Confessions Of a Metal Mouth
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The Good, The Bad, And The Ugly

4/18/2016

8 Comments

 
Even though I knew this part of treatment was coming for a long time, I was still dreading it.  I talked in my last post about my extremely loose front teeth when they were out of the arch wires at my last appointment.  This has been an ongoing issues since my first surgery when I found out that my roots were disappearing on my teeth without any word from my treating ortho or surgeon about it.  They just let it happen and like everything else, turned the other way.  When it finally got brought up, they told me it was just hints of some root blunting and nothing to worry about.  Well, here it was some severe resorption going on and not just hints of blunting, which really wouldn't have been a big deal.  Bad enough resorption where great care should have been given as to how my teeth were being moved, and instead my first ortho was super wildly yanking them all over the place to try and compensate for how messed up I came out of surgery.  So, like everything else in my treatment, I took it upon myself to get with a prosthodontist and start monitoring the root health of my teeth.  He's been wonderful.  He's also super honest, and has told me from the start that the prognosis on my upper front teeth was not good at all.  So, I proceeded with my second round of ortho (because I was in that much face and jaw pain that I didn't have a choice and had to risk more damage and possibly losing these teeth by going through ortho again) and knew we would be revisiting the state of these teeth.  Well.... we're finally at a place to do that.  So, lets break today's appointment in to the good, the bad, and the ugly.

The good:  I've got about 6 months of braces left.  That is what my ortho said when he called my prosthodontist to talk.  So, yay for that.  But then it's a huge boo, because that was literally the only good out of this appointment.

The bad:  The resorption is bad.  Really bad.  He didn't even take new PA's (which I am surprised at, because I think I am due for them soon anyway), which means he probably just talked to my ortho and heard from him how loose those teeth were.  My ortho had a face on him like, pure shock, where he had never seen teeth that loose before.  I am not too worried about not having the PA's today because today was just a rough meeting to start to pow wow on what we want to do.  We've got 6 months to stew on all of this.  My prosthodontist is actually going to try to get back together with my ortho and surgeon to talk about everything and decide best course of action for us.  The other bad is the beginning of what is going to be an endless money pit.  I had nothing done today.  No xrays, no nothing.  Just to sit and talk with my doc for 15 minutes, that was $125.  This is just the beginning of all of this.  I've been trying to stash away what I can to cover what's coming, but just thinking about the numbers makes me sick.  Luckily my first orthodontist refunded me back the $8300 I spent for treatment with him, but that totally just turned around and went to my next ortho.  So $8300 for braces, and we're sitting at $6000 for surgery (including the cost of the copay for my surgeon and cost of picking up the extra medical for him. Surgery costs will probably go up since I haven't gotten the hospital bill yet), and all the restorative work is going to be in the $10,000-$15,000 range if I had to guess.  So I'm looking to be up around $30,000 for my mouth the last 3.5 years when this is all said and done.  No wonder my savings account keeps going down instead of up the last few years!  Ugh!

The Ugly:  The teeth are goners.  My 4 main upper front teeth (the 4 teeth in between the K9's, teeth 7-10).  We were hoping teeth 8-10 could maybe stick around for another 5-10 or maybe even 15 years, but they seem less optimistic now.  Actually, my prosthodontist today said something like "actually, I can pretty much be 100% certain if you try to keep these teeth, it's only going to be a couple years.  Maybe 2-3."  So, they sound pretty damn sure at this point.  So, what are my options?  Do we rip them all out and go straight for the gold as soon as my braces are off?  Do a wait and see approach?  Do 4 implants on all of them, or go for an implant on each lateral incisor and bridge the two main incisors in between?  The prosth is leaning towards the outer implants with the bridge.  I am super hesitant on this, as I've done some research that says that is not good for bone.  I'm young, and that is an awful lot of years for bone to shrink away and it ends up looking like dog crap later.  But he says it would be worse to do 4 implants next to each other, because you end up losing gum/tissue when they are right next to each other and that ends up looking like crap later.  So, sounds like I am damned if I do and damned if I don't.  I definitely trust his opinion though, and I really want to hear what my surgeon has to say about this.  He does implants all the time, and last I talked to him he was down with 1.) me keeping the teeth as long as I could to preserve bone, and 2.) I think he was also thinking implants for the same reason I was, but I'd have to ask him again because I am not 100% sure on that since it wasn't a point blank question and more of just a sum of some things he's said over time.  I definitely for sure trust his opinion too.  I wish I was seeing him sooner than in 3.5 weeks because my mind is going to be spinning wondering what he thinks.  All of them are going to talk about this, and if I had to guess, they'll tap in to their study groups and get the other docs opinions too.  So, there will be lots of eyes on my planning again, which is really fantastic. 

