Well, about 14 more hours to go. Actually, a little more than that, but I'm waiting.
Truth be told, I'm just wanting to get the damned spacers out from between my teeth. I'm getting tired of the feeling of constantly chewing on rubber! What's happening is the elastic bands are sticking out over the occlusal surfaces of the teeth, so they're making contact with the biting surfaces of the teeth below and above them. The right side of my mouth is okay, but this feeling only encourages me to unconciously clench my teeth, so I don't know if it's the movement of my teeth or my teeth clenching together that's causing the soreness in my jaws. Either way, IT'S GOT TO FUCKING GO! :(
Regardless, this just means I'm one more month closer to getting this surgery done and over with and I can't wait. :)
Monday, August 2, 2010
Friday, July 30, 2010
Rubber Baby Buggy Bumpers
Well, it's been 3 days since I've gotten my spacers. They're not painful when they're sitting there, but the ones in my upper left quadrant are sticking out a bit so it feels like I'm chewing on rubber when I close my mouth. Very weird feeling.
The only time I do have problems is when I try to eat. Chewing is not my favorite thing right now because that's when I really feel the movement of my teeth. It also feels like the molars on my right side are higher on the bottom or lower on the top arch. But, it looks like I'm just going to have to stick it out.
Four more days to go and then I'll be getting braced. Check back again soon!
The only time I do have problems is when I try to eat. Chewing is not my favorite thing right now because that's when I really feel the movement of my teeth. It also feels like the molars on my right side are higher on the bottom or lower on the top arch. But, it looks like I'm just going to have to stick it out.
Four more days to go and then I'll be getting braced. Check back again soon!
Tuesday, July 27, 2010
Chewy
So, soon after I posted the previous blog entry, I walked to the Downtown area of Huntington Beach to go catch the route 1. While on board, I resumed playing Sudoku on my nook.
This was not a good idea, because I ended up missing my stop and had to walk back to the previous stop, about a good mile away. I called up OCTA to find out when the next route 35 was leaving so I could get to Dr. Graham's office and found that it was leaving the next minute. "Run, Forrest! Run!"
So, I ran and got to the bus about a minute after it was supposed to leave, but the driver saw me running and waited. I hopped on board and grabbed a seat in the back and the driver doesn't have the air conditioning running. When I got to my stop, I had to yell at him to stop or else he would have driven right past it.
Now, irritated, I walk into Dr. Graham's office. Soon, the waiting room is full of patients for their 10:30 appointments. We all got herded into a 2nd waiting area, then get called in and assigned different seats.
Soon, one of the dental assistants joined me and asked if I was getting all my spacers put in. I didn't think about this at first and said "Yes" before I remembered that Dr. Graham was going to brace me on the bottom first to make room for the upper brackets. The assistant came back with the spacers and I told her what was going on. She inspected my bite, then went and got my chart. She then made a quick consultation with Dr. Graham and started placing the spacers between my molars and 2nd bicuspids.
I think the spacers are blue elastic bands that they use for braces. When they place them in, they stretch them out so that they're like a slightly thicker piece of dental floss. They then spring into their normal shape and move the teeth apart form each other so there is space to place the metal bands.
When the assistant was finished, she told me that she's looking forward to the finished results of my surgery. She related the story of her ex-husband and told me that his underbite was even more severe than my own. The results were, in her words, fantastic. Of course, dopey me, I forgot to ask her name or look at her nametag. Oh well, I'll be in next week.
Next week, I go in for braces and the whole thing really begins in earnest. Forward, ever forward. Check back here next week.
This was not a good idea, because I ended up missing my stop and had to walk back to the previous stop, about a good mile away. I called up OCTA to find out when the next route 35 was leaving so I could get to Dr. Graham's office and found that it was leaving the next minute. "Run, Forrest! Run!"
So, I ran and got to the bus about a minute after it was supposed to leave, but the driver saw me running and waited. I hopped on board and grabbed a seat in the back and the driver doesn't have the air conditioning running. When I got to my stop, I had to yell at him to stop or else he would have driven right past it.
Now, irritated, I walk into Dr. Graham's office. Soon, the waiting room is full of patients for their 10:30 appointments. We all got herded into a 2nd waiting area, then get called in and assigned different seats.
Soon, one of the dental assistants joined me and asked if I was getting all my spacers put in. I didn't think about this at first and said "Yes" before I remembered that Dr. Graham was going to brace me on the bottom first to make room for the upper brackets. The assistant came back with the spacers and I told her what was going on. She inspected my bite, then went and got my chart. She then made a quick consultation with Dr. Graham and started placing the spacers between my molars and 2nd bicuspids.
I think the spacers are blue elastic bands that they use for braces. When they place them in, they stretch them out so that they're like a slightly thicker piece of dental floss. They then spring into their normal shape and move the teeth apart form each other so there is space to place the metal bands.
When the assistant was finished, she told me that she's looking forward to the finished results of my surgery. She related the story of her ex-husband and told me that his underbite was even more severe than my own. The results were, in her words, fantastic. Of course, dopey me, I forgot to ask her name or look at her nametag. Oh well, I'll be in next week.
Next week, I go in for braces and the whole thing really begins in earnest. Forward, ever forward. Check back here next week.
Back On Track
Well, less than an hour and a half to go. In about 90 minutes, I'll be in Dr. Graham's office to finally get my spacers for my braces.
This appointment was reset after news came that the Judge Malette threw Emperor Schwarzenegger's case out of court. When word came on that Friday, I called the following Monday to make my appointment.
This procedure involves placing pieces between the molars to make room for the application of metal bands that will be used as anchors around the molars. Next week, I will be getting said bands around my teeth and be getting braces placed on my bottom teeth so they can be moved into their position and also so I won't be breaking off my upper brackets when they're applied.
This reminds me, I also have to ask Dr. Graham to refer me to the x-ray clinic so I can get another encephalographic radiogram to show that my jaw is no longer growing and that the jaw distance is being caused by the bone and not the braces.
Time to go! Check back later.
This appointment was reset after news came that the Judge Malette threw Emperor Schwarzenegger's case out of court. When word came on that Friday, I called the following Monday to make my appointment.
This procedure involves placing pieces between the molars to make room for the application of metal bands that will be used as anchors around the molars. Next week, I will be getting said bands around my teeth and be getting braces placed on my bottom teeth so they can be moved into their position and also so I won't be breaking off my upper brackets when they're applied.
This reminds me, I also have to ask Dr. Graham to refer me to the x-ray clinic so I can get another encephalographic radiogram to show that my jaw is no longer growing and that the jaw distance is being caused by the bone and not the braces.
Time to go! Check back later.
Tuesday, July 6, 2010
Hosed, again
Well, I was supposed to go in and get spacers put on today, but being that I'm an employee of the State of California, I now have to worry about whether or not I am even going to be able to make my rent, as minimal as it is, for the next couple of months thanks to Governor Schwarzenegger's plan to reduce all employees to Federal Minimum Wage until the budget is passed.
Until then, ALL appointments regarding an orthodontist are now indefinitely on hold until I get my full paycheck. I simply don't know if I'll even have the ability to pay my regular bills.
Until then, ALL appointments regarding an orthodontist are now indefinitely on hold until I get my full paycheck. I simply don't know if I'll even have the ability to pay my regular bills.
Wednesday, June 16, 2010
Light Head
Last week, as I said, I scheduled my appointment to have teeth #6 and #12 removed in order to prepare for braces. After arranging final transportation arrangements with my friend Erik, I waited for Monday.
On the day, I had woken up early, but went back to sleep after an hour and a half out of boredom. Eventually, I came back around a little after 8, took a shower, brushed my teeth and got dressed. Erik called to get the directions and we took off down the street.
I checked into the clinic and eventually was given my paperwork after giving the x-rays and extraction order to the ladies at the front desk. After filling out the health history and consent form, they had me come back for panorex x-rays and periapical shots of the teeth they were removing. Soon, I was in the operatory meeting Dr. John Choi, the oral surgeon. Dr. Choi gave me a little background on himself and I was relieved to find that he's been doing oral surgery for 15 years. After a final check on my health history and forms, I was taken back to another operatory.
There, I was hooked up to a heart and respiration monitor. After a few minutes, I was given an intravenous bag of saline while the operating crew got ready. Everyone came in and they started the oxygen mask on me, and eventually started the nitrous oxide mix. The surgical assistant, whose name I didn't get - damn shame too, she was cute - then put a mask over my eyes to keep any fluids from going into them. The last thing I remember is looking up into grayish blue from the mask over my eyes.
The next thing I remember is getting into Erik's car with some assistance. Another gap of time passed and I am already upstairs opening the door to my apartment. Erik made sure I had everything I needed and I went inside and realized that my mouth was full of gauze. I didn't care about that because I knew why it was there and I proceeded to my room and promptly fell asleep for about an hour and a half.
When I woke back up, I got back out of bed and walked (yes, I'm out of my fucking mind!) to the bus stop to go to the pharmacy and then the Albertsons. I got my prescriptions filled (amoxicillin, 800 mgs of Motrin and my favorite, vicodin) and walked to Albertsons to get some soft foods and protein shakes to maintain some semblance of nutrition. By the time I got back to the bus stop to make my way home, I was feeling a bit more normal and spent the rest of the day recuperating by watching "Batman Begins."
Upon awakening the next morning, I was greeted by the taste of blood. My own. I think I became a self-parasitic vampire. This was nothing that couldn't be taken care of as I brushed my teeth and did a mild salt water rinse.
Yesterday, I called Dr. Graham's office to schedule my appointments. I was offered an appointment for next week but, due to financial constraints, I asked to be scheduled after the first of July. My first appointment is Tuesday, July 6th for spacers between my molars, then another appointment on Tuesday, July 13th in the afternoon to have braces put on.
So, this is it! It's all coming together at last. If I don't post another blog before then, check back on the 7th day of July. That's all for now.
On the day, I had woken up early, but went back to sleep after an hour and a half out of boredom. Eventually, I came back around a little after 8, took a shower, brushed my teeth and got dressed. Erik called to get the directions and we took off down the street.
I checked into the clinic and eventually was given my paperwork after giving the x-rays and extraction order to the ladies at the front desk. After filling out the health history and consent form, they had me come back for panorex x-rays and periapical shots of the teeth they were removing. Soon, I was in the operatory meeting Dr. John Choi, the oral surgeon. Dr. Choi gave me a little background on himself and I was relieved to find that he's been doing oral surgery for 15 years. After a final check on my health history and forms, I was taken back to another operatory.
There, I was hooked up to a heart and respiration monitor. After a few minutes, I was given an intravenous bag of saline while the operating crew got ready. Everyone came in and they started the oxygen mask on me, and eventually started the nitrous oxide mix. The surgical assistant, whose name I didn't get - damn shame too, she was cute - then put a mask over my eyes to keep any fluids from going into them. The last thing I remember is looking up into grayish blue from the mask over my eyes.
The next thing I remember is getting into Erik's car with some assistance. Another gap of time passed and I am already upstairs opening the door to my apartment. Erik made sure I had everything I needed and I went inside and realized that my mouth was full of gauze. I didn't care about that because I knew why it was there and I proceeded to my room and promptly fell asleep for about an hour and a half.
When I woke back up, I got back out of bed and walked (yes, I'm out of my fucking mind!) to the bus stop to go to the pharmacy and then the Albertsons. I got my prescriptions filled (amoxicillin, 800 mgs of Motrin and my favorite, vicodin) and walked to Albertsons to get some soft foods and protein shakes to maintain some semblance of nutrition. By the time I got back to the bus stop to make my way home, I was feeling a bit more normal and spent the rest of the day recuperating by watching "Batman Begins."
Upon awakening the next morning, I was greeted by the taste of blood. My own. I think I became a self-parasitic vampire. This was nothing that couldn't be taken care of as I brushed my teeth and did a mild salt water rinse.
Yesterday, I called Dr. Graham's office to schedule my appointments. I was offered an appointment for next week but, due to financial constraints, I asked to be scheduled after the first of July. My first appointment is Tuesday, July 6th for spacers between my molars, then another appointment on Tuesday, July 13th in the afternoon to have braces put on.
So, this is it! It's all coming together at last. If I don't post another blog before then, check back on the 7th day of July. That's all for now.
Wednesday, June 9, 2010
Back Again
Well, it has been quite a while, hasn't it. A lot of things have changed, some went back the way they were and some new things have come into play, but most of this has nothing to do with the surgery. I'm sure I could have posted more stuff on here about it, but there really hasn't been anything to report in the way of what's been going on with this topic, so I hadn't felt much inclination to report on nothing. The other stuff that was happening, many of my friends already know about, but that wasn't related to this. So, time for an update.
After cancelling my appointment with Dr. Punim due to the cost factor, I went back to Dr. Graham's office. I received my surgery order and found that the treatment plan had changed so that he was going to extrude my right upper canine to bring it into place with the other teeth. This is not what he and I had previously discussed, so I called them back. Yesterday, I went in for another consultation and he issued me out a new extraction order, this time to remove the canine, as well as the first bicuspid in my upper left quadrant.
Today, I scheduled, or tried to schedule, an appointment to get the teeth extracted. Being that my dental office already has an oral surgeon, I decided to go through them since they already have all my records and they're going to be following me through this whole procedure. Tentatively, I'm schedule to have my teeth extracted on Monday morning, assuming that I can find a ride to get there and get back out of there since they're going to be sedating me. Probably a good thing since they're going to have to go into the hard palate to get the canine tooth pulled out.
So far, my main struggle is finding someone available to give me a ride so I can get there and back since they won't do the surgery without it. This is still pending, but I'm going to go ahead and schedule the appointment.
More to come.
After cancelling my appointment with Dr. Punim due to the cost factor, I went back to Dr. Graham's office. I received my surgery order and found that the treatment plan had changed so that he was going to extrude my right upper canine to bring it into place with the other teeth. This is not what he and I had previously discussed, so I called them back. Yesterday, I went in for another consultation and he issued me out a new extraction order, this time to remove the canine, as well as the first bicuspid in my upper left quadrant.
Today, I scheduled, or tried to schedule, an appointment to get the teeth extracted. Being that my dental office already has an oral surgeon, I decided to go through them since they already have all my records and they're going to be following me through this whole procedure. Tentatively, I'm schedule to have my teeth extracted on Monday morning, assuming that I can find a ride to get there and get back out of there since they're going to be sedating me. Probably a good thing since they're going to have to go into the hard palate to get the canine tooth pulled out.
So far, my main struggle is finding someone available to give me a ride so I can get there and back since they won't do the surgery without it. This is still pending, but I'm going to go ahead and schedule the appointment.
More to come.
Tuesday, May 4, 2010
"I did!?"
Yesterday, I contacted Dr. Punim's office to cancel my orthodontic appointments. Cost was the primary consideration in my decision - seriously, an additional $1,339 for the exact same treatment plan? I'm sorry, it's not going to work...at least without breaking my budget. I advised Dr. Punim's office of my decision, then I contacted Dr. Graham's office.
For some reason, they had trouble finding my records of my previous visits. After being on hold for what seemed like 5 minutes, they advised that they would return my call when they found it. I went back to work and was in the middle of watching a radio position when they called me back.
As it turns out, somewhere at sometime, without my even knowing about it, I had requested my records be sent to Dr. Punim's office back in March. Personally, I would like to see whose signature is on this paperwork because I can guarantee it isn't mine!
So, this means still another delay. I'm not even worried about it at this point. It's already been delayed nearly a full year at this point since I had the septoplasty, so what's another couple of days?
For some reason, they had trouble finding my records of my previous visits. After being on hold for what seemed like 5 minutes, they advised that they would return my call when they found it. I went back to work and was in the middle of watching a radio position when they called me back.
As it turns out, somewhere at sometime, without my even knowing about it, I had requested my records be sent to Dr. Punim's office back in March. Personally, I would like to see whose signature is on this paperwork because I can guarantee it isn't mine!
So, this means still another delay. I'm not even worried about it at this point. It's already been delayed nearly a full year at this point since I had the septoplasty, so what's another couple of days?
Thursday, April 29, 2010
Stomach Curdling
Well, yesterday was my appointment with Dr. Punim for my final consultation. After reviewing the study models and x-rays of my mouth, jaws and teeth, she presented the treatment plan.
