of time to talk to me, and basically did all of my pictures and measurements right away.  I've had two appointments at the other ortho, and he hasn't even taken any measurements.  His assistant did take my pictures and xrays during the last appointment, so I'm sure I'll see a bill for that if I don't continue treatment there.  There were so many names and numbers he was calling out that I can't even remember it all, but I made sure to get the overjet measurement since I tried to estimate that myself, and I was kind of close-- 8mm.  No bueno!  So, here is a rundown of what he suggested:

-Double jaw surgery.  Giving me referral for specialist who does nothing but this surgery up in Oakland.
-Bone graft and implant first on 19, instead of after braces.
-Braces if I elect surgical route.
-Invisalign if I elect non-surgical

I'm back to being torn on the surgery.  I've read so many stories about people having permanent numbness in their chin/lip-- but even with those people, they always mention, "but I would do it again and I don't regret it!"  This ortho said that out of his 500 surgical cases over the years (he's been doing this a long time. no spring chicken here!) he hasn't really seen significant issues.  I have another friend who works in an ortho office and she kind of said the same thing.  So, maybe these stories I've read are the minority and, much like restaurant reviews, people are more inclined to go out of their way to write something when something is wrong, and be less inclined to do it if it went perfectly.  Out of all the consults I've had, I just get such a sense of "you really should have this surgery," even though they say they are trying not to sway me either way. 

I really don't know what to do.  My windshield appointment got canceled, and I came into the house, burst out into tears, and poured some wine.  Why?  Partially because I'm overwhelmed, and then partially because I had to sit and look at pictures that were close up of my face/teeth for an hour while he talked to me and it just kind of bummed me out.  I regret not putting on make up or doing my hair this morn, but I just hate looking at my mouth and smile.  Here's the file they started today (So hard to post this, but I guess I'm committed to sharing my story):

I forget what he called it, but in my side profile you can see my top lip is flat.  That would be fixed with surgery when the teeth were brought up/forward enough.  My lips will also come out more with braces.  I also forget what he called that... maybe confident lip or something?  Gosh, I forget.  It's beside the point, I guess.

Another issue-- this office said insurance denied coverage for the braces, which I will have to call them on because we got on this plan because they covered adult orthodontics.  If insurance won't cover, then I'm looking at an $8200 price tag :( :( :(  BUT.... if I get Kaiser this fall during my open season and elect for the surgery, then that would end up being about $500 all said and done, for a surgery that would cost 50K without insurance. 

I really don't know what to do.  Anybody stumbling on this blog off the internet and have some input, go ahead and reply please!

And so it begins....... finally, I'm getting braces.  I'm almost 30, but that's OK.  I know right now I'm doing it more for me more than anybody else.  And even with that, I am doing it more for me for medical reasons and not so much the cosmetic anymore.  I'm a meteorologist-- for the National Weather Service and not on the news, so I don't have to worry about being TV worthy or anything, but I do give stand up briefings daily to air traffic control managers, so I guess cosmetically there is still a little bit of influence there.  I think I'm just passed that point where I cared as much like when I was younger.  I just want my teeth straight and easier to keep clean now.  College wasn't bad, but back in grade school..... man, oh man, I just wanted to crawl under a rock and hide those chompers.

I always hated my smile, even at a young age.  I went to a small school that was pretty cliquey, so I did end up taking a lot of flack and getting made fun of quite often.  To this day I remember the first really harsh verbal assault very clearly, which was in about 3rd or 4th grade when somebody called me "shit tooth."  Since then, I've spent my life holding back smiles (I don't want to smile too much and show all the gum), and often times cover my hand with my mouth if I'm laughing, smiling, or talking.  My teeth were bad from the start.  Even my baby teeth.  I had enamel deficiency that caused stains and dark brown spots on the 2 front teeth and my teeth were moderately-severely crowded with overlapping teeth and some teeth being pushed backwards behind others.  I've always had these tiny little teeth, and a LOT of gum and bone, especially on top.  I have an overbite/open bite, and my front teeth jet out (not sure of the measurement yet-- will get that later this week at my next orthodontist visit, but if I had to guess it's probably a good 6-8mm) over my bottom teeth.  Even when I had my baby teeth, dentists were already telling my parents of all the dental woes I would have down the road, including the need to break and reset my jaw.  Scary stuff for a kid, so I think hearing all of that from a dentist while I was young has contributed to my gnarly fear/anxiety when it comes to seeing a dentist.  What I've come to find out now is those dentist were right-- my bones were already growing at different rates.  My arches are way too small on top and bottom, and my upper jaw has way outgrown my bottom, which is why I show a ton of gum when I smile (see "before" pictures in this post), and my teeth overjet the bottom teeth.

I grew up without insurance.  Braces were not an option for me.  In fact, I had not seen a dentist since 1993 when I had a deep filling in my first molar.... well, and again in 2001 when I broke a tooth and needed a root canal (but they just did the RC and stuck temp putty in-- no crown, no cleaning, etc).  Fast forward to thanksgiving 2009-- I am out of college, gainfully employed for 2 years with decent insurance, and I still had not seen a dentist.  I think at this point I was, 1.) still scared to death and especially feared all the work that I knew needed to be done, and 2.) deeply embarrassed because I knew my mouth was in bad shape.... like, really bad shape-- my gums bled all the time, even during my sleep, my breath was bad, I knew I probably had cavities, and that tooth I had the root canal on was going on 9 years of temporary putty filling that kept me from chewing on that side of my mouth, and my back left molar (#19) had a subtle ache on it every now and then for years, which was accompanied by a pocket on the side of the gum that would become inflamed and filled with a liquid that drained.  My bad tooth genetics and lack of seeing a dentist are not all to blame.  I lacked good dental hygiene-- I rarely flossed and I never brushed my teeth at night.  I, especially after becoming an adult, am completely to blame for all of that.  