So, I have really mixed emotions over today.  This is not necessarily new news.  They've slowly been prepping me to hear that this wasn't going to work out.  They've been honest with me from the start on the prognosis of these teeth, but I guess in the back of my mind I had a secret hope that we could make do with teeth 8-10 for a good long while and take care of them later.  I am not worried at all about 1 implant, but the thought of losing all 4 upper front teeth at once is completely devastating for some reason.  I originally embarked on all of this work so I could save my teeth, and here I ended up losing at least 4, and possibly more (my bottom incisors actually don't look great on xray to me, but my team has not said anything about them....yet) because of it.  So, in terms of tooth health, I was better to begin with when they told me I wouldn't be!  Ha!  Funny how life works sometimes.  Despite this not being new news, I managed to still get a little rocked by this today. I think the prosth was waiting for me to lose my shit in his chair,  but as always, I remain composed.  I know at an appointment when he first told me I was going to lose these teeth, he said he was surprised I wasn't more emotional.  Like, maybe he thought I didn't get it or it didn't sink in what he was telling me.  Nope.  I am just usually not a crier, especially in public places in front of strangers.  So, I did what I normally do in these situations...... I lost my shit in my car instead.  I got in my car and had to pull over and just have 10 minutes to let it go.  It's teeth.  Why is it such a big deal?  Well, it's something so permanent to each of us. Something to integral to our health and well being.  It's quite a big deal, actually.  Think about it-- have you ever had a nightmare about losing teeth or getting teeth pulled?  There are even definitions in dream books about this because the dream is that common.  I also think another reason I am so upset is because this was something that was probably preventable. I am not 100% sure, but I am pretty sure that my first orthodontist was a huge cause of this.  Could I genetically be prone to resorption?  Yes.  But that guy moved my teeth SO hard and SO fast.  Ridiculously hard and fast.  I had to eat vicodin through my whole round of treatment with him, and my second round of ortho I haven't needed so much as an advil.  I am not sure, but I think if you look at my xrays, they show that the amount of resorption I have is not typical of somebody experiencing normal resorption from normal orthodontic movement.  It's definitely trauma induced.  And once it started, that was it.  No matter how gentle and slow my second ortho is (and he has been amazingly gentle, slow, and attentive to my roots), the damage was already done and going.  So, just the force of being in even the lightest wire is going to keep the damage coming no matter what we do.  So, that is the deck of cards I have been dealt here.  And on the tangible side with all of this, it sucks that I am again left paying for damage somebody else did to me. When I am all done with this, I'll probably have spent $30,000 to fix what my original surgeon and orthodontist have done to me.  All the while, they just get to keep on keepin on. 

So, last tid bits and on to a different topic(s)--- I sent letters to both my first ortho and surgeon.  I let them know how I feel about everything that has happened to me, let them know that their treatment for me was not only wrong, but down right immoral, and I updated them with some records to show them what good work and at least the standard of care looks like.  They might not even read it.  Who knows, but at least I feel like I've said my final word and can hopefully get some closure from it.  It's probably the closest thing I'll get to closure there.  Otherwise, my bite is still looking great!  Actually, it's starting to feel really good. My bicuspid on the left is no longer tooth tip to tooth tip and everything is now seated in their new little homes in their grooves.  I wouldn't be surprised if I am officially class I all the way around now. At least it looks/feels like it to me!  Still getting used to it, even two months in to this now.  It will definitely take much longer to feel normal again.  Like last time, it didn't happen over night, so I am in no rush.  Pain wise I am doing pretty good.  I think the worst of it for me is in the morning after clenching at night, my upper jaw across the osteotomy site is sore and around the plates and screws are puffy/sore.  I remember this happening a long while last time too. I'm still puffy in the same spots.  My numbness has gotten a smidge better on my lip/chin.  I feel like I can definitely feel my lip more, and I am getting some bad shocks and zingers this week.  One yesterday was REALLY painful and lasted for a good couple of minutes where I was out loud saying to myself, "wtf?!"  I've also hit the super sensitive phase where my gums/teeth are sensitive.  I think this is the feeling coming back in the gums.  I hate brushing with my electric tooth brush right now, but it has to be done.  I think this lasted 1-2 months last time. Ugh, no bueno for that.  And last but not least in other news.... I got a hair cut!  I made the big chop back to a pixie cut (see pics below).  Hard not having a mop to hide my puffy face behind, but oh well.  I started losing hair again bad like I did after the last surgery, so I am not dealing with it again.  Off it went!!  I am still not sure I am in love with it, but it will be fun to have while my hair goes through this weird shock and shed cycle again! 
8 Comments
Traci
4/19/2016 08:23:51 pm

Hi! I've written you a few times...I am the dramatic one with all the issues (tmj and now bite relapse). I'm so sorry to hear about the state of your teeth. I'm glad the revision surgery has went well and your bite is closing up but I know how upsetting it must be about your teeth. After my double jaw surgery in 2013, I went in to have my implants placed for my upper lateral incisors (I was born without them) and discovered that my front two teeth are very loose and I have 40% bone loss. The doctor who tried to put implants in suggested I get a six tooth bridge across the front but the cost, losing good teeth, and the fact that they need replaced regularly really upset me. I went to my surgeon who has done my double jaw surgery, 4 arthrocentesis', bilateral fat graft TMJ surgery, and redo one-sided fat graft surgery, and he was able to place my implants. My front teeth are still loose and I have bad gum recession but so far so good...I am keeping those two front ones right now. Maybe down the line I'll lose them but not yet! I'm still waiting to find out what they are going to do about my bite relapse. It sounds like they believe my lower jaw relapsed after my bad discs were removed and rebuilt with the fat graft. They think the only way to close my VERY open bite is to redo my lower jaw surgery, at the very least. Not fun at all. Hang in there with the teeth! You've got good docs now who are looking out for you. My implants were VERY difficult to place and had to be done at a very crazy angle due to bone loss but they've been in for 18 months now!