What I'm looking at is the same thing that Dr. Graham was presenting to me - removal of my impacted right maxillary canine, the 2nd bicuspid of the upper arch as well as possibly the second bicuspids on the lower arch. There was only one really huge difference:
$1,339!
Essentially, Dr. Punim wants me to come up with $1,500 up front, then $190 a month for 20 months. Plus, she doesn't work directly with my dental insurance company, so I would have to wait to be reimbursed. Dr. Graham does work directly with the insurance, so I would only have to come up with $461, first and last month's payment and monthly payments of $125 a month. So, I think my decision is made up. Personally, I don't understand why Dr. Punim's office is charging that much more for the same work.
What I'm looking at is the same thing that Dr. Graham was presenting to me - removal of my impacted right maxillary canine, the 2nd bicuspid of the upper arch as well as possibly the second bicuspids on the lower arch. There was only one really huge difference:
$1,339!
Essentially, Dr. Punim wants me to come up with $1,500 up front, then $190 a month for 20 months. Plus, she doesn't work directly with my dental insurance company, so I would have to wait to be reimbursed. Dr. Graham does work directly with the insurance, so I would only have to come up with $461, first and last month's payment and monthly payments of $125 a month. So, I think my decision is made up. Personally, I don't understand why Dr. Punim's office is charging that much more for the same work.
Monday, April 12, 2010
The Room of Gray Light
For those of you who have not read Stephen King's Dark Tower series in its entirety and don't want the ending ruined, stop reading this RIGHT NOW. If you have read the series, or simply don't care, continue on.
I made my way through the parking lot of the venue where my friend's band was performing. I had not seen her perform for nearly 6 years, or even really seen her since the time management and I had a falling out, but you wouldn't know it from the way we talked to each other. We did have other business to attend to on this evening, so she led me inside.
Outside, various bands were performing at this venue as opening acts for her band. Several of my friends were not only spectators to the show, several others were also performing, and I bid them all a quick greeting as I made my way through the parking lot and side door to the stage. All pleasantries were brief, though cordial.
We made our way to the stage and continued to the backstage area. However, in this case, the backstage area belied the actual size of the venue that we were in and extended past its walls. On we went, past the next act performing and loading in equipment, up a set of wooden stairs to the upstairs green room. Several more of my friends were there eating from the complimentary deli and veggie trays and drinking the usual cheap, domestic bottled beer from the cooler. Salutations were given and my lady friend and I continued on towards another door which opened to a set of stairs.
This set of stairs was not straight as the others had been, but was curved and the only light available to see was at the top of the next level. At the top of this flight of stairs were several rooms. Looking inside the first room, I noticed several framed photographs and items from the time of my birth. I looked into the next room and noticed more framed photographs and items from the months following my birth.
"Not here," my friend said. She led me on up another staircase, where more doors awaited. Each room continued to be from another time period of my existence. It was then that I realized that my friend Wanda was leading me into my own version of Roland Deschain's Dark Tower. Would I find myself trapped in here forever, or, like Roland, be forced to continue on the same path? I continued following Wanda.
We then came to a door at the top of the 39th floor. This door was unmarked and painted flat black with a brass circular knob. It was outstanding in its normalcy, except that it seemed to shrink away from anyone that wished to look at it and the general vicinity. Was this door alive and not wanting contact with anyone?
Scanning down from the top of the door jamb to the bottom, I noticed gray light escaping from the space between the bottom of the door and the floor beneath it. Wanda reached up, grasped the knob and turned to me.
"Once inside, you will make a crucial decision." Her voice sounded as though I had my headphones on, centered directly between both ears rather than coming from in front of me and from those beautiful lips. Never did she take her eyes off me. "You have two choices. One door will return you back to your old life. The other door will force you to progress in a different direction."
"Turning around to come back the way you came is not an option. Once you pass through this door, you will only see a wall behind you, and you may not remain in the room. Regardless of which door you choose, there shall be no guarantee of comfort, and both ways will still promise certain death." She smiled then and said, "Of course, this will happen to all of us."
"One door will not guarantee progression. However, this is only if you fail to learn from what you experience, but the other can only guarantee stagnation. You will have no guide and can only rely on your own desires and instincts to guide you." She turned her left hand and opened the door. With a sense of trepidation, I wandered into the room.
As she had foretold, once the door was shut behind me, it simply vanished. The only thing behind me was the wall. Looking around me, I found a room that was illuminated with gray lights. These were not the shade seen in UV blacklight bulbs, but were a constant shade of gray that was slightly darker than the gray found on naval battleships. The room was mostly unadorned. No furniture, so no way to sit and think about my next step. There were photographs, but no pictures of any perspective that I would recognize. To my right I noticed a close-up picture of teeth with orthodontic braces placed on them.
As I started to scan towards my left, I noticed the wall before me had two doors placed in it. Both were painted with a glossy, black lacquer finish. On each door was written a single word.
"Resumption"
"Progression"
I moved forward to the midway point between both doors and took a deep breath. Unlike Roland, I was given a choice of where to go at the top of the staircase.
From the "Progression" door, I heard White Zombie's "Electric Head, Pt. 1 (The Agony)" Silence came from the door marked "Resumption." I opened the door with the music and proceeded inside
To find I had been woken up by my fucking cellphone ringing. "Chris, Roshalle called out sick and I saw you were signed up to work overtime. Do you want to come in early?"
"No!" Goddamn it!
I made my way through the parking lot of the venue where my friend's band was performing. I had not seen her perform for nearly 6 years, or even really seen her since the time management and I had a falling out, but you wouldn't know it from the way we talked to each other. We did have other business to attend to on this evening, so she led me inside.
Outside, various bands were performing at this venue as opening acts for her band. Several of my friends were not only spectators to the show, several others were also performing, and I bid them all a quick greeting as I made my way through the parking lot and side door to the stage. All pleasantries were brief, though cordial.
We made our way to the stage and continued to the backstage area. However, in this case, the backstage area belied the actual size of the venue that we were in and extended past its walls. On we went, past the next act performing and loading in equipment, up a set of wooden stairs to the upstairs green room. Several more of my friends were there eating from the complimentary deli and veggie trays and drinking the usual cheap, domestic bottled beer from the cooler. Salutations were given and my lady friend and I continued on towards another door which opened to a set of stairs.
This set of stairs was not straight as the others had been, but was curved and the only light available to see was at the top of the next level. At the top of this flight of stairs were several rooms. Looking inside the first room, I noticed several framed photographs and items from the time of my birth. I looked into the next room and noticed more framed photographs and items from the months following my birth.
"Not here," my friend said. She led me on up another staircase, where more doors awaited. Each room continued to be from another time period of my existence. It was then that I realized that my friend Wanda was leading me into my own version of Roland Deschain's Dark Tower. Would I find myself trapped in here forever, or, like Roland, be forced to continue on the same path? I continued following Wanda.
We then came to a door at the top of the 39th floor. This door was unmarked and painted flat black with a brass circular knob. It was outstanding in its normalcy, except that it seemed to shrink away from anyone that wished to look at it and the general vicinity. Was this door alive and not wanting contact with anyone?
Scanning down from the top of the door jamb to the bottom, I noticed gray light escaping from the space between the bottom of the door and the floor beneath it. Wanda reached up, grasped the knob and turned to me.
"Once inside, you will make a crucial decision." Her voice sounded as though I had my headphones on, centered directly between both ears rather than coming from in front of me and from those beautiful lips. Never did she take her eyes off me. "You have two choices. One door will return you back to your old life. The other door will force you to progress in a different direction."
"Turning around to come back the way you came is not an option. Once you pass through this door, you will only see a wall behind you, and you may not remain in the room. Regardless of which door you choose, there shall be no guarantee of comfort, and both ways will still promise certain death." She smiled then and said, "Of course, this will happen to all of us."
"One door will not guarantee progression. However, this is only if you fail to learn from what you experience, but the other can only guarantee stagnation. You will have no guide and can only rely on your own desires and instincts to guide you." She turned her left hand and opened the door. With a sense of trepidation, I wandered into the room.
As she had foretold, once the door was shut behind me, it simply vanished. The only thing behind me was the wall. Looking around me, I found a room that was illuminated with gray lights. These were not the shade seen in UV blacklight bulbs, but were a constant shade of gray that was slightly darker than the gray found on naval battleships. The room was mostly unadorned. No furniture, so no way to sit and think about my next step. There were photographs, but no pictures of any perspective that I would recognize. To my right I noticed a close-up picture of teeth with orthodontic braces placed on them.
As I started to scan towards my left, I noticed the wall before me had two doors placed in it. Both were painted with a glossy, black lacquer finish. On each door was written a single word.
"Resumption"
"Progression"
I moved forward to the midway point between both doors and took a deep breath. Unlike Roland, I was given a choice of where to go at the top of the staircase.
From the "Progression" door, I heard White Zombie's "Electric Head, Pt. 1 (The Agony)" Silence came from the door marked "Resumption." I opened the door with the music and proceeded inside
To find I had been woken up by my fucking cellphone ringing. "Chris, Roshalle called out sick and I saw you were signed up to work overtime. Do you want to come in early?"
"No!" Goddamn it!
Sunday, April 11, 2010
Update
If you're wondering why I haven't put any posts here, it's simply because (1) I've been incredibly goddamn busy and (2) I haven't had any news to report regarding braces, surgery, etc.
My next appointment with the ortho is coming up in 2 weeks or so and will be my final consultation before I start treatement with her. We're going to have to see what's going on because of all the problems that I've written about before. I do have a cleaning on Wednesday, but I don't think that's going to be all that important to this blog.
As for busy-ness, I've finally finished reading Stephen King's "Dark Tower" series and I'm re-reading it. If you've not heard of it, you should check it out if you like stuff like "Lord of the Rings" or other fantasy stuff. I've also restarted taking Karate after a 12 year layoff. (This was due to finances and time conflicts, nothing more.) http://itosu-ryu.us Check it out here! There's other developments on the horizon, but I don't want to spoil the surprise.
So, check back in about 2 weeks when I finish my final consultation with Dr. Punim. That's all for now, but I've also decided I'll also put up other random posts of various things and goings on. Watch for it!
My next appointment with the ortho is coming up in 2 weeks or so and will be my final consultation before I start treatement with her. We're going to have to see what's going on because of all the problems that I've written about before. I do have a cleaning on Wednesday, but I don't think that's going to be all that important to this blog.
As for busy-ness, I've finally finished reading Stephen King's "Dark Tower" series and I'm re-reading it. If you've not heard of it, you should check it out if you like stuff like "Lord of the Rings" or other fantasy stuff. I've also restarted taking Karate after a 12 year layoff. (This was due to finances and time conflicts, nothing more.) http://itosu-ryu.us Check it out here! There's other developments on the horizon, but I don't want to spoil the surprise.
So, check back in about 2 weeks when I finish my final consultation with Dr. Punim. That's all for now, but I've also decided I'll also put up other random posts of various things and goings on. Watch for it!
Wednesday, March 24, 2010
Additional Info
Okay, so I realized that I left out some information about yesterday's consultation that Dr. Punim discussed with me.
First, she wasn't making any statements of getting my teeth aligned quickly before the surgery. Admittedly, this did kind of raise a red flag with Dr. Graham, though I do trust his judgement and it was nice to have a second opinion.
Something that Dr. Punim brought up that wasn't discussed with Dr. Graham was the amount of bone in the front of my jaw. This is going to make moving the lower front teeth backward or forward take longer than what Dr. Graham was discussing. It seems that there's not too much bone material in the front of my mandibular incisors, so this will present quite a case. Dr. Punim was saying about going somewhat slow so she can monitor the movement to make sure she wasn't inadvertently pulling out the teeth. She also pointed out that my upper incisors have shorter roots than the rest of the teeth. Yet another thing she's going to have to watch for.
Well, next appointment is my cleaning, and then my final orthodontic consult. I'll have more to report next month!
First, she wasn't making any statements of getting my teeth aligned quickly before the surgery. Admittedly, this did kind of raise a red flag with Dr. Graham, though I do trust his judgement and it was nice to have a second opinion.
Something that Dr. Punim brought up that wasn't discussed with Dr. Graham was the amount of bone in the front of my jaw. This is going to make moving the lower front teeth backward or forward take longer than what Dr. Graham was discussing. It seems that there's not too much bone material in the front of my mandibular incisors, so this will present quite a case. Dr. Punim was saying about going somewhat slow so she can monitor the movement to make sure she wasn't inadvertently pulling out the teeth. She also pointed out that my upper incisors have shorter roots than the rest of the teeth. Yet another thing she's going to have to watch for.
Well, next appointment is my cleaning, and then my final orthodontic consult. I'll have more to report next month!
Tuesday, March 23, 2010
"Golly, That Looks Tasty!"
Just got home a few minutes ago from seeing Dr. Punim for my consultation. It was much the same as with Dr. Graham, only this time I was charged for my appointment.
Actually, the only reason why I was charged was because I authorized having the impressions of my teeth taken. This fee, as well as the additional fee that will be coming up for my next consultation will be put towards my cost for braces and the retainers.
That alginate for the impressions sure is tasty. I don't care how much mint flavoring they put into it, I can still taste the base of that shit! Now, I gotta go brush my teeth again. =Þ Bleh!
I go back on April 28th at 9 for my final consultation and get this whole thing started. By then, we'll see what can be done with my teeth in general, but also see about correcting my deviated midline, as well as whether or not we're going to be able to save tooth #6.
I'm already feeling my face starting to hurt from smiling. Time for full speed.
Actually, the only reason why I was charged was because I authorized having the impressions of my teeth taken. This fee, as well as the additional fee that will be coming up for my next consultation will be put towards my cost for braces and the retainers.
That alginate for the impressions sure is tasty. I don't care how much mint flavoring they put into it, I can still taste the base of that shit! Now, I gotta go brush my teeth again. =Þ Bleh!
I go back on April 28th at 9 for my final consultation and get this whole thing started. By then, we'll see what can be done with my teeth in general, but also see about correcting my deviated midline, as well as whether or not we're going to be able to save tooth #6.
I'm already feeling my face starting to hurt from smiling. Time for full speed.
Monday, March 22, 2010
Once Again, From The Top
Finally finished reading Stephen King's "Dark Tower" series. It only took about 5 years to get through the last book, or whenever it was that it came out. Hard to believe that it's been 20+ years since I started reading the first book. That story was a hard road to Hell - not trying to read it, I'm talking the actual story! Without giving out a spoiler for those of you who are reading it or are thinking about reading it, I really do think the story is Roland Deschaine's personal Hell.
Tomorrow is the appointment with Dr. Patrice Punim for the orthodontic consult. Will have to bring in the x-rays I have and have them call and get the x-rays from the lab. Glad things are going digital. I'll find out what Dr. Punim has to say about what she can do for me. I'm also going to stop by the OMS office (they're husband and wife and they're in the same building) to see about getting the paperwork started for prior approval or if it's needed (thanks for the suggestion Jaw Nom Nom). I spoke with the medical group already and they said that since I was already seen for the consult that I received from Dr. Archer that I'll be approved by them for the surgery.
My appointment is at 9:30 a.m. Time to relax and watch the 1980 version of "The Empire Strikes Back." See you tomorrow!
Tomorrow is the appointment with Dr. Patrice Punim for the orthodontic consult. Will have to bring in the x-rays I have and have them call and get the x-rays from the lab. Glad things are going digital. I'll find out what Dr. Punim has to say about what she can do for me. I'm also going to stop by the OMS office (they're husband and wife and they're in the same building) to see about getting the paperwork started for prior approval or if it's needed (thanks for the suggestion Jaw Nom Nom). I spoke with the medical group already and they said that since I was already seen for the consult that I received from Dr. Archer that I'll be approved by them for the surgery.
My appointment is at 9:30 a.m. Time to relax and watch the 1980 version of "The Empire Strikes Back." See you tomorrow!
Thursday, March 18, 2010
Once Again
Yeah, this is late. Whoop-dee-fuckin' doo.
Woke up Tuesday having forgotten to turn off my alarm. That was probably a good thing with the time change, much as I hate it. Played around with the ACID Music Studio Pro program, showered and went off to Disneyland before it got too hot and the crowds got ridiculous.
