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.