Thanksgiving weekend 2009 I broke a wisdom tooth while at work (the one next to #19 that ached on and off).  I had never been in such excruciating pain in terms of a toothache.  I couldn't function.  Nothing had ever hurt me like that before.  My boss gave me his dentists phone number, and since I was not a patient they had seen before, the best they could do was phone me antibiotics since it sounded like infection pain to them.  Up until this point, I had never so badly wanted to get to a dentist office! ha!  So, I get in and sure enough-- huge issues!  It wasn't the wisdom tooth that was hurting me at all.  It was the abscessed #19 molar in front of it!  The wisdom tooth was in fact broken, and impacted (as was the other bottom one on the right), but the infection in 19 was so advanced there was no doubt that tooth was responsible for the pain.  The infection ate into a lot of the bone between the roots and they weren't sure the tooth could be saved.  All these years I had been walking around with infection in the tooth.  No bueno!!

So, that started it all.  Ever since then I've been in and out of dentists and specialists offices more times than anybody I know.  This has already become a long story, but lets try and shorten it up with a quick run down to catch up to where I am today, which is finally at the orthodontic stage (yay!):

Dec 2009 (First time to a dentist in practically 15 years):

• Periodentisis (lots of 5-6mm pockets in the gums. Even an isolated 7mm here and there, particularly around the infected tooth) ; got the scaling/root planing and good cleaning.
• #19 back molar root canal and crown at the endodontist.
• Unbelievably I had ZERO cavities..... just all this other crap that was wrong.

2010:

• 2 impacted and 2 errupted wisdom teeth removed at the oral surgeon.
• 3 month recall cleanings.
• 2 fillings.
• Finally got a crown on upper right molar that had the root canal back in 2001!  Since I hadn't chewed on it for a decade, it was still OK (thankfully!).

2011:

• New dentist puts me on 6 month recall cleanings.
• Periodontist gives me gigivectomy on top front teeth to make my teeth longer and smile less gummy. (see "after" photo below).
• Front overlapping teeth are reshaped and have bonding built on them to make teeth appear straight (this was a quick fix before my wedding that I now regret....more on that below).

2012:

•  Upper right molar aches. Dentist says nothing wrong.  Tooth abscesses (like, golfball growing out of my face kinda bad) while out of the country in Mexico on vacation.  2nd Root Canal needed.
• Bottom left molar #19 aches. Dentist catches the abscess this time, and only a month after the other 2nd root canal, I am back to the endodontist for another 2nd root canal retreatment. Tooth can not be saved.

Time for a new dentist I decided.......

2012 continued:

• New dentist said I should have never been on 6 month recalls-- another scaling/root planing done (btw, if you're wondering, these REALLY suck!!!).
• 3 month cleaning recalls.
• Referral to orthodontist, but can not be started until oral surgeon extracts #19.

2013:

• 4 month recalls
• #19 extracted at oral surgeon 
• Orthodontist consults
• Oral/maxiofacial surgeon consults for possible jaw surgery as suggested by ortho.
• Estimated date to have braces put on:  March 19th!   

  

 The plan at this point is to get the braces on and go from there.  I've had to do a lot of thinking about the jaw surgery.  It is VERY invasive and is a major surgery that would put me in the hospital for a few days.  I would be out of work for a few months, and there is a good chance I would never regain full feeling back in my lower chin/lip.  It would be great since my bite would be fixed and everything more aligned (like, right now I can't even bite through a piece of lettuce in a sandwich.  My front teeth sit about 1.5-2 teeth forward from where they should be sitting and my bite just sucks), but I just don't think it's worth the recovery time and all the risks and permanent damage associated with it.  At this point, I want to see if they can close my bite even a little bit with elastics/braces, straight my teeth (which may require a few teeth to be removed if I am opting out of the jaw surgery that would widen my arches and make room for everything), and just have it good enough that I can keep everything clean easier.  I accumulate plaque very easily (again....stupid genetics!), and it's near impossible to keep all the crevices clean between the overlapping and crooked teeth.  I take decent care of my teeth (I have a sonicare, floss almost every day, and go for cleanings every 4 months) and if I can get to a point where I can keep up the care and be able to go for cleanings 6 months like everybody else, that would be AWESOME!

So, probably a two year sentence for the metal mouth....maybe a little more.  I'll need a bone graft and implant done where they took #19 out, but they won't start that until they know how big of a hole I'll have left once my teeth are all shifted around by the braces.  And then I have to look at a few vaneers up front since I had those teeth foolishly shaved down and bonding built on them for my quick fix (which was great at first, and it did improve my wedding photo's and overall confidence, but not worth it in the long run now that I am getting everything fixed).  After everything is said and done, I'm probably going to have about $10-15K invested in my mouth-- and that's not even including the braces ,which luckily I only have a $500 copay on with my husbands super fantabulous insurance!  So, take it from me, people-- take care of your chompers and you'll be able to hold on to your wallets! 

I'll be keeping up with posting progress photos (since that is my favorite part of other people's blogs.... love seeing the transformation and the final before/after shots.  amazing stuff!!), but to do that means I need some before shots.  I guess I better get comfortable with letting all the readers all up in my grill. lol