Left the park and headed over to the surgeon's office. The route 29, however, was running late - so late that there were 3 buses coming my way when I transferred off the 70! (Way to cut service, OCTA.) I had the feeling that this might happen, so I had contacted the office prior to let them know I might be a few minutes late, but that I was still coming.
I get to the office and walk into the building after finally locating the front door that's adjacent to the parking lot. Walk through the glass doors into a lobby leading to three offices. Looking from right to left, I find Dr. Levin's office to my left side. I went in, advised them I had an appointment. They gave me my health questionnaire and ask for my license and medical insurance card. Fill out my paperwork and wait to be seen.
I was led into an operatory where Dr. Levin introduced himself. We immediately started discussing my options for surgery. As I thought, he stated he would most likely be performing the bimaxillary osteotomy to correct my underbite. He stated, however, that he wasn't going to notify my medical group at this time to get approval of the surgery as it was still too early and that I wasn't in braces yet. I advised him of the problems that I had been facing regarding the insurance company and Dr. Levin advised me that this type of condition is covered under my insurance policy.
I went back into the lobby and got a card for Dr. Patrice Punim to get an orthodontic consultation, then realized that her office was right next door and thought, "Fuck it, I'm right here - why use the cellphone minutes?" I went in and spoke to the lady at the desk who scheduled me for Tuesday of next week. I forgot to ask if they were going to need x-rays. That's not a worry, though. I can just contact the x-ray lab to e-mail them over.
Even after all of this, I still have to wonder if I'm going to be having trouble with BCBS in trying to get this approved. I think I'm going to have to contact the medical group myself and ask them, though I may be worried more than necessary.
I found out later that the insurance company and the medical group will only authorize treatment within 60 days of any actual procedure. Upon speaking with the medical group after my appointment, I found that since I was already referred to the OMS by my physician, I should be approved by them for the procedure without any trouble. (Author)
Well, see you back here next week for another update where I hopefully will share the treatment options given by the orthodontist.
Woke up Tuesday having forgotten to turn off my alarm. That was probably a good thing with the time change, much as I hate it. Played around with the ACID Music Studio Pro program, showered and went off to Disneyland before it got too hot and the crowds got ridiculous.
Left the park and headed over to the surgeon's office. The route 29, however, was running late - so late that there were 3 buses coming my way when I transferred off the 70! (Way to cut service, OCTA.) I had the feeling that this might happen, so I had contacted the office prior to let them know I might be a few minutes late, but that I was still coming.
I get to the office and walk into the building after finally locating the front door that's adjacent to the parking lot. Walk through the glass doors into a lobby leading to three offices. Looking from right to left, I find Dr. Levin's office to my left side. I went in, advised them I had an appointment. They gave me my health questionnaire and ask for my license and medical insurance card. Fill out my paperwork and wait to be seen.
I was led into an operatory where Dr. Levin introduced himself. We immediately started discussing my options for surgery. As I thought, he stated he would most likely be performing the bimaxillary osteotomy to correct my underbite. He stated, however, that he wasn't going to notify my medical group at this time to get approval of the surgery as it was still too early and that I wasn't in braces yet. I advised him of the problems that I had been facing regarding the insurance company and Dr. Levin advised me that this type of condition is covered under my insurance policy.
I went back into the lobby and got a card for Dr. Patrice Punim to get an orthodontic consultation, then realized that her office was right next door and thought, "Fuck it, I'm right here - why use the cellphone minutes?" I went in and spoke to the lady at the desk who scheduled me for Tuesday of next week. I forgot to ask if they were going to need x-rays. That's not a worry, though. I can just contact the x-ray lab to e-mail them over.
Even after all of this, I still have to wonder if I'm going to be having trouble with BCBS in trying to get this approved. I think I'm going to have to contact the medical group myself and ask them, though I may be worried more than necessary.
I found out later that the insurance company and the medical group will only authorize treatment within 60 days of any actual procedure. Upon speaking with the medical group after my appointment, I found that since I was already referred to the OMS by my physician, I should be approved by them for the procedure without any trouble. (Author)
Well, see you back here next week for another update where I hopefully will share the treatment options given by the orthodontist.
Monday, March 15, 2010
"Stop It, Stitch!"
Here I sit, watching Voivod on DVD. Awesome band, in my opinion. Sadly underrated. I don't know if you would like them, but if not, that's cool. I listen to a lot of stuff that most people don't understand.
Right now, I feel like Stitch on his first visit to Lilo and Nani's house. "Hey, what's this? RAAWR!" Smash! I'm so tempted to go out and weave a path of destruction, regardless of how it might affect others, but I'm doing what I can to hold back. I can't help it!
Tomorrow, I go in for my consultation with Dr. Levin. This will be my consultation to find out if I can get this whole thing covered under my medical insurance. I know Dr. Graham said that when the surgeon sees my cephalometric x-rays and outline, as well as the panorex that he's going to start drooling, but I'm still the pessimist of the family. I'm doing what I can to calm down. I'm still pretty hyped up, even after being up since 12:45 a.m. for work (1:45 a.m. start time for a 12 hour work shift). Tried watching "True Blood" to relax and that still didn't do much. So many things on my mind, especially after work.
Spent a good portion of my day listening to a couple of female co-workers sitting next to me talking about the physical attractiveness of males...and these were guys that weren't THAT bad-looking. Kind of sucks to be a fly on the wall knowing that I look the way that I do. It also didn't help hearing an insult from one of my other co-workers yesterday about my own appearance. I feel worthless. I know this surgery changes your appearance, but I just want to look NORMAL. =( I hope I'm not asking too much.
Right now, I feel like Stitch on his first visit to Lilo and Nani's house. "Hey, what's this? RAAWR!" Smash! I'm so tempted to go out and weave a path of destruction, regardless of how it might affect others, but I'm doing what I can to hold back. I can't help it!
Tomorrow, I go in for my consultation with Dr. Levin. This will be my consultation to find out if I can get this whole thing covered under my medical insurance. I know Dr. Graham said that when the surgeon sees my cephalometric x-rays and outline, as well as the panorex that he's going to start drooling, but I'm still the pessimist of the family. I'm doing what I can to calm down. I'm still pretty hyped up, even after being up since 12:45 a.m. for work (1:45 a.m. start time for a 12 hour work shift). Tried watching "True Blood" to relax and that still didn't do much. So many things on my mind, especially after work.
Spent a good portion of my day listening to a couple of female co-workers sitting next to me talking about the physical attractiveness of males...and these were guys that weren't THAT bad-looking. Kind of sucks to be a fly on the wall knowing that I look the way that I do. It also didn't help hearing an insult from one of my other co-workers yesterday about my own appearance. I feel worthless. I know this surgery changes your appearance, but I just want to look NORMAL. =( I hope I'm not asking too much.
Tuesday, March 9, 2010
Information and Explanation, Part II
About the surgery:
While I would be lying if I said that this surgery wasn't completely about my appearance, I have discovered symptoms of other medical problems that could be abated or eliminated with this surgery. Not only is my occlusion a problem, I'm also facing a more serious medical problem.
Originally, I was worried that this condition was causing the bruxism (grinding of the teeth) that was causing damage to the occlusal surface of my right mandibular first bicuspid. However, this is not the only dental problem I've been having. Thanks to the mouth breathing, I've also been having periodontal problems. The last two dentists that I have seen have both agreed that inflammation of my gums is caused by my mouth breathing, and this is in spite of brushing and flossing 3 times a day. This, however, pales in comparison to the reason why my physician gave me the referral. The mouth breathing is an indication that I'm still not getting enough air into my lungs, despite a recent septoplasty. Sinus congestion can be partly to blame, but there is still a physical aspect of the diminished sinus area that I have which is causing or contributing to obstructive sleep apnea (OSA).
Sleep apnea is a disorder characterized by pauses in breathing of the patient. One or more breaths are missed for a period of 10 seconds or longer and this can occur several times during a person's normal sleeping period. The patient is often forced to wake up, often several times, during the night, though many people are not aware of ever waking.
Obstructive sleep apnea differs from central sleep apnea, or Cheyne-Stokes respiration, in that OSA is caused by some obstruction in the airway. Central sleep apnea is caused by an imbalance in the brain's respiratory control center. Neurological feedback mechanisms monitor the levels of carbon dioxide in the blood but fail to react properly to keep even respiratory rates. The body will try to compensate for the apnea by increasing the breathing rate (hyperpnea) when breathing has restarted to acquire oxygen and eliminate waste gases. (Episodes may also happen when the patient is awake.) In central sleep apnea, no effort is made to breathe during this pause in breathing.
OSA is caused by some blockage to the airway. This could be caused by something as simple as the position that one sleeps in; the tissues of the throat (i.e. the tonsils or adenoids); being overweight or obese; the tongue or throat relaxing more than is normal; or physical attributes, such as a deviated septum, enlarged tongue and/or the shape of the neck and head.
In my own case, add the constant sinus congestion with the deformation of the bones of my skull which is causing a lack of air being drawn through the sinuses. There's been plenty of mornings I have woken up even after getting 9-10 hours of sleep and still feeling tired, unrefreshed and sleepy throughout the day. This might also explain the dizziness that I feel waking up most mornings. Originally, I thought the feeling of waking up with the feeling of a hangover from an all-night bender when I hadn't been drinking was a result of my cholesterol medication. This has given me pause. OSA may also be contributing to my hypertension. This surgery, as you will read later in the description of the LeFort I osteotomy, will help open the sinus passageway.
Pre-operative:
In order to prepare for the surgery, the Oral Maxillofacial Surgeon (OMS) will have you go to an orthodontist for braces. Often, this is an orthodontist that the dentist works with closely on surgery cases such as these.
Orthodontics is the field of dentistry where the teeth are aligned. Getting braces prior to orthognathic surgery is much the same as braces without the surgery - the goal is to align the teeth to match up and be straight. However, in this case, the doctors want your teeth properly aligned so that the bite will properly match when the surgery is complete. Often times, necessary pre-operative orthodontic treatment can make a patient's bite look like it's getting worse. It is, in a way, but this is not anything to become discouraged about as it is necessary for this surgery. Anyone who is thinking about going through this procedure should not worry about their appearance because the surgery should happen soon afterwards.
Do not be surprised if the orthodontist recommends having teeth removed. This will help increase the room for the teeth to get into position and can save you time wearing braces. In my own case, Dr. Graham stated that he could help me keep all of my teeth and get my maxillary right canine to be exposed for a balanced look. This would add months, if not years, to my pre-operative work, as well as present complications with getting my deviated midline corrected.
Surgery:
The general medical name for the corrective jaw surgery I am looking to have done is known as dentofacial osteotomy. What occurs in this surgery is bone is cut, modified, moved and realigned until it is in the proper place to enable the patient to chew, talk, breathe properly, swallow, etc.
Dentofacial osteotomies have been in use since the 1940's and were developed to correct malocclusions and maxillary and mandibular prognathisms. Technology for these surgeries has greatly improved resulting in ease for the surgeon and comfort of the patient.
20 years ago, I was told that I would be looking to have a surgery known as a bi-maxillary osteotomy. This is actually 2 surgeries, usually performed at the same time; the LeFort I osteotomy and the sagittal split osteotomy.
Le Fort I Osteotomy: this surgery, as well as the LeFort II and III surgeries, were named after René Le Fort (1869 – 1951), a French army surgeon who developed a classification system for fractures of the bones in the face that were usually caused by some form of trauma. The three LeFort surgeries can all be used to adjust the facial area. A LeFort I fracture usually runs above the teeth of the maxillary arch from just below, or including, the nasal entrance.
The LeFort I surgery recreates this type of fracture, but in a controlled setting. When this surgery is performed, it allows mobilization of the palate so that it may be moved up, down, forwards or backwards. Not only does this help to increase the area of the midfacial region of the patient, it also helps to open the sinus cavity, allowing more air through. In my own case, my physician believes that this will help with my obstructive sleep apnea (OSA).
This surgery would be used to bring the maxilla forward and down. My maxillary incisors are behind the mandibular incisors with an open bite (an open space between the maxillary and mandibular incisors) greater than 7 millimeters. The mandibular teeth also come up in front of the maxillary teeth over 5 mm making the upper teeth look completely covered.
Sagittal Split Osteotomy: This surgery is used to correct both overbites and underbites by moving the mandible forward or backward. In my own case, the jaw would be moved back. Cuts are usually made at the bottom of the jaw, usually near the molars, and then up to the center of the jaw and straight back to the ramus (the trapezoidal-shaped part of the bone that connects the jaw to the skull). This keeps as much bone contact as possible to facilitate healing.
The surgeon uses specialized electric saws and burs, as well as manual chisels for this operation. The purpose is to use the saws and burs to make incisions in the bones, but not go through the nerves. When the desired cuts are made, the surgeon then uses the chisels to break apart the bones, sparing the nerves from being severed. However, this does still result in trauma and many patients will feel numb for days, weeks or months after surgery - in some rare cases, the numbness is permanent.
In the case of patients having this surgery to correct an open bite, bone grafts will be used to help fill in the space that is left open between the bones that were cut. The material for the grafts usually comes from the patient's hip. There are also artificial bone materials that can be used. I may need this if the maxilla is moved down to help correct the vertical displacement of my incisors.
When the surgery is completed, the doctor places metal plates and screws to assist in keeping the patient's bones in their proper places until the bone heals. The surgeon will also most likely keep the patients jaw shut. Originally, this was done with wire, and someone having this surgery done would have to carry around wire clippers in the event of vomiting. With the advances in surgery, many surgeons now use heavy elastic bands to keep the teeth together. Also, with the introduction of rigid internal fixation, the amount of time that a patient spends with their jaws closed shut has been greatly reduced.
Post-Surgical:
Once the surgery is completed, you will still need to be seen by the orthodontist. This is to continue to ensure that the teeth are put into their final positions after surgery, as well as to fine tune the occlusion.
Often, the surgery will result in an appearance that is not only different from what the patient originally looked like, but will result in a look that is much more "normal." In some cases, the difference is dramatic, resulting in a heightened sense of self-esteem for most patients. The change in appearance is so great for some, people who have known the patient their entire lives don't even recognize them. Some patients are recommended to see a psychologist during this process.
http://en.wikipedia.org/wiki/Dentofacial_Osteotomy
While I would be lying if I said that this surgery wasn't completely about my appearance, I have discovered symptoms of other medical problems that could be abated or eliminated with this surgery. Not only is my occlusion a problem, I'm also facing a more serious medical problem.
Originally, I was worried that this condition was causing the bruxism (grinding of the teeth) that was causing damage to the occlusal surface of my right mandibular first bicuspid. However, this is not the only dental problem I've been having. Thanks to the mouth breathing, I've also been having periodontal problems. The last two dentists that I have seen have both agreed that inflammation of my gums is caused by my mouth breathing, and this is in spite of brushing and flossing 3 times a day. This, however, pales in comparison to the reason why my physician gave me the referral. The mouth breathing is an indication that I'm still not getting enough air into my lungs, despite a recent septoplasty. Sinus congestion can be partly to blame, but there is still a physical aspect of the diminished sinus area that I have which is causing or contributing to obstructive sleep apnea (OSA).
Sleep apnea is a disorder characterized by pauses in breathing of the patient. One or more breaths are missed for a period of 10 seconds or longer and this can occur several times during a person's normal sleeping period. The patient is often forced to wake up, often several times, during the night, though many people are not aware of ever waking.
Obstructive sleep apnea differs from central sleep apnea, or Cheyne-Stokes respiration, in that OSA is caused by some obstruction in the airway. Central sleep apnea is caused by an imbalance in the brain's respiratory control center. Neurological feedback mechanisms monitor the levels of carbon dioxide in the blood but fail to react properly to keep even respiratory rates. The body will try to compensate for the apnea by increasing the breathing rate (hyperpnea) when breathing has restarted to acquire oxygen and eliminate waste gases. (Episodes may also happen when the patient is awake.) In central sleep apnea, no effort is made to breathe during this pause in breathing.
OSA is caused by some blockage to the airway. This could be caused by something as simple as the position that one sleeps in; the tissues of the throat (i.e. the tonsils or adenoids); being overweight or obese; the tongue or throat relaxing more than is normal; or physical attributes, such as a deviated septum, enlarged tongue and/or the shape of the neck and head.