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Ashley
4/20/2016 05:46:25 am

Hey, Traci! Now that I am doing research on all the implant stuff, I can't believe how common it is to actually have those lateral incisors missing! I had no clue! I am glad the implants are taking for you though. I too have some bone loss issues, so we're going to have to address that for sure and it's probably another reason why the implant supported bridge is better for me right now. Hopefully they can get you going with the jaw redo so you can get some relief. Are you seeing a surgeon right now for all of that? Or still with the same guy?

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Traci
4/20/2016 05:19:31 pm

It is very common and I didn't realize until a few years ago. There are 4 teachers at my school who don't have them! I will see my surgeon in 2-4 weeks so he can evaluate me with his own eyes and take a new CT. Some people tell me I should find a new doctor but honestly he's done nothing wrong...I've just been a very difficult case and had some pretty cruddy luck. In addition, there are not many surgeons who do this type of surgery...I already travel 2 hours to my surgeon. Just so I can say I got another opinion. I'm seeing another orthodontist in my town next week. However, I told them that I want it be a completely unbiased opinion...I don't want the doctor to see any of my xrays or history before he examines me. I'm nervous but curious by the appt....I guess we'll see what happens!

Ashley
4/20/2016 05:34:29 pm

Oh, wow! Definitely drop me a line and let me know what happens! I'm sure the appt will go well!

Katherine
4/20/2016 05:19:12 am

Glad to hear things are progressing along even if it means progressing to the part of treatment you have been dreading. You are looking great! Love the haircut. I have heard from quite a few people that they experience hair loss after the surgery. Is it a noticeable amount? What causes it / Is there a way to prevent or minimize it?

Thanks!

Reply
Ashley
4/20/2016 05:54:58 am

Not everybody goes through the hair thing. I actually talked to a dermatologist about it last month and she said it's a toss up. Some people see it after anesthesia and some have no issues. But if you have issues, then you'll have it every time after general anesthesia. If you want to look up more information on it, it's called Telogen Effluvium hair loss. There is nothing you can do for it. No magic pills to take or lotions to put on your head. Just time to let the hair come back around to it's natural growth cycle again. First surgery it hit me around 3-10 months post op and then started to slowly regrow after, but in that time frame my hair thinned and got really greasy. I just didn't feel like dealing with that again, so it was a good excuse to go back to a pixie again! :)

Reply
Roger
4/23/2016 02:36:07 am

Hi Ashley. I came across the link to your blog on the Archwired forum for orthognathic surgery. I am 7 months into ortho treatment and will be having similar bi-max surgery in a few months time in the UK (London). I am having the surgery for functional reasons to address severe sleep apnea which was the probable cause of a minor heart attack a couple of years back (I am quite a bit older than you!). I have an appointment with my prosthodontist next week as I am worried about resorption/loose tooth. I have read your extraordinary story from beginning to end and have found it really informative, well-balanced and inspirational. We are all warned of the risks that any surgery involves, however, in your case there seems little doubt that your surgeon was negligent, whether or not she permitted a resident (which seems very likely) to undertake the procedure. Your experience with the expert witness is truly shocking but not unusual for the medical profession which tends to look after its own ahead of its patients when the chips are down. Add to that the private medical insurance industry in the US, which is all about maximising profit....it seems entirely likely that they got to your expert witness. From all I have read, it would seem that you had a very strong case against your surgeon and her paymasters. I would like to help expose them is a small way by starting a new thread on the archwired forum about accountability for botched surgery if you are OK with me attaching the link to your blog? Please let me know.....Otherwise, thanks so much for your excellent blog and for being such an inspiration in dealing with the truly awful hand you have been dealt! Most people would have fallen apart under the circumstances....I sincerely hope that the worst is now behind you. Very best wishes!

Reply
Ashley
4/23/2016 08:48:40 am

Hi, Roger! Thanks for keeping up with my blog! And I am really glad it's been some kind of helpful information for you. Helping other patients is definitely my main motivation for keeping this site going, so I'm always glad to hear when somebody gets something out of it! :) Feel free to share anything from here. It's all out in public and there for the looking. I'll have to check the thread out and see what kind of discussion it sparks. It's a tough discussion to have, but the reality is there are some not so great docs out there. Not being a great surgeon by what you do with your hands is one thing, but I also learned there are some not so great docs just in the sense of they are not honest or moral, and sometimes for me that is an even bigger injustice. So, I am glad to get in on discussions and talk. If that can help somebody else avoid picking docs like I picked for my first treatment, then I am all for it!

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