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...

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].)

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.

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!

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.

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.

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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.

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