In my own case, add the constant sinus congestion with the deformation of the bones of my skull which is causing a lack of air being drawn through the sinuses. There's been plenty of mornings I have woken up even after getting 9-10 hours of sleep and still feeling tired, unrefreshed and sleepy throughout the day. This might also explain the dizziness that I feel waking up most mornings. Originally, I thought the feeling of waking up with the feeling of a hangover from an all-night bender when I hadn't been drinking was a result of my cholesterol medication. This has given me pause. OSA may also be contributing to my hypertension. This surgery, as you will read later in the description of the LeFort I osteotomy, will help open the sinus passageway.
Pre-operative:
In order to prepare for the surgery, the Oral Maxillofacial Surgeon (OMS) will have you go to an orthodontist for braces. Often, this is an orthodontist that the dentist works with closely on surgery cases such as these.
Orthodontics is the field of dentistry where the teeth are aligned. Getting braces prior to orthognathic surgery is much the same as braces without the surgery - the goal is to align the teeth to match up and be straight. However, in this case, the doctors want your teeth properly aligned so that the bite will properly match when the surgery is complete. Often times, necessary pre-operative orthodontic treatment can make a patient's bite look like it's getting worse. It is, in a way, but this is not anything to become discouraged about as it is necessary for this surgery. Anyone who is thinking about going through this procedure should not worry about their appearance because the surgery should happen soon afterwards.
Do not be surprised if the orthodontist recommends having teeth removed. This will help increase the room for the teeth to get into position and can save you time wearing braces. In my own case, Dr. Graham stated that he could help me keep all of my teeth and get my maxillary right canine to be exposed for a balanced look. This would add months, if not years, to my pre-operative work, as well as present complications with getting my deviated midline corrected.
Surgery:
The general medical name for the corrective jaw surgery I am looking to have done is known as dentofacial osteotomy. What occurs in this surgery is bone is cut, modified, moved and realigned until it is in the proper place to enable the patient to chew, talk, breathe properly, swallow, etc.
Dentofacial osteotomies have been in use since the 1940's and were developed to correct malocclusions and maxillary and mandibular prognathisms. Technology for these surgeries has greatly improved resulting in ease for the surgeon and comfort of the patient.
20 years ago, I was told that I would be looking to have a surgery known as a bi-maxillary osteotomy. This is actually 2 surgeries, usually performed at the same time; the LeFort I osteotomy and the sagittal split osteotomy.
Le Fort I Osteotomy: this surgery, as well as the LeFort II and III surgeries, were named after René Le Fort (1869 – 1951), a French army surgeon who developed a classification system for fractures of the bones in the face that were usually caused by some form of trauma. The three LeFort surgeries can all be used to adjust the facial area. A LeFort I fracture usually runs above the teeth of the maxillary arch from just below, or including, the nasal entrance.
The LeFort I surgery recreates this type of fracture, but in a controlled setting. When this surgery is performed, it allows mobilization of the palate so that it may be moved up, down, forwards or backwards. Not only does this help to increase the area of the midfacial region of the patient, it also helps to open the sinus cavity, allowing more air through. In my own case, my physician believes that this will help with my obstructive sleep apnea (OSA).
This surgery would be used to bring the maxilla forward and down. My maxillary incisors are behind the mandibular incisors with an open bite (an open space between the maxillary and mandibular incisors) greater than 7 millimeters. The mandibular teeth also come up in front of the maxillary teeth over 5 mm making the upper teeth look completely covered.
Sagittal Split Osteotomy: This surgery is used to correct both overbites and underbites by moving the mandible forward or backward. In my own case, the jaw would be moved back. Cuts are usually made at the bottom of the jaw, usually near the molars, and then up to the center of the jaw and straight back to the ramus (the trapezoidal-shaped part of the bone that connects the jaw to the skull). This keeps as much bone contact as possible to facilitate healing.
The surgeon uses specialized electric saws and burs, as well as manual chisels for this operation. The purpose is to use the saws and burs to make incisions in the bones, but not go through the nerves. When the desired cuts are made, the surgeon then uses the chisels to break apart the bones, sparing the nerves from being severed. However, this does still result in trauma and many patients will feel numb for days, weeks or months after surgery - in some rare cases, the numbness is permanent.
In the case of patients having this surgery to correct an open bite, bone grafts will be used to help fill in the space that is left open between the bones that were cut. The material for the grafts usually comes from the patient's hip. There are also artificial bone materials that can be used. I may need this if the maxilla is moved down to help correct the vertical displacement of my incisors.
When the surgery is completed, the doctor places metal plates and screws to assist in keeping the patient's bones in their proper places until the bone heals. The surgeon will also most likely keep the patients jaw shut. Originally, this was done with wire, and someone having this surgery done would have to carry around wire clippers in the event of vomiting. With the advances in surgery, many surgeons now use heavy elastic bands to keep the teeth together. Also, with the introduction of rigid internal fixation, the amount of time that a patient spends with their jaws closed shut has been greatly reduced.
Post-Surgical:
Once the surgery is completed, you will still need to be seen by the orthodontist. This is to continue to ensure that the teeth are put into their final positions after surgery, as well as to fine tune the occlusion.
Often, the surgery will result in an appearance that is not only different from what the patient originally looked like, but will result in a look that is much more "normal." In some cases, the difference is dramatic, resulting in a heightened sense of self-esteem for most patients. The change in appearance is so great for some, people who have known the patient their entire lives don't even recognize them. Some patients are recommended to see a psychologist during this process.
http://en.wikipedia.org/wiki/Dentofacial_Osteotomy
Tuesday, March 2, 2010
Information and Explanation Part I
This was started on Wednesday, January 27th, 2010 and is broken into 2 parts. I'm hoping to have Part II completed by next week.
"I do not recognize the vessel, but the eyes seem so familiar."
I suddenly realized that I had not written anything about the procedure which will most likely be done in order to correct my bite. I also discovered yesterday while at the Barnes & Noble in Huntington Beach, CA that there are no books dealing with mandibular or maxillary prognathism, or other corrective jaw surgeries, what to expect or what can be done as far as anything from the patient's perspective. Yes, there are textbooks that deal with such maladies, but nothing like this. A look at Amazon.com shows 4 books written about malocclussion, but only one of these is written about humans and this is from the perspective of a dentist.
Well, if they can write libraries about giving birth and what to expect with that medical procedure, why not corrective jaw surgery? It seems to me that this is a market that, while small, isn't being tapped. However, unlike childbirth, this is not something that is a result of a choice made by the patient - this occurs by accident or genetics.
So, let's get to it!
Originally, I thought that this was something that was attributed simply to a genetic malady; however, after doing more research, I have found what may truly be the cause. Around the age of 8, I began having serious allergy problems. Not only was this caused by enviromental factors, such as allergies to grass, weeds, dust and other contaminants aggravating my sinuses, my septum was deviating. This helped to twist my nose so that the tip is now deviated to my right by about a full centimeter. According to the Atlanta Dental Group, an underbite may be caused by "nasal obstruction, mouth breathing and tongue thrust. The tongue has to stay down so it doesn't block air from getting in. Many tongue thrust patients brace their tongues against the sides of their lower jaws and lower teeth when they swallow. This constant pressure causes the lower jaw to overgrow and creates a mismatch between the larger lower jaw and smaller upper jaw. The result is that only the back teeth touch."
With my mouth always open to breathe, the teeth stopped fitting together and there was nothing to control the growth of my jaw in comparison to the palate. If left unchecked and without proper orthodontics, it continues to grow. In spite of shots twice a week to control my allergies, I continued to have the problem of constant sinus congestion. My deviated septum was also a contributing factor, and would be made worse by the polyps that developed along with a ping pong ball-sized cyst that would develop in my left maxillary sinus.
Early intervention from an orthodontist could probably have prevented or abated the growth of my jaw, but I was never taken to a dentist as a child. Living with divorced parents, I was never really with my father long enough for him to take me on the weekends, and he may have assumed that my mother was taking me to see one. As I found out a few years ago, my mother had not gone to a dentist in many years thanks to her odontophobia caused by a dentist visit when she was a child where she was unanesthetized for a filling. While my friends were being taken to the dentist for exams, braces and cleanings, I was left out of that experience due to her own fear. It was only after twisting her arm to convince her to go when she had a dental emergency due to constant pain that she finally went in to see a dentist.
In December of 1987, I enlisted in the US Navy and was waiting to go in after the summer of 1988. It was within a few days of my 18th birthday that I had my first examination at the Recruit Training Command of the Naval Training Center in San Diego. It was there I learned the measurement of my underbite - 8 millimeters.
Part of the problem with being in the service of the military is that while you are being kept in as healthy a condition as possible, the needs of deployments still need to be met. All through my time of working in the clinics of 2nd and 11th Dental Companies (in the 2nd and 3rd Dental Battalions, respectively) I was not a candidate for this surgery as I was with Marine units and had to be deployable. I was told that I could look into having this procedure done once I had returned to an actual Dental Clinic on a land-based duty post. This idea was shot down when I inquired into getting this done as I only had a year and a half left on my enlistment and I would have reached tenure on a 2nd enlistment and been out of service for not making rank.
The idea of getting this done was nearly forgotten until the middle of last year when I again thought of having it done and I started watching videos of patients who had this surgery. What I saw shocked me. The transformation of these people - many of them young adults - was dramatic. This is what I wanted after years of hearing comments about my appearance. I went first to one dentist where I heard one of those same comments, then went to another dentist as you've already read earlier in this blog.
What typically happens after seeing the general dentist, you will be given a referral to a consultation with an orthodontist. However, if you wish to have this surgery covered under insurance and you do receive a referral to an orthodontist, immediately contact your physician. This is a medical procedure, not dental. Dental insurance will not cover this surgery - it's not their area. If only the teeth were involved, then it would be a dental matter. Yes, the surgery is done by a dentist, but an oral maxillofacial surgeon is a specialist with extensive medical training.
Depending on your medical insurance, if the malocclusion is severe enough, they will view surgery to correct it as a medical necessity.
Many companies view this surgery as being medically necessary when accompanied by one or more of the following functional impairments: obstructive sleep apnea; impairment of speech; temporomandibular joint disorder (TMD); the inability to bite (incise) or chew (masticate) solid food (masticatory misfunction) leading to malnutrition; choking on incompletely masticated solid food; and, damage to the soft tissues caused by the teeth being out of alignment.
These can be caused by any of the following malocclusions, as defined by the American Association of Oral Maxillofacial Surgeons:
Anteroposterior discrepancies of greater than 2 standard deviations from published norms defined as either of the following:
Maxillary/Mandibular incisor relationship: overjet of 5mm or more, or a value less than or equal to zero (norm 2mm). (Note: Overjet up to 5mm may be treatable with routine orthodontic therapy); or
Maxillary/Mandibular anteroposterior molar relationship discrepancy of 4mm or more (norm 0 to 1mm).
Vertical discrepancies defined as any of the following:
Presence of a vertical facial skeletal deformity which is two or more standard deviations from published norms for accepted skeletal landmarks; or
Open bite (defined as one of the following):
No vertical overlap of anterior teeth; or
Unilateral or bilateral posterior open bite greater than 2mm; or
Deep overbite with impingement or irritation of buccal or lingual soft tissues of the opposing arch; or
Supra-eruption of a dentoalveolar segment due to lack of occlusion.
Transverse discrepancies defined as either of the following:
Presence of a transverse skeletal discrepancy which is two or more standard deviations from published norms; or
Total bilateral maxillary palatal cusp to mandibular fossa discrepancy of 4mm or greater, or a unilateral discrepancy of 3mm or greater, given normal axial inclination of the posterior teeth.
Asymmetries defined as the following:
Anteroposterior, transverse or lateral asymmetries greater than 3mm with concomitant occlusal asymmetry.
If they feel that this surgery is not a necessity or for reconstruction of the bones after a traumatic injury, it will be regarded as purely cosmetic. Most, if not all, medical insurance companies will not cover cosmetic problems, resulting in an out-of-pocket expense to you. For many, this will require a loan. If an underbite or overbite is slight enough, it can be corrected using orthodontics alone - in extreme cases however, surgery is required. Contact your physician to get prior approval for the referral to an oral maxillofacial surgeon.
"I do not recognize the vessel, but the eyes seem so familiar."
I suddenly realized that I had not written anything about the procedure which will most likely be done in order to correct my bite. I also discovered yesterday while at the Barnes & Noble in Huntington Beach, CA that there are no books dealing with mandibular or maxillary prognathism, or other corrective jaw surgeries, what to expect or what can be done as far as anything from the patient's perspective. Yes, there are textbooks that deal with such maladies, but nothing like this. A look at Amazon.com shows 4 books written about malocclussion, but only one of these is written about humans and this is from the perspective of a dentist.
Well, if they can write libraries about giving birth and what to expect with that medical procedure, why not corrective jaw surgery? It seems to me that this is a market that, while small, isn't being tapped. However, unlike childbirth, this is not something that is a result of a choice made by the patient - this occurs by accident or genetics.
So, let's get to it!
Originally, I thought that this was something that was attributed simply to a genetic malady; however, after doing more research, I have found what may truly be the cause. Around the age of 8, I began having serious allergy problems. Not only was this caused by enviromental factors, such as allergies to grass, weeds, dust and other contaminants aggravating my sinuses, my septum was deviating. This helped to twist my nose so that the tip is now deviated to my right by about a full centimeter. According to the Atlanta Dental Group, an underbite may be caused by "nasal obstruction, mouth breathing and tongue thrust. The tongue has to stay down so it doesn't block air from getting in. Many tongue thrust patients brace their tongues against the sides of their lower jaws and lower teeth when they swallow. This constant pressure causes the lower jaw to overgrow and creates a mismatch between the larger lower jaw and smaller upper jaw. The result is that only the back teeth touch."
With my mouth always open to breathe, the teeth stopped fitting together and there was nothing to control the growth of my jaw in comparison to the palate. If left unchecked and without proper orthodontics, it continues to grow. In spite of shots twice a week to control my allergies, I continued to have the problem of constant sinus congestion. My deviated septum was also a contributing factor, and would be made worse by the polyps that developed along with a ping pong ball-sized cyst that would develop in my left maxillary sinus.
Early intervention from an orthodontist could probably have prevented or abated the growth of my jaw, but I was never taken to a dentist as a child. Living with divorced parents, I was never really with my father long enough for him to take me on the weekends, and he may have assumed that my mother was taking me to see one. As I found out a few years ago, my mother had not gone to a dentist in many years thanks to her odontophobia caused by a dentist visit when she was a child where she was unanesthetized for a filling. While my friends were being taken to the dentist for exams, braces and cleanings, I was left out of that experience due to her own fear. It was only after twisting her arm to convince her to go when she had a dental emergency due to constant pain that she finally went in to see a dentist.
In December of 1987, I enlisted in the US Navy and was waiting to go in after the summer of 1988. It was within a few days of my 18th birthday that I had my first examination at the Recruit Training Command of the Naval Training Center in San Diego. It was there I learned the measurement of my underbite - 8 millimeters.
Part of the problem with being in the service of the military is that while you are being kept in as healthy a condition as possible, the needs of deployments still need to be met. All through my time of working in the clinics of 2nd and 11th Dental Companies (in the 2nd and 3rd Dental Battalions, respectively) I was not a candidate for this surgery as I was with Marine units and had to be deployable. I was told that I could look into having this procedure done once I had returned to an actual Dental Clinic on a land-based duty post. This idea was shot down when I inquired into getting this done as I only had a year and a half left on my enlistment and I would have reached tenure on a 2nd enlistment and been out of service for not making rank.
The idea of getting this done was nearly forgotten until the middle of last year when I again thought of having it done and I started watching videos of patients who had this surgery. What I saw shocked me. The transformation of these people - many of them young adults - was dramatic. This is what I wanted after years of hearing comments about my appearance. I went first to one dentist where I heard one of those same comments, then went to another dentist as you've already read earlier in this blog.
What typically happens after seeing the general dentist, you will be given a referral to a consultation with an orthodontist. However, if you wish to have this surgery covered under insurance and you do receive a referral to an orthodontist, immediately contact your physician. This is a medical procedure, not dental. Dental insurance will not cover this surgery - it's not their area. If only the teeth were involved, then it would be a dental matter. Yes, the surgery is done by a dentist, but an oral maxillofacial surgeon is a specialist with extensive medical training.
Depending on your medical insurance, if the malocclusion is severe enough, they will view surgery to correct it as a medical necessity.
Many companies view this surgery as being medically necessary when accompanied by one or more of the following functional impairments: obstructive sleep apnea; impairment of speech; temporomandibular joint disorder (TMD); the inability to bite (incise) or chew (masticate) solid food (masticatory misfunction) leading to malnutrition; choking on incompletely masticated solid food; and, damage to the soft tissues caused by the teeth being out of alignment.
These can be caused by any of the following malocclusions, as defined by the American Association of Oral Maxillofacial Surgeons:
Anteroposterior discrepancies of greater than 2 standard deviations from published norms defined as either of the following:
Maxillary/Mandibular incisor relationship: overjet of 5mm or more, or a value less than or equal to zero (norm 2mm). (Note: Overjet up to 5mm may be treatable with routine orthodontic therapy); or
Maxillary/Mandibular anteroposterior molar relationship discrepancy of 4mm or more (norm 0 to 1mm).
Vertical discrepancies defined as any of the following:
Presence of a vertical facial skeletal deformity which is two or more standard deviations from published norms for accepted skeletal landmarks; or
Open bite (defined as one of the following):
No vertical overlap of anterior teeth; or
Unilateral or bilateral posterior open bite greater than 2mm; or
Deep overbite with impingement or irritation of buccal or lingual soft tissues of the opposing arch; or
Supra-eruption of a dentoalveolar segment due to lack of occlusion.
Transverse discrepancies defined as either of the following:
Presence of a transverse skeletal discrepancy which is two or more standard deviations from published norms; or
Total bilateral maxillary palatal cusp to mandibular fossa discrepancy of 4mm or greater, or a unilateral discrepancy of 3mm or greater, given normal axial inclination of the posterior teeth.
Asymmetries defined as the following:
Anteroposterior, transverse or lateral asymmetries greater than 3mm with concomitant occlusal asymmetry.
If they feel that this surgery is not a necessity or for reconstruction of the bones after a traumatic injury, it will be regarded as purely cosmetic. Most, if not all, medical insurance companies will not cover cosmetic problems, resulting in an out-of-pocket expense to you. For many, this will require a loan. If an underbite or overbite is slight enough, it can be corrected using orthodontics alone - in extreme cases however, surgery is required. Contact your physician to get prior approval for the referral to an oral maxillofacial surgeon.
Friday, February 26, 2010
A Preview
Hey gang,
Originally I wasn't going to post anything until closer to my consultation appointment with Dr. Levin as there was no new information of my own experience to report. But, this does not meant that I haven't been busy researching. I started a post close to the end of last month that I've been learning more and more information regarding the development of my own particular occlusion problem. I've learned that mandibular prognathism is not entirely genetic - well, not all of it, anyway.
The only problem with this new post is that it's so lengthy, I'm going to have to break it up into two seperate parts. I also am trying to make sure that the flow is there to make it fun to read and you're not falling asleep at your computer, as I'm sure you're doing now.
I'm aiming to put up the first part by Tuesday of next week, and possibly following that up the Tuesday after with the second half. If I'm lucky, I'll be finished with it by then.
Stay tuned.
Originally I wasn't going to post anything until closer to my consultation appointment with Dr. Levin as there was no new information of my own experience to report. But, this does not meant that I haven't been busy researching. I started a post close to the end of last month that I've been learning more and more information regarding the development of my own particular occlusion problem. I've learned that mandibular prognathism is not entirely genetic - well, not all of it, anyway.
The only problem with this new post is that it's so lengthy, I'm going to have to break it up into two seperate parts. I also am trying to make sure that the flow is there to make it fun to read and you're not falling asleep at your computer, as I'm sure you're doing now.
I'm aiming to put up the first part by Tuesday of next week, and possibly following that up the Tuesday after with the second half. If I'm lucky, I'll be finished with it by then.
Stay tuned.
Tuesday, February 16, 2010
Video Links
2 blogs in one day...such value for money, eh kids?
I decided to include some video links for you to watch so you can see just what it is that I may be having done here.
This first link demonstrates the sagittal split osteotomy. Most likely, this is what will be used to correct my underbite.
http://www.youtube.com/watch?v=w9sJArgbXpU&NR=1
This second link shows the bimaxillary osteotomy. This could also be done as my prognathism is rather severe. In fact, I've been having a hard time finding someone with a malocclusion as severe as mine in all the web searches I've been doing.
http://www.youtube.com/watch?v=SCaG6ZfXi1s&feature=related
This final link shows the LeFort I osteotomy. I have seen this technique used to correct underbites before with extremely esthetic results.
http://www.youtube.com/watch?v=FbP9DaSgINU&feature=related
I decided to include some video links for you to watch so you can see just what it is that I may be having done here.
This first link demonstrates the sagittal split osteotomy. Most likely, this is what will be used to correct my underbite.
http://www.youtube.com/watch?v=w9sJArgbXpU&NR=1
This second link shows the bimaxillary osteotomy. This could also be done as my prognathism is rather severe. In fact, I've been having a hard time finding someone with a malocclusion as severe as mine in all the web searches I've been doing.
http://www.youtube.com/watch?v=SCaG6ZfXi1s&feature=related
This final link shows the LeFort I osteotomy. I have seen this technique used to correct underbites before with extremely esthetic results.
http://www.youtube.com/watch?v=FbP9DaSgINU&feature=related
And Then, There Came An Answer...
As I stated last week, Dr. Archer wasn't exactly sure how to go about getting me the referral to Dr. Levin for my underbite. It's not that she's a bad physician - far from it, I trust her judgement and she's the one that got things started so I can breathe through my nose like humans do - it's just that she's never had to deal with anything like this before. I admit I do love giving people a challenge, and love them myself, but I didn't think it would have to get to this.
The last week has been possibly one of the most stressful in my life with all of the research on insurance coverage and what it is that each agency covers and for what to try to figure out if I could get coverage for this surgery. The only thing that I could find regarding this for my own insurance was that it covers the surgery to correct skeletal deformity. Okay, but to what limits? Trying to get any information other than that in the paperwork was a waste of time, and dealing with the phone operators was...you know, I really do wonder if they get paid by the call! It seemed like they were trying to get me off the phone with little help at all.
Regardless, I decided to wait the week out and see what would happen. Unfortunately, Monday was a federal holiday and I didn't receive any mail to find out any information. Also, I decided on Sunday that I would call and just make the appointment and pay out of pocket so I could find out for myself if this could be covered. Calling on Monday proved fruitless as the office was closed and all calls were going straight to voicemail. I hate voicemail to begin with, so I just decided I'd have to wait until Tuesday.
When today arrived, I woke early as I was scheduled to go to my mother's house to take her to her doctor for her appointment. As I was walking down the street at 6:45 a.m., she phoned me to tell me that she would not be going to the appointment (this is yet another drama I have to deal with) and that I should just go and enjoy my day. So, being that I was so far away from the apartment to walk back, I jumped the bus to Orange Coast College to have breakfast in the cafeteria and also get a large, hot chai tea from the coffee stand outside the Literature and Languages building. I walked back to Harbor Boulevard and caught the route 43 to 1313 S. Harbor Blvd. in Anaheim, CA.
Well, it seems that everyone came out for Fat Tuesday. Hey, kids...this isn't New Orleans - go THERE! The good thing was that I didn't have to wait until 10 a.m. for the park to open as it opened at 9 which meant no waiting around for another hour and 15 minutes. Head up to Main Street USA and wait for them to drop the rope and let us in, went to Space Mountain for a Fastpass, then caught a train to New Orleans Square to jump a ride on the Haunted Mansion. I thought for a second about what time it was, checked my cellphone and realized that it was after 9 a.m. so I figured that Dr. Levin's office must be open, so I called up the number.
When I called, a woman named Cheryl answered the phone and I told her I wanted to schedule an appointment. She asked me if I had insurance and responded, "Yes" and told her my insurance coverage. She asked me if I was referred and I told her that I was willing to pay out of pocket just so I could get some questions answered. I told her the situation about what happened with Dr. Archer's referral and I just wanted to get this thing scheduled. She asked me which medical group I belonged to, so I told her. She then asked, "Would you like me to check their website to see if you're pending approval?" I didn't even know about this, and asked her if she could and she responded positively. She told me to hold on, so I waited. After a few seconds that seemed like an eternity, she gave me an answer.
I've been approved for my referral!
I had to stop there at the entrance to the Mansion and move to the side of the line. This was not just because I didn't want to lose the reception on my phone but because I was getting so excited my eyes were tearing up. Cheryl looked up what she had for consultation appointments and I took the first available appointment. I disconnected and went into the Mansion. Once in my "Doom Buggy" and away from view of the general populace, I kind of lost it. At last, I now have a true sense of getting somewhere with something that has bothered me physically, psychologically and socially since I was a child. I am so hyped up, everything looks beautiful to me. I wanted to share this as soon as possible, so I sent off a text message to my friend, Loana, once I got off the ride. I then sent off a text to my sister to find out if she was working so I could deliver her the news myself; I sent an offline Yahoo! Instant Message to my friend, Evelyn; then another message to my cousin's wife Becky.
My appointment is March 16th, 2010 at 2 p.m. (3:16, as Loana pointed out, would have a new meaning for me today - I didn't even think of that! I almost cracked up on the bus after reading that text message.) According to the referral letter I received, this does not confirm eligibility. This will have to be done by Dr. Levin to show that this is surgery is medically necessary, I think. I'm sure I'll worry about it then, but this takes a gigantic load off my mind so I can just get on with my life.
Onward!
The last week has been possibly one of the most stressful in my life with all of the research on insurance coverage and what it is that each agency covers and for what to try to figure out if I could get coverage for this surgery. The only thing that I could find regarding this for my own insurance was that it covers the surgery to correct skeletal deformity. Okay, but to what limits? Trying to get any information other than that in the paperwork was a waste of time, and dealing with the phone operators was...you know, I really do wonder if they get paid by the call! It seemed like they were trying to get me off the phone with little help at all.
Regardless, I decided to wait the week out and see what would happen. Unfortunately, Monday was a federal holiday and I didn't receive any mail to find out any information. Also, I decided on Sunday that I would call and just make the appointment and pay out of pocket so I could find out for myself if this could be covered. Calling on Monday proved fruitless as the office was closed and all calls were going straight to voicemail. I hate voicemail to begin with, so I just decided I'd have to wait until Tuesday.
When today arrived, I woke early as I was scheduled to go to my mother's house to take her to her doctor for her appointment. As I was walking down the street at 6:45 a.m., she phoned me to tell me that she would not be going to the appointment (this is yet another drama I have to deal with) and that I should just go and enjoy my day. So, being that I was so far away from the apartment to walk back, I jumped the bus to Orange Coast College to have breakfast in the cafeteria and also get a large, hot chai tea from the coffee stand outside the Literature and Languages building. I walked back to Harbor Boulevard and caught the route 43 to 1313 S. Harbor Blvd. in Anaheim, CA.
Well, it seems that everyone came out for Fat Tuesday. Hey, kids...this isn't New Orleans - go THERE! The good thing was that I didn't have to wait until 10 a.m. for the park to open as it opened at 9 which meant no waiting around for another hour and 15 minutes. Head up to Main Street USA and wait for them to drop the rope and let us in, went to Space Mountain for a Fastpass, then caught a train to New Orleans Square to jump a ride on the Haunted Mansion. I thought for a second about what time it was, checked my cellphone and realized that it was after 9 a.m. so I figured that Dr. Levin's office must be open, so I called up the number.
When I called, a woman named Cheryl answered the phone and I told her I wanted to schedule an appointment. She asked me if I had insurance and responded, "Yes" and told her my insurance coverage. She asked me if I was referred and I told her that I was willing to pay out of pocket just so I could get some questions answered. I told her the situation about what happened with Dr. Archer's referral and I just wanted to get this thing scheduled. She asked me which medical group I belonged to, so I told her. She then asked, "Would you like me to check their website to see if you're pending approval?" I didn't even know about this, and asked her if she could and she responded positively. She told me to hold on, so I waited. After a few seconds that seemed like an eternity, she gave me an answer.
I've been approved for my referral!
I had to stop there at the entrance to the Mansion and move to the side of the line. This was not just because I didn't want to lose the reception on my phone but because I was getting so excited my eyes were tearing up. Cheryl looked up what she had for consultation appointments and I took the first available appointment. I disconnected and went into the Mansion. Once in my "Doom Buggy" and away from view of the general populace, I kind of lost it. At last, I now have a true sense of getting somewhere with something that has bothered me physically, psychologically and socially since I was a child. I am so hyped up, everything looks beautiful to me. I wanted to share this as soon as possible, so I sent off a text message to my friend, Loana, once I got off the ride. I then sent off a text to my sister to find out if she was working so I could deliver her the news myself; I sent an offline Yahoo! Instant Message to my friend, Evelyn; then another message to my cousin's wife Becky.
My appointment is March 16th, 2010 at 2 p.m. (3:16, as Loana pointed out, would have a new meaning for me today - I didn't even think of that! I almost cracked up on the bus after reading that text message.) According to the referral letter I received, this does not confirm eligibility. This will have to be done by Dr. Levin to show that this is surgery is medically necessary, I think. I'm sure I'll worry about it then, but this takes a gigantic load off my mind so I can just get on with my life.
Onward!
Tuesday, February 9, 2010
Bureaucracy
After sleeping in late this morning, I eventually got up, had breakfast, then went to the gym. I don't remember what time I left for the gym, but by the time I had finished with my workout, it was already 1:15 p.m. So, I left there, went home and showered and got dressed. I then walked to Dr. Rita Archer's office.
After waiting a few minutes, Rita came in and went over my general health and medications, including my pharmacy losing my prescription for my testosterone again. We also went over that I was due for blood work, so she gave me the form I needed to get that done. Then, we got to the heart of the matter.
I showed Dr. Archer my cephalometric x-ray and she asked how long I had been living with the underbite. It's been like that for so long, I couldn't figure out how long I've been dealing with it. I took a wild guess and said since about 8 years of age. We discussed if I'd been having other problems which could be caused by this, including snoring, sleep apnea, etc. I also advised her of the muscle pain that I've been having in the sides of my jaw, as well as the clicking and popping I have.
Part of the problem that Dr. Archer has about getting approval for this surgery is trying to figure out how to tell the insurance company of why they should approve it. She's working on my side for this, she's just at a loss to figure out which code she needs to use to submit. She knows that Dr. Levin will know what to tell them, but until then, I have to wait again. Her estimate is that it will be about a week and I'll get a letter saying "yes" or "no."
Fuck...
After waiting a few minutes, Rita came in and went over my general health and medications, including my pharmacy losing my prescription for my testosterone again. We also went over that I was due for blood work, so she gave me the form I needed to get that done. Then, we got to the heart of the matter.
I showed Dr. Archer my cephalometric x-ray and she asked how long I had been living with the underbite. It's been like that for so long, I couldn't figure out how long I've been dealing with it. I took a wild guess and said since about 8 years of age. We discussed if I'd been having other problems which could be caused by this, including snoring, sleep apnea, etc. I also advised her of the muscle pain that I've been having in the sides of my jaw, as well as the clicking and popping I have.Part of the problem that Dr. Archer has about getting approval for this surgery is trying to figure out how to tell the insurance company of why they should approve it. She's working on my side for this, she's just at a loss to figure out which code she needs to use to submit. She knows that Dr. Levin will know what to tell them, but until then, I have to wait again. Her estimate is that it will be about a week and I'll get a letter saying "yes" or "no."
Fuck...
Monday, February 8, 2010
Reaction
" Holy crap! You could eat a tomato through a tennis racket!!!" --Dave Clark
"Woooooooooooooooooooooooooooooooooooow!" --Laura Smart
"Looking at this is making my eyes water." --Jessica Marks
Well, now you can kind of see how messed up my underbite is by these reactions to my cephalometric x-rays by my co-workers if you haven't seen the pictures from my last post. (I'm still not entirely sure what the hell Dave is trying to say, but I think I'll get it eventually.) Laura's reaction was most telling. The fact that she could make the word "wow" last for nearly 5 seconds upon seeing it drives home just how freakishly abnormal this is.
There's still a few things I wish I could find out. First, how are underbites measured? Then, I could see if mine has progressed since I was 17 when I had it measured the first time. Also, what do the insurance companies consider as being severe enough to cover the financial portion for this surgery? I think this is beyond cosmetics and it's the one thing that's still bugging the crap out of me. If anything, I think it would be better to cover this thing regardless of the severity just for the psychological well-being of their customers.
Tomorrow, I have my appointment with Dr. Archer to get the referral to Dr. Levin. I'm glad that I have the x-rays with me. I'm sure it will save time explaining the whole situation with Dr. Archer. Until then, it's the waiting and the unanswered questions to deal with.
Next update is tomorrow afternoon.
"Woooooooooooooooooooooooooooooooooooow!" --Laura Smart
"Looking at this is making my eyes water." --Jessica Marks
Well, now you can kind of see how messed up my underbite is by these reactions to my cephalometric x-rays by my co-workers if you haven't seen the pictures from my last post. (I'm still not entirely sure what the hell Dave is trying to say, but I think I'll get it eventually.) Laura's reaction was most telling. The fact that she could make the word "wow" last for nearly 5 seconds upon seeing it drives home just how freakishly abnormal this is.
There's still a few things I wish I could find out. First, how are underbites measured? Then, I could see if mine has progressed since I was 17 when I had it measured the first time. Also, what do the insurance companies consider as being severe enough to cover the financial portion for this surgery? I think this is beyond cosmetics and it's the one thing that's still bugging the crap out of me. If anything, I think it would be better to cover this thing regardless of the severity just for the psychological well-being of their customers.
Tomorrow, I have my appointment with Dr. Archer to get the referral to Dr. Levin. I'm glad that I have the x-rays with me. I'm sure it will save time explaining the whole situation with Dr. Archer. Until then, it's the waiting and the unanswered questions to deal with.
Next update is tomorrow afternoon.
Thursday, February 4, 2010
"Ah, shit...here we go again!"
Well, I was going to add this to my previous post for today, but decided that if I was going to do this, it kind of deserved its own post.
Showed up early to Dr. Graham's office and chilled out in the waiting room for about 20 minutes. No problem as I'm still on vacation. Only thing on my plate was that I was meeting my sister for a shabu shabu dinner. While I'm waiting there, I see a cute, blonde dental assistant working in the operatory. I couldn't tell if she was staring at me or not. I don't know...I've never really felt used to being stared at by girls. Eventually, I go in and get taken into Dr. Graham's office which is on the opposite side of the wall in the waiting room where I was sitting.
A different assistant showed me into the room and laid out the booklets that I later took with me and also laid out the photos that I had taken on Monday. I also got to see the x-rays I had taken which were turned into glossy photos. I was invited by his assistant to read through the booklets while waiting for Dr. Graham, so I did.
This illustration was made from my cephalometric radiograph and gives the measurements that I have for my underbite. I have included it here so you can see just how severe my underbite is. The two molars shown are actually the front molars and the distance between the top and bottom first molars is about 3 millimeters, from what I'm guessing. Most severe underbites cephalometric radiographs that I've seen have the 2 first molars meeting each other midway. From what Dr. Graham says, when the oral maxillofacial surgeon sees this underbite, he's going to go apeshit. Okay, not his exact words, but you can see where this is going. The good thing is that the top teeth are close to being in the position that they're going to need to be, but they're going to have to tweek the bottom teeth - more on that in a few paragraphs.
Within a few minutes, Dr. Graham came in and we started discussing the treatment plan. As it turns out, tooth #6 is not actually located in the facial area of my gingiva (gums) as I'd thought. It turns out that it's located in the palate (roof) of my mouth. This does present a problem - he can save the tooth, but it will add an additional 2 years to my treatment to bring it forward and hook onto it with braces. It would also have to be glued to tooth #5 to make sure that it stayed there. Doing this would also cause a problem with trying to correct my midline which, as you'll see from the panorex radiograph below, is deviated a few millimeters to my right. If I want my midline corrected, I would have to have 4 teeth removed. Originally, I thought that I would have to have my canine teeth removed, but from what Dr. Graham is proposing, I would have 3 of my bicuspids removed - 1 from either quadrant of the mandibular teeth and 1 from the left quadrant of my maxillary teeth. Tooth #11 will be kept and either tooth #4 or #5 will be kept to use as its esthetic replacement.
The only other question that comes in at this point is just which surgeon in the area accepts the Blue Shield of California HMO plan. This is my main concern. Dr. Graham didn't know if the surgeon that he usually refers people to, Dr. Lee, accepts Blue Shield's HMO plan, and it looks like he doesn't. I was recommended to contact Blue Shield and also check with my general dentist to see if they had a list of any OMS's in the area that takes my insurance.
Show up at my regular dentist's office to see if they had any doctors that participated as contractors for my insurance and get told that I would have to go through my primary care provider, Dr. Rita Archer, to get a referral to an oral surgeon that's in my provider group. I tried to get in for an appointment for tomorrow, but Dr. Archer doesn't work on Fridays, it seems. So, I did what I could do and I'll be able to get in on Tuesday to talk with her about this and see if I can get prior approval. After that, I can then get the consult to the oral surgeon and discuss the treatment plan, including removing the teeth.
The good thing about all of this is that if I have the 4 teeth removed, it will lighten up the load of work that will have to be done prior to having my surgery. After removing the teeth, I'll be back in for impressions so they can get everything prepared to have the braces put on.
There is still an additional problem: my upper teeth come into place behind my lower teeth as you'll see from this x-ray. Not only does this result in an open bite up front, it also causes a problem with placing of the brackets for the braces. Most likely, I'll have to have the braces put on the lower arch prior to getting the upper arch put on to change the position of the teeth in the lower arch to make sure I'm not making my braces on the top loose when I bite down.
The good news for today is that from that point, Dr. Graham said that he estimates that I'll be ready for surgery by the end of the year! That works for me - let's get it moving! =)
P.S. Okay, if anyone is reading this in America and is looking to get this covered through their medical insurance/HMO - and medical insurance WILL cover this surgery if it is a medical necessity - check with your Primary Medical Care Provider FIRST! This will save you all kinds of time and running around from one dentist to another only to find out that you're not going to be covered.
Showed up early to Dr. Graham's office and chilled out in the waiting room for about 20 minutes. No problem as I'm still on vacation. Only thing on my plate was that I was meeting my sister for a shabu shabu dinner. While I'm waiting there, I see a cute, blonde dental assistant working in the operatory. I couldn't tell if she was staring at me or not. I don't know...I've never really felt used to being stared at by girls. Eventually, I go in and get taken into Dr. Graham's office which is on the opposite side of the wall in the waiting room where I was sitting.
A different assistant showed me into the room and laid out the booklets that I later took with me and also laid out the photos that I had taken on Monday. I also got to see the x-rays I had taken which were turned into glossy photos. I was invited by his assistant to read through the booklets while waiting for Dr. Graham, so I did.
This illustration was made from my cephalometric radiograph and gives the measurements that I have for my underbite. I have included it here so you can see just how severe my underbite is. The two molars shown are actually the front molars and the distance between the top and bottom first molars is about 3 millimeters, from what I'm guessing. Most severe underbites cephalometric radiographs that I've seen have the 2 first molars meeting each other midway. From what Dr. Graham says, when the oral maxillofacial surgeon sees this underbite, he's going to go apeshit. Okay, not his exact words, but you can see where this is going. The good thing is that the top teeth are close to being in the position that they're going to need to be, but they're going to have to tweek the bottom teeth - more on that in a few paragraphs.
Within a few minutes, Dr. Graham came in and we started discussing the treatment plan. As it turns out, tooth #6 is not actually located in the facial area of my gingiva (gums) as I'd thought. It turns out that it's located in the palate (roof) of my mouth. This does present a problem - he can save the tooth, but it will add an additional 2 years to my treatment to bring it forward and hook onto it with braces. It would also have to be glued to tooth #5 to make sure that it stayed there. Doing this would also cause a problem with trying to correct my midline which, as you'll see from the panorex radiograph below, is deviated a few millimeters to my right. If I want my midline corrected, I would have to have 4 teeth removed. Originally, I thought that I would have to have my canine teeth removed, but from what Dr. Graham is proposing, I would have 3 of my bicuspids removed - 1 from either quadrant of the mandibular teeth and 1 from the left quadrant of my maxillary teeth. Tooth #11 will be kept and either tooth #4 or #5 will be kept to use as its esthetic replacement.
The only other question that comes in at this point is just which surgeon in the area accepts the Blue Shield of California HMO plan. This is my main concern. Dr. Graham didn't know if the surgeon that he usually refers people to, Dr. Lee, accepts Blue Shield's HMO plan, and it looks like he doesn't. I was recommended to contact Blue Shield and also check with my general dentist to see if they had a list of any OMS's in the area that takes my insurance.
Show up at my regular dentist's office to see if they had any doctors that participated as contractors for my insurance and get told that I would have to go through my primary care provider, Dr. Rita Archer, to get a referral to an oral surgeon that's in my provider group. I tried to get in for an appointment for tomorrow, but Dr. Archer doesn't work on Fridays, it seems. So, I did what I could do and I'll be able to get in on Tuesday to talk with her about this and see if I can get prior approval. After that, I can then get the consult to the oral surgeon and discuss the treatment plan, including removing the teeth.
The good thing about all of this is that if I have the 4 teeth removed, it will lighten up the load of work that will have to be done prior to having my surgery. After removing the teeth, I'll be back in for impressions so they can get everything prepared to have the braces put on.
There is still an additional problem: my upper teeth come into place behind my lower teeth as you'll see from this x-ray. Not only does this result in an open bite up front, it also causes a problem with placing of the brackets for the braces. Most likely, I'll have to have the braces put on the lower arch prior to getting the upper arch put on to change the position of the teeth in the lower arch to make sure I'm not making my braces on the top loose when I bite down.
The good news for today is that from that point, Dr. Graham said that he estimates that I'll be ready for surgery by the end of the year! That works for me - let's get it moving! =)
P.S. Okay, if anyone is reading this in America and is looking to get this covered through their medical insurance/HMO - and medical insurance WILL cover this surgery if it is a medical necessity - check with your Primary Medical Care Provider FIRST! This will save you all kinds of time and running around from one dentist to another only to find out that you're not going to be covered.
Cart Before The Horse
I'm beginning to wonder if I'm getting ahead of myself while I'm sleeping. Last night, I had a dream that they were prepping me for surgery in the hospital. Maybe it's because today is my final consultation with the orthodontist where we discuss everything and get started in earnest on this whole endeavor. I AM being realistic about the timeline I'm looking at here, but you know what they say about the mind playing tricks. Stop that brain!
I reviewed my medical insurance yesterday. Seems they'll cover everything except the teeth portion as long as it's medically necessary. As I said in a previous blog, the masticatory muscles are still sore since having the septoplasty done last June. And, having seen my cephalometric radiographs, I don't think it will be too hard to convince them to approve this operation. With any luck, Dr. Graham will refer me to the surgeon today. I would like to know if I'll be having any teeth pulled prior to getting my braces or if I'll be able to keep them all.
I'm also really interested to find out what, if anything, they can do about tooth #6, my right maxillary canine tooth. That tooth never erupted and I can feel the tip of it just underneath my gums sitting at a nearly 45 degree angle over tooth #7, the right lateral incisor. Dr. Graham says this can be a tricky problem as to put it into place, you're forcing it into a position where there are already other teeth. I know this could delay things for a bit if they decide to extract all of the canines to make room for the other teeth when they put the braces on.
Well, 6 hours to go from the time of this writing, so I think I'll go find something to do until then. Check back later on this post.
I reviewed my medical insurance yesterday. Seems they'll cover everything except the teeth portion as long as it's medically necessary. As I said in a previous blog, the masticatory muscles are still sore since having the septoplasty done last June. And, having seen my cephalometric radiographs, I don't think it will be too hard to convince them to approve this operation. With any luck, Dr. Graham will refer me to the surgeon today. I would like to know if I'll be having any teeth pulled prior to getting my braces or if I'll be able to keep them all.
I'm also really interested to find out what, if anything, they can do about tooth #6, my right maxillary canine tooth. That tooth never erupted and I can feel the tip of it just underneath my gums sitting at a nearly 45 degree angle over tooth #7, the right lateral incisor. Dr. Graham says this can be a tricky problem as to put it into place, you're forcing it into a position where there are already other teeth. I know this could delay things for a bit if they decide to extract all of the canines to make room for the other teeth when they put the braces on.
Well, 6 hours to go from the time of this writing, so I think I'll go find something to do until then. Check back later on this post.
Monday, February 1, 2010
Restless
I had a hard time sleeping this morning. I can't say last night as I was up doing more research on this surgery and was practicing with Uprooted until 11 p.m. However, this didn't keep me from falling asleep.
The problem once I fell asleep was that I kept having dreams where I had already gotten my braces! I'd get so excited that I kept waking up! And, each time, I had to tell myself, "Dude, calm down. It's coming. Today is just an appointment for x-rays. The final consultation appointment is coming up on Thursday, be excited for that!"
I'll update this post with what happens in about an hour when I get home. I'm going to a dental x-ray clinic that's down the street from Dr. Graham's office and in the same parking lot as the local branch of my bank. I'm not entirely sure of what type of x-rays I'll be getting, but I'm pretty sure I'll be having a panorex (panoramic view) of my jaw done, as well as P.A. (periapical) x-rays so Dr. Graham can see the entire root structure of each tooth and what he'll have to deal with as far as me being a patient. Personally, I hope it's a full-mouth series of P.A. x-rays as this is going to cost me $140 out of my own pocket!
More to come when I return.
Okay, back and getting ready for school. Tonight's the first night of Intermediate Spanish.
Not only was this a full-mouth series like I thought, it was more. After I checked in, the technician brought me in to the room. I put my stuff that I had with me on a counter, then was sat in a chair.
The first thing that I did was I had my picture taken for a profile shot, then a head shot. I was then given plastic devices to hold my lips away from my teeth so that my bite could be photographed up close. He also took photos of my occlusal surfaces, which I could have done without. I wasn't too keen with having a 3" x 5" mirror placed in my mouth, but I dealt with it. After the photos were taken, I was taken to the other side of the 10' x 15' room. There, I had my panorex x-ray taken.
What this x-ray does is give a panoramic view of all of the teeth and the jaws and any work that's currently in place. While useful, this x-ray is not the most reliable as the image is distorted since the machines travels all the way around the head 270 degrees. I was used to dealing with this x-ray from my days in the Navy. Fortunately, everything at this lab is done digitally so I didn't have to wait 5-10 minutes for the film to be developed.
The next x-ray I had taken was a full profile of my head, or lateral cephalometric x-ray. The only thing I didn't like about this was the calipers placed in my ears to hold my head steady while the machine was working. If you've seen the film "Star Trek 2: The Wrath of Khan," you'll know what I'm talking about. This is only a minor complaint as I got to see this picture just after it was taken.
I've seen this same x-ray in web searches for underbite surgery for what's labeled "extreme underbite," and most of the ones I've seen are not as severe as mine. Most patients that I've seen this x-ray of have their 2nd mandibular molars overlapping about halfway with their 1st maxillary molars. I don't have this problem - my 2nd mandibular molars meet up directly with my 1st maxillary molars. My maxillary teeth could not even be seen on the scan as they're too far below the mandibular teeth. In comparison with some of the pictures that I've seen, I have to wonder if my underbite really has gotten worse with age. Hopefully, I'll find out soon.
After the cephalometric analysis was completed, I then had 2 occlusal x-rays taken. These take picutres of the actual biting surfaces of the teeth and show how the roots and other teeth match up. One is taken from the top and one from the bottom. After these shots, I then had a full P.A. series taken - all 14 of them. Fortunately, only one of them had to be retaken. I could feel the thing moving right when the technician walked away from me to take the picture.
My next appointment is coming on Thursday. This will be my final orthodontic consultation, then it's full speed ahead once I've paid 10% of the total cost for the orthodontic treatment which looks like it will be 20 months total - well, at least the payments will be for that length of time. Tune back in on Thursday evening after shabu shabu dinner with one of the siblings.
Ever onward...
The problem once I fell asleep was that I kept having dreams where I had already gotten my braces! I'd get so excited that I kept waking up! And, each time, I had to tell myself, "Dude, calm down. It's coming. Today is just an appointment for x-rays. The final consultation appointment is coming up on Thursday, be excited for that!"
I'll update this post with what happens in about an hour when I get home. I'm going to a dental x-ray clinic that's down the street from Dr. Graham's office and in the same parking lot as the local branch of my bank. I'm not entirely sure of what type of x-rays I'll be getting, but I'm pretty sure I'll be having a panorex (panoramic view) of my jaw done, as well as P.A. (periapical) x-rays so Dr. Graham can see the entire root structure of each tooth and what he'll have to deal with as far as me being a patient. Personally, I hope it's a full-mouth series of P.A. x-rays as this is going to cost me $140 out of my own pocket!
More to come when I return.
Okay, back and getting ready for school. Tonight's the first night of Intermediate Spanish.
Not only was this a full-mouth series like I thought, it was more. After I checked in, the technician brought me in to the room. I put my stuff that I had with me on a counter, then was sat in a chair.
The first thing that I did was I had my picture taken for a profile shot, then a head shot. I was then given plastic devices to hold my lips away from my teeth so that my bite could be photographed up close. He also took photos of my occlusal surfaces, which I could have done without. I wasn't too keen with having a 3" x 5" mirror placed in my mouth, but I dealt with it. After the photos were taken, I was taken to the other side of the 10' x 15' room. There, I had my panorex x-ray taken.
What this x-ray does is give a panoramic view of all of the teeth and the jaws and any work that's currently in place. While useful, this x-ray is not the most reliable as the image is distorted since the machines travels all the way around the head 270 degrees. I was used to dealing with this x-ray from my days in the Navy. Fortunately, everything at this lab is done digitally so I didn't have to wait 5-10 minutes for the film to be developed.
The next x-ray I had taken was a full profile of my head, or lateral cephalometric x-ray. The only thing I didn't like about this was the calipers placed in my ears to hold my head steady while the machine was working. If you've seen the film "Star Trek 2: The Wrath of Khan," you'll know what I'm talking about. This is only a minor complaint as I got to see this picture just after it was taken.
I've seen this same x-ray in web searches for underbite surgery for what's labeled "extreme underbite," and most of the ones I've seen are not as severe as mine. Most patients that I've seen this x-ray of have their 2nd mandibular molars overlapping about halfway with their 1st maxillary molars. I don't have this problem - my 2nd mandibular molars meet up directly with my 1st maxillary molars. My maxillary teeth could not even be seen on the scan as they're too far below the mandibular teeth. In comparison with some of the pictures that I've seen, I have to wonder if my underbite really has gotten worse with age. Hopefully, I'll find out soon.
After the cephalometric analysis was completed, I then had 2 occlusal x-rays taken. These take picutres of the actual biting surfaces of the teeth and show how the roots and other teeth match up. One is taken from the top and one from the bottom. After these shots, I then had a full P.A. series taken - all 14 of them. Fortunately, only one of them had to be retaken. I could feel the thing moving right when the technician walked away from me to take the picture.
My next appointment is coming on Thursday. This will be my final orthodontic consultation, then it's full speed ahead once I've paid 10% of the total cost for the orthodontic treatment which looks like it will be 20 months total - well, at least the payments will be for that length of time. Tune back in on Thursday evening after shabu shabu dinner with one of the siblings.
Ever onward...
Tuesday, January 26, 2010
Consultation
The muscles in my tempromandibular joint area are sore from smiling so much today. A recap:
I was awoken at 4:23 a.m. with an overriding urge to urinate that was simply not going to go away. As much as I tried to ignore it and go to sleep, I decided to just get up and go. Of course, since I spent so much time trying to get rid of the feeling in the first place, my body had revolted and said, "Guess what, Asshole!? You're staying up!" So, I went and relieved myself and had some breakfast.
Surfed the web and listened to tunes until 8:30 or so, then hit the gym to do some cardio for about 25 minutes. Did some light chest work on the weight machines then headed home to take my shower and catch the bus to the orthodontist's office.
I walked into the office and was greeted with wood paneling along all the walls. The front desk was to my left, so I checked in. The usual information was requested for my insurance. I didn't have my card, but I gave them my name, date of birth and Social Security number so they could contact Delta Dental to get my benefits information while they had me fill out my medical history information.
I turned in my information and waited on the carpeted bench. Meanwhile, numerous patients were in an out of the lobby and operatory. Within half an hour, I was guided into a room with wallpaper that looked like clouds on a blue sky and sat in a dental chair with what looked like a 1980's-era fuzzy seat cover. Up above me and to my right in one corner of the room were porcelain seagulls. I did notice that the operatory where patients were being seen was the ocean. I also saw several assistants working. Dr. Graham came in and said, "So, this is what we do on semi-rainy days." He didn't even introduce himself! That's fine with me, though. It's pretty obvious who my appointment was with, so he didn't even have to introduce himself.
Looking over my medical history, he also saw my occupation and we discussed areas of my job with the Highway Patrol. This went on for a few minutes, then he took a look at my teeth.
In addition to discussing certain problems, notably the absence of tooth #6 and the problem it presents since it's impacted in front of my other teeth, we discussed treatment and he said that he could help me out, with the surgeon or possibly not. My personal preference is to work with the surgeon in order to correct this problem once and for all and get the teeth set up for the surgery since he works in cooperation with the oral surgeon to get this set up. Dr. Graham also mentioned that to me that he could have me set up for this surgery even faster than I thought, giving an estimation of 6 months to a year before I had my surgery! This was an even shorter time than I had previously been quoted when I was in the Navy, where the minimum time I would have to wait for the surgery was 18 months. He then advised me that he would have me in for a final consultation where we would discuss the treatment plan after I had my x-rays taken. The front desk assistant then came in and gave me a breakdown on the costs before and after what will be paid for by Delta Dental Insurance.
My total fee payment for the braces comes to $3,961, with my insurance benefit covering $1,000 of the braces. This leaves me with a balance of $2,961 with $461 dollars due on my banding appointment. The rest will be spread out over 20 payments at $125 a month. I also have to go get x-rays done for the orthodontic survey and Delta covers half of that, leaving me with a payment of $140.
My appointment is scheduled for Monday, February 1st at 9 a.m. and my final consultation appointment is scheduled for February 4th at noon.
And so, it begins...
I was awoken at 4:23 a.m. with an overriding urge to urinate that was simply not going to go away. As much as I tried to ignore it and go to sleep, I decided to just get up and go. Of course, since I spent so much time trying to get rid of the feeling in the first place, my body had revolted and said, "Guess what, Asshole!? You're staying up!" So, I went and relieved myself and had some breakfast.
Surfed the web and listened to tunes until 8:30 or so, then hit the gym to do some cardio for about 25 minutes. Did some light chest work on the weight machines then headed home to take my shower and catch the bus to the orthodontist's office.
I walked into the office and was greeted with wood paneling along all the walls. The front desk was to my left, so I checked in. The usual information was requested for my insurance. I didn't have my card, but I gave them my name, date of birth and Social Security number so they could contact Delta Dental to get my benefits information while they had me fill out my medical history information.
I turned in my information and waited on the carpeted bench. Meanwhile, numerous patients were in an out of the lobby and operatory. Within half an hour, I was guided into a room with wallpaper that looked like clouds on a blue sky and sat in a dental chair with what looked like a 1980's-era fuzzy seat cover. Up above me and to my right in one corner of the room were porcelain seagulls. I did notice that the operatory where patients were being seen was the ocean. I also saw several assistants working. Dr. Graham came in and said, "So, this is what we do on semi-rainy days." He didn't even introduce himself! That's fine with me, though. It's pretty obvious who my appointment was with, so he didn't even have to introduce himself.
Looking over my medical history, he also saw my occupation and we discussed areas of my job with the Highway Patrol. This went on for a few minutes, then he took a look at my teeth.
In addition to discussing certain problems, notably the absence of tooth #6 and the problem it presents since it's impacted in front of my other teeth, we discussed treatment and he said that he could help me out, with the surgeon or possibly not. My personal preference is to work with the surgeon in order to correct this problem once and for all and get the teeth set up for the surgery since he works in cooperation with the oral surgeon to get this set up. Dr. Graham also mentioned that to me that he could have me set up for this surgery even faster than I thought, giving an estimation of 6 months to a year before I had my surgery! This was an even shorter time than I had previously been quoted when I was in the Navy, where the minimum time I would have to wait for the surgery was 18 months. He then advised me that he would have me in for a final consultation where we would discuss the treatment plan after I had my x-rays taken. The front desk assistant then came in and gave me a breakdown on the costs before and after what will be paid for by Delta Dental Insurance.
My total fee payment for the braces comes to $3,961, with my insurance benefit covering $1,000 of the braces. This leaves me with a balance of $2,961 with $461 dollars due on my banding appointment. The rest will be spread out over 20 payments at $125 a month. I also have to go get x-rays done for the orthodontic survey and Delta covers half of that, leaving me with a payment of $140.
My appointment is scheduled for Monday, February 1st at 9 a.m. and my final consultation appointment is scheduled for February 4th at noon.
And so, it begins...
Sunday, January 24, 2010
Anticipation
A little over 12 hours to go and I've been feeling pretty antsy all week about wanting to get this thing started. Part of the reason is that I know that in most cases, insurance won't cover this surgery as they view it to be cosmetic. I hope that doesn't happen to me. After all, this surgery can cost upwards of $35,000!
Reading over my benefits package with Blue Shield, I see that orthognathic surgery is covered "when it is medically necessary to correct skeletal deformity. Certain services, such as implants and orthodontia are not covered." I know that orthodontia is not covered by medical insurance. Personally, I don't see any reason why they wouldn't cover this surgery.
Sadly, Delta Dental only covers $1,000 for orthodontics, but the price for that is somewhat reasonable in comparison to the rest of the surgery. I can manage the price for braces with payments. I have read, however, that dental insurance companies cover the cost of braces in extreme cases of orthognathic surgery. This makes me wonder if I qualify.
The other reason I'm feeling antsy is because I've been wanting to get this done for a long time. I know this may seem odd because I know there is a lot of pain associated with orthodontic appliances (braces), but I'm looking forward to it. The braces, not the pain. I'm crazy, not a masochist.
Thus far, I've been thinking over the procedure and making predictions about what will have to happen before this whole thing can be started with braces. I'm predicting that I will have to see an oral surgeon prior to getting the braces to have teeth #2, #11, #15, #22, and #27 removed prior to getting braces. Teeth #22 and #27 will probably be removed in order to make room to straighten and align my lower incisors (lower front teeth). Teeth #2 and #15 (the upper 2nd molars) may have to be removed. There's nothing wrong with the teeth themselves with the exception being that there's nothing to keep them from descending since there are no molars on the bottom to stop them. Tooth #11 (the left lateral incisor or canine tooth) may be removed for symmetry as tooth #6 is impacted (the tooth rests below the gumline, in my case at a nearly 30 degree angle).
I'm also wondering how it is that the orthodontist can correct my midline (the space between the front teeth) deviation as the midline of the maxilla is deviated a few millimeters to my right in comparison to my mandible. I think the whole thing was caused by tooth #11 growing in and pushing the other teeth over to my right.
Well, all of this is great fodder for a blog for tomorrow. I'll update you all on what I find out. Wish me luck! =)
In the meantime, I recommend these links for you to watch. These videos were made by a girl in Australia who had this surgery done about 10 months ago, starting from 1 week pre-op to 3 weeks post surgery and then after having her braces removed. Check them out.
http://www.youtube.com/user/Morgz1992#p/a/u/2/Dv9fgYUQ19w
http://www.youtube.com/user/Morgz1992#p/a/u/1/NGguq6h_LNc
http://www.youtube.com/user/Morgz1992#p/a/u/0/abliimiRTls
(Note: when counting the teeth, start from your right side and count the upper teeth all the way to your left [#1-16]. For the bottom teeth, start on your left side and count to your right [#17-32].)
Reading over my benefits package with Blue Shield, I see that orthognathic surgery is covered "when it is medically necessary to correct skeletal deformity. Certain services, such as implants and orthodontia are not covered." I know that orthodontia is not covered by medical insurance. Personally, I don't see any reason why they wouldn't cover this surgery.
Sadly, Delta Dental only covers $1,000 for orthodontics, but the price for that is somewhat reasonable in comparison to the rest of the surgery. I can manage the price for braces with payments. I have read, however, that dental insurance companies cover the cost of braces in extreme cases of orthognathic surgery. This makes me wonder if I qualify.
The other reason I'm feeling antsy is because I've been wanting to get this done for a long time. I know this may seem odd because I know there is a lot of pain associated with orthodontic appliances (braces), but I'm looking forward to it. The braces, not the pain. I'm crazy, not a masochist.
Thus far, I've been thinking over the procedure and making predictions about what will have to happen before this whole thing can be started with braces. I'm predicting that I will have to see an oral surgeon prior to getting the braces to have teeth #2, #11, #15, #22, and #27 removed prior to getting braces. Teeth #22 and #27 will probably be removed in order to make room to straighten and align my lower incisors (lower front teeth). Teeth #2 and #15 (the upper 2nd molars) may have to be removed. There's nothing wrong with the teeth themselves with the exception being that there's nothing to keep them from descending since there are no molars on the bottom to stop them. Tooth #11 (the left lateral incisor or canine tooth) may be removed for symmetry as tooth #6 is impacted (the tooth rests below the gumline, in my case at a nearly 30 degree angle).
I'm also wondering how it is that the orthodontist can correct my midline (the space between the front teeth) deviation as the midline of the maxilla is deviated a few millimeters to my right in comparison to my mandible. I think the whole thing was caused by tooth #11 growing in and pushing the other teeth over to my right.
Well, all of this is great fodder for a blog for tomorrow. I'll update you all on what I find out. Wish me luck! =)
In the meantime, I recommend these links for you to watch. These videos were made by a girl in Australia who had this surgery done about 10 months ago, starting from 1 week pre-op to 3 weeks post surgery and then after having her braces removed. Check them out.
http://www.youtube.com/user/Morgz1992#p/a/u/2/Dv9fgYUQ19w
http://www.youtube.com/user/Morgz1992#p/a/u/1/NGguq6h_LNc
http://www.youtube.com/user/Morgz1992#p/a/u/0/abliimiRTls
(Note: when counting the teeth, start from your right side and count the upper teeth all the way to your left [#1-16]. For the bottom teeth, start on your left side and count to your right [#17-32].)
Wednesday, January 20, 2010
Preparation
After my exam and deep cleaning yesterday, I attempted to reach the orthodontist to schedule an appointment for the consultation. All day, the phone continued to ring without even routing to voicemail, which wasn't giving me much hope until after I logged onto Facebook and heard about the tornado warnings that had been issued for Orange County. This made me wonder if H.B. had also been having any power blackouts yesterday like we had this afternoon which would explain the lack of voicemail. I also found out later that many people lost phone service throughout the area.
After working overtime this morning, I left the communications center and proceeded to my mother's house. While walking to her house, I called the doctor's office and got through to the assistant working the phone. I was offered an appointment for Monday, but I didn't feel like using up more sick time to make an appointment during work hours, so I asked if they had anything else. They had an appointment open for Tuesday morning, so I took that spot.
More to come next week. Check back Tuesday evening.
After working overtime this morning, I left the communications center and proceeded to my mother's house. While walking to her house, I called the doctor's office and got through to the assistant working the phone. I was offered an appointment for Monday, but I didn't feel like using up more sick time to make an appointment during work hours, so I asked if they had anything else. They had an appointment open for Tuesday morning, so I took that spot.
More to come next week. Check back Tuesday evening.
Tuesday, January 19, 2010
Turnaround
Well, as stated yesterday, I scheduled an appointment for my exam and got a whole lot more than that today!
After downloading Sigh's "Scenes From Hell" off iTunes (very recommended, by the way) and loading it on to my iPod, I proceeded to walk to the dental clinic. Not only is the building conveniently sandwiched between the Mother's Market and Albertson's stores that I shop at, they have most specialists under the same roof. I got there and started taking care of paperwork for my insurance. They were having trouble locating my files at Delta, but it turns out they were looking for my Premier account which, much to my surprise, was changed to a PPO plan. This meant I no longer had to worry about switching dentists. They took me in and shot my x-rays.
Radiology has advanced quite a bit since I was doing it in the USN back in the late 80's/early 90's. The x-rays were all digital and I got to see them within seconds of having them taken, rather than minutes. This was quite nice.
I was then introduced to Dr. Jonathon Shapiro. Dr. Shapiro proceeded to do my full exam and we immediately discussed the consultation for orthodontics and my mandibular prognathism. We also discussed my current dental state. Turns out that while I still have no cavities (whoohoo!), I had some subgingival calculus (tartar below the gumline) despite having had a root planing (cleaning below the gumline) 6 months ago. He also did an inspection of tooth #28 (this is your first bicuspid on your lower right) and said that it's still in good shape, but does show damage from my malocclusion. We could work on it, but it's not worth doing until after I get my teeth straightened. He then gave me a referral to an orthodontist here in Huntington Beach off of Brookhurst and Atlanta.
(Something that also makes me give 2 thumbs up is that he noticed my Slayer shirt from the 1998 tour and asked me when I had seen them and the current tour's cancellation due to Tom Araya's back surgery. Metal dentist!)
Dr. Shapiro said that normally he would refer me to their own orthodontist, Dr. Chen, but she's only in on Thursdays and the orthodontist they're referring me to works closely with an oral surgeon for cases such as mine. Upon inspecting the website of Dr. Neil J. Graham, I found that he's not only a USC graduate, but also a patent lawyer, with 10 patents for various products not only in the dental field, including invisible aligners (a 1986 invention similar to Invisalign), but also things like contact lens placement instruments!
I'll be making the call to Dr. Graham's office tomorrow when I'm finished with overtime at work. More to come!
After downloading Sigh's "Scenes From Hell" off iTunes (very recommended, by the way) and loading it on to my iPod, I proceeded to walk to the dental clinic. Not only is the building conveniently sandwiched between the Mother's Market and Albertson's stores that I shop at, they have most specialists under the same roof. I got there and started taking care of paperwork for my insurance. They were having trouble locating my files at Delta, but it turns out they were looking for my Premier account which, much to my surprise, was changed to a PPO plan. This meant I no longer had to worry about switching dentists. They took me in and shot my x-rays.
Radiology has advanced quite a bit since I was doing it in the USN back in the late 80's/early 90's. The x-rays were all digital and I got to see them within seconds of having them taken, rather than minutes. This was quite nice.
I was then introduced to Dr. Jonathon Shapiro. Dr. Shapiro proceeded to do my full exam and we immediately discussed the consultation for orthodontics and my mandibular prognathism. We also discussed my current dental state. Turns out that while I still have no cavities (whoohoo!), I had some subgingival calculus (tartar below the gumline) despite having had a root planing (cleaning below the gumline) 6 months ago. He also did an inspection of tooth #28 (this is your first bicuspid on your lower right) and said that it's still in good shape, but does show damage from my malocclusion. We could work on it, but it's not worth doing until after I get my teeth straightened. He then gave me a referral to an orthodontist here in Huntington Beach off of Brookhurst and Atlanta.
(Something that also makes me give 2 thumbs up is that he noticed my Slayer shirt from the 1998 tour and asked me when I had seen them and the current tour's cancellation due to Tom Araya's back surgery. Metal dentist!)
Dr. Shapiro said that normally he would refer me to their own orthodontist, Dr. Chen, but she's only in on Thursdays and the orthodontist they're referring me to works closely with an oral surgeon for cases such as mine. Upon inspecting the website of Dr. Neil J. Graham, I found that he's not only a USC graduate, but also a patent lawyer, with 10 patents for various products not only in the dental field, including invisible aligners (a 1986 invention similar to Invisalign), but also things like contact lens placement instruments!
I'll be making the call to Dr. Graham's office tomorrow when I'm finished with overtime at work. More to come!
Monday, January 18, 2010
Reset, Restart
Well, after the weekend derailment of my plans, I have decided to carry forth with my plan of finding a new dentist. I called this afternoon at work and found that the clinic that's even closer to my apartment was not only open, but they answered their phone after the first ring! Trying to get my previous dentist to even answer the phone at all was a fucking miracle.
The good thing about this dental office is that they have nearly every type of dentist under the same roof. General dentists, an endodontist, an orthodontist, a periodontist and an oral surgeon all at the same address. This way I can see how much damage my 1st bicuspid on my right side (tooth #28) has sustained thanks to my fucked up underbite and will hopefully get it filled to prevent any further damage. I can also meet with the orthodontist to get braces to get this whole thing started, as well as a consult with the oral surgeon to see about surgery to correct my bite.
My examination appointment will be tomorrow morning at 9:30 a.m. and I've already submitted my health history to them. Let's hope things go for the better, this time.
The good thing about this dental office is that they have nearly every type of dentist under the same roof. General dentists, an endodontist, an orthodontist, a periodontist and an oral surgeon all at the same address. This way I can see how much damage my 1st bicuspid on my right side (tooth #28) has sustained thanks to my fucked up underbite and will hopefully get it filled to prevent any further damage. I can also meet with the orthodontist to get braces to get this whole thing started, as well as a consult with the oral surgeon to see about surgery to correct my bite.
My examination appointment will be tomorrow morning at 9:30 a.m. and I've already submitted my health history to them. Let's hope things go for the better, this time.
Saturday, January 16, 2010
Incompetence
At noon, I was released from work. I then proceeded home to look for my insurance card, then left the apartment to head out to the dentist's office. Traffic was rather heavy on Pacific Coast Highway as I ventured southwest to the office. Eventually, I finally got there a few minutes after 3 p.m. for my 3:30 appointment.
Waiting in the lobby was a man wearing medical smocks. It turns out this is Dr. Borna who introduced himself. He then asked me if I was there to have teeth pulled. I must have been taken back quite a bit by this question as I suddenly found I was stammering out that I was there to get a consultation for my underbite. He then called the assistant, Jessie - who also works at the Sea Cliff Dentist in Huntington Beach - to the front desk and she requested that I fill out my medical history.
For some reason, they had scheduled me to have my wisdom teeth removed. There's a small problem with this: I had my wisdom teeth removed back in 1990 and I stated that I told Dr. Tran's office that I was requesting a consultation with an oral surgeon for my mandibular prognathism.
Dr. Borna then stated that he did not specialize in this and that I needed an appointment with an oral maxillofacial surgeon or an orthodontist. I thought that's what I was there for!
All of this wouldn't have made me so completely irritated if it weren't for the fact that the doctor and assistant then started looking through the computer to see what their next appointment was and acting as though I didn't even exist, rather than try to offer up a different solution such as a possible referral to an orthodontist or oral maxillofacial surgeon.
Not only has this temporarily derailed my plans on getting this whole thing started, it has resulted in me deciding to get in contact with a new dentist. I've found that there's one that's actually closer to me that I can get to on the way to and from work on Beach Boulevard, they also have several specialists under the same roof, including an oral surgeon and an orthodontist. Hopefully there, they'll actually listen to their patients when they're told that they need something done.
We are experiencing technical difficulties. Please, stand by.
Waiting in the lobby was a man wearing medical smocks. It turns out this is Dr. Borna who introduced himself. He then asked me if I was there to have teeth pulled. I must have been taken back quite a bit by this question as I suddenly found I was stammering out that I was there to get a consultation for my underbite. He then called the assistant, Jessie - who also works at the Sea Cliff Dentist in Huntington Beach - to the front desk and she requested that I fill out my medical history.
For some reason, they had scheduled me to have my wisdom teeth removed. There's a small problem with this: I had my wisdom teeth removed back in 1990 and I stated that I told Dr. Tran's office that I was requesting a consultation with an oral surgeon for my mandibular prognathism.
Dr. Borna then stated that he did not specialize in this and that I needed an appointment with an oral maxillofacial surgeon or an orthodontist. I thought that's what I was there for!
All of this wouldn't have made me so completely irritated if it weren't for the fact that the doctor and assistant then started looking through the computer to see what their next appointment was and acting as though I didn't even exist, rather than try to offer up a different solution such as a possible referral to an orthodontist or oral maxillofacial surgeon.
Not only has this temporarily derailed my plans on getting this whole thing started, it has resulted in me deciding to get in contact with a new dentist. I've found that there's one that's actually closer to me that I can get to on the way to and from work on Beach Boulevard, they also have several specialists under the same roof, including an oral surgeon and an orthodontist. Hopefully there, they'll actually listen to their patients when they're told that they need something done.
We are experiencing technical difficulties. Please, stand by.
Friday, January 15, 2010
Less Than 24 Hours To Go
Finally, my consultation appointment is tomorrow afternoon. While I am excited, I'm too tired from work to be left sleepless. From there, I shall hopefully see what it is that I'm going to have to go through to get this surgery taken care of, including braces, teeth extraction and the actual surgery.
Stay tuned.
Stay tuned.
Tuesday, January 5, 2010
Preparation For Surgery
In less than 2 weeks, I will be heading into the oral surgeon's office for a consultation to have another congenital defect corrected. (The first correction was the deviated septum.) For those that don't know what I'm referring to, it's my underbite.
The technical name for this facial skeletal deformity is known medically as mandibular prognathism. This is where the lower jaw (the mandible) extends out farther than the upper jaw (the maxilla). In my case, when I last had it measured, my jaw extends out 8 mm. This measurement was taken when I was 17 for my first ever visit to a dentist when I was in Basic Training in the US Navy. It's possible that my underbite may have progressed even further as I was still growing all the way up until the age of 26.
I also have several crossbites (an abnormal relation of one or more teeth of one arch to the opposing tooth or teeth of the other arch, caused by deviation of tooth position or abnormal jaw position.), overjets (increased projection of the upper teeth in front of the lower teeth, usually measured parallel to the occlusal plane. Also called horizontal overlap), general tooth crowding (you can figure this out for yourself) and a malocclusion (a reversal of the normal relationship of the mandibular and maxillary teeth, with lateral displacement of opposing teeth–i.e. a poor bite).
The result for me is that rather than all of my teeth matching up as they are supposed to, I currently only have 4 major contact points in my mouth where my teeth come together. This is a problem when it comes to eating - I have to eat closer to the corner of my mouth in order to tear food apart when not using utensils like knives as my upper and lower front teeth don't match up.
This also affects my appearance. Many people think that I'm mad about something since my jaw is "jutting out." It's not uncommon for one of my female co-workers to constantly ask me, "What's wrong?" when in fact, there is nothing wrong. It also resulted in the highlight of my first visit Dr. Kheim Tran. She is the dentist who referred me to the surgeon. After discussing the surgery procedures I had been advised of back when I was in the USN as a Dental Assistant (DT-8707) and what I could expect as far as follow up and whatnot, she stated, "When they do that, then you'll be handsome."
What I can look forward to, based on what I was told back in the late 80's/early 90's is about 18 months of orthodontic appliances (braces) prior to the surgery, as well as about a year or so of braces after the surgery. The surgery itself will possibly involve incisions in the mandible and moving it back, as well as removing the maxilla and replacing it further forward, lower and possibly to the side. This could result in screws, pins or other metal items in my mouth which could make going into the airport a lot of fun.
Also, from what I've been studying, the old technique of wiring a patient's jaw shut after the surgery has been phased out in most cases. Instead, they're now using strong rubber bands to help keep the jaw set rather than wires, which was the older way of doing this type of surgery. The rubber bands are much easier to remove in the case of vomiting, as opposed to carrying wire cutters in case such a thing should happen. Also, with the recent introduction of rigid internal fixation (plates and screws) for this surgery, much of the immobilization of the jaw has been eliminated so that the mouth is kept closed for only a few days, versus several weeks.
I also get to look forward to finding out what kind of orthodontic appliances I will be getting and seeing how much of the cost of that will be covered under insurance. In my studies, I've found that $1,000 is covered in most cases; however, in severe cases of malocclusion, the entire cost is covered under dental insurance. From what I've read, things like Invisalign, which a co-worker of mine is going for this year, and colored braces are not an option for cases such as mine.
The actual surgery itself is not covered under my dental plan, but it is covered under my medical insurance. This, I think, is very odd, but hey.
All in all, if it helps my appearance, that's fine. I'm doing this, though, so I can eat properly. However, all of the surgical information is still up in the air as I've not actually had my first visit with the surgeon to find out what is in store. I will update you on this once I actually find out what I can expect in the coming months.
Sources:
http://medical-dictionary.thefreedictionary.com/crossbite
http://medical-dictionary.thefreedictionary.com/overjet
http://medical-dictionary.thefreedictionary.com/malocclusion+of+teeth
The technical name for this facial skeletal deformity is known medically as mandibular prognathism. This is where the lower jaw (the mandible) extends out farther than the upper jaw (the maxilla). In my case, when I last had it measured, my jaw extends out 8 mm. This measurement was taken when I was 17 for my first ever visit to a dentist when I was in Basic Training in the US Navy. It's possible that my underbite may have progressed even further as I was still growing all the way up until the age of 26.
I also have several crossbites (an abnormal relation of one or more teeth of one arch to the opposing tooth or teeth of the other arch, caused by deviation of tooth position or abnormal jaw position.), overjets (increased projection of the upper teeth in front of the lower teeth, usually measured parallel to the occlusal plane. Also called horizontal overlap), general tooth crowding (you can figure this out for yourself) and a malocclusion (a reversal of the normal relationship of the mandibular and maxillary teeth, with lateral displacement of opposing teeth–i.e. a poor bite).
The result for me is that rather than all of my teeth matching up as they are supposed to, I currently only have 4 major contact points in my mouth where my teeth come together. This is a problem when it comes to eating - I have to eat closer to the corner of my mouth in order to tear food apart when not using utensils like knives as my upper and lower front teeth don't match up.
This also affects my appearance. Many people think that I'm mad about something since my jaw is "jutting out." It's not uncommon for one of my female co-workers to constantly ask me, "What's wrong?" when in fact, there is nothing wrong. It also resulted in the highlight of my first visit Dr. Kheim Tran. She is the dentist who referred me to the surgeon. After discussing the surgery procedures I had been advised of back when I was in the USN as a Dental Assistant (DT-8707) and what I could expect as far as follow up and whatnot, she stated, "When they do that, then you'll be handsome."
What I can look forward to, based on what I was told back in the late 80's/early 90's is about 18 months of orthodontic appliances (braces) prior to the surgery, as well as about a year or so of braces after the surgery. The surgery itself will possibly involve incisions in the mandible and moving it back, as well as removing the maxilla and replacing it further forward, lower and possibly to the side. This could result in screws, pins or other metal items in my mouth which could make going into the airport a lot of fun.
Also, from what I've been studying, the old technique of wiring a patient's jaw shut after the surgery has been phased out in most cases. Instead, they're now using strong rubber bands to help keep the jaw set rather than wires, which was the older way of doing this type of surgery. The rubber bands are much easier to remove in the case of vomiting, as opposed to carrying wire cutters in case such a thing should happen. Also, with the recent introduction of rigid internal fixation (plates and screws) for this surgery, much of the immobilization of the jaw has been eliminated so that the mouth is kept closed for only a few days, versus several weeks.
I also get to look forward to finding out what kind of orthodontic appliances I will be getting and seeing how much of the cost of that will be covered under insurance. In my studies, I've found that $1,000 is covered in most cases; however, in severe cases of malocclusion, the entire cost is covered under dental insurance. From what I've read, things like Invisalign, which a co-worker of mine is going for this year, and colored braces are not an option for cases such as mine.
The actual surgery itself is not covered under my dental plan, but it is covered under my medical insurance. This, I think, is very odd, but hey.
All in all, if it helps my appearance, that's fine. I'm doing this, though, so I can eat properly. However, all of the surgical information is still up in the air as I've not actually had my first visit with the surgeon to find out what is in store. I will update you on this once I actually find out what I can expect in the coming months.
Sources:
http://medical-dictionary.thefreedictionary.com/crossbite
http://medical-dictionary.thefreedictionary.com/overjet
http://medical-dictionary.thefreedictionary.com/malocclusion+of+teeth
Subscribe to:
Posts (Atom)
