Tuesday, March 26, 2013

My decison to have jaw surgery

I realize from the backstory post it makes it seem like the decision to have surgery was an easy one.  It was not and I felt it was worth adding a post addressing this.

I hated having braces as a kid.  I did everything I was told just so I could be done fast.  I was the only kid in my class who had permanent teeth pulled.  I never understood why.  I hated how I looked when I had the big gaps in my teeth during treatment.  Truthfully, I never understood why I needed braces because I thought my top teeth looked pretty good and my smile was "pretty." I never liked the way my smile looked after getting braces off even though the teeth were straight.  There were actually a few black gaps between the top and bottom teeth but I figured that must be normal (later found out that was my open bite).  I felt there was something about the missing teeth that made my smile look less attractive.  Or maybe I was just being harsh on myself because my face was changing during those awkward teen years.  I was always bitter about the loss of those teeth, there was nothing wrong with them and now I'm already starting out adult life with less teeth than 95% of my peers.

Turns out what I didn't like all those years was actually my skeletal problems. The "mile high gums" were what made my smile look less attractive.  The front teeth were tipped back, making my face look sunken.  The black gaps in my teeth was my openbite.  The frowny looking face with dimples on my chin when I held my mouth closed was the long face with lip incompetance.  And for being 100 lbs, I thought I always looked like I had no chin line, that was my rethnogenia.

When I went to the dentist 3 years ago (moved to a new city), and they diagnosed me with all of these problems plus an overjet and class II molar relationship, I was honestly devastated. I couldn't believe that after all the unhappiness of going through treatment as a kid, NONE of these problems were fixed.  And now that I was an adult, they gave me the even worse news that the only way to fix it was with surgery.  Hell NO!  I HATE hospitals.  I outright refused.  But then it started to eat at me...

Sometimes I think it's psychological, once someone points out a "blemish" you can't help but obsess over it. 

I did a lot of research and decided to schedule consultations with at least 3 different orthodontists to see if my situation could be fixed WITHOUT surgery.  I heard about these things called TADS/miniscrews that could be drilled in your jaw and attached to braces, could push all your teeth into your gums, making the openbite and gummy smile a bit better.  I was so desperate to do this without surgery, I was looking into doctors in neighboring states (3-5 hours away) just because they might help me.  I ended up picking 3 different local orthodontists to consult first. 

At my first consultation, the orthodontist said that my teeth looked "fine" and he wouldn't want to fix them.  He also poo-pooed my TMJ and joint damage.  He suggested I get veneers if I didn't like the openbite.  WOW.  Nice. 

At my second consultation, the orthodontist said I absolutely needed surgery or my underlying conditions would get worse.  They really pointed out the extent to which my skeletal problem was a detriment to my health.  I came off very combative and listed about 10 reasons I didn't want to do surgery.  They were impressed with how much research I had done.  They offered the TAD option, but explained it wouldn't fix all my concerns and had a high chance of relapse since the true underlying problem isn't actually getting fixed.  Before I left the room, the doctor looked me in the eyes and said, "After spending this hour with you, I think I know the kind of person you are, and you won't be happy unless you get the real problem fixed... think about the surgery." 

At my third consutation, the orthodontist gave me two options: she said I really needed surgery to fix everything.  I immediately barked back NO way!  Then she moved onto the TAD/miniscrew option.  She was going to pull up the back teeth, reducing the gummy smile somewhat.  I agreed to this treatment.  She sent me to an oral surgeon for a consult about the TADs.  Turns out they weren't going to do just screws, but whole plates with hooks.  The surgeon would cut into my gums and screw "temporary" plates into the upper jaw bone around my nose and then a metal hook would hang down into my mouth area.  They explained this was surgery and that I would have to spend the rest of the day at home resting and gave me prescriptions for narcotics and told me that I would need to ice the area because it would cause swelling.  The total cost just for installation was a couple thousand and this was without anesthesia.  Yikes!  Sounds like a lot of money, a surgery situation, and still only half results.  And insurance wasn't going to cover any of this. 

In the middle of this, I had started seeing an ENT (Ear, nose, and throat) doctor because the second orthodontist suggested I might have sleep apnea tendencies due to my face structure.  I explained the situation to the ENT and he agreed, saying that all the factors I listed placed me at a high risk for sleep apnea without even having to run a sleep test.  I had a smaller than normal airway and a deviated septum.  He said patients like me as they get older tend to bend forward as they try to get better breath and end up more hunched over and wheeze because their airway starts to collapse.  He left it up to me, but said I would definitely benefit from the surgery. 

I realized, being a pretty stubborn person, sometimes I'm willing to do anything BUT what I really should do, just because I'm hellbent on not doing it. 

After sitting on this information for a while, I called the orthodontist I had chosen and told her that I wanted to seriously look into the jaw surgery thing, not the TADs.  She gave me a reccomendation of a great oral surgeon (makes the Top Doctors list in DC) and I went to my consult with a list of combative questions in an effort to shoot down the idea of surgery because of the risk of numbness... or fear of surgery in general.... or that I might lose weight during recovery... any stupid excuse my stupid brain could come up with.  I went to see the surgeon, showed him my list of questions, he answered each one.  I think he gave me a dose of reality... it's not that bad of a surgery, the possible side effects are minor and nuisances, nothing life altering or life threatening.  He said I need to get over my fear of hospitals and surgery, you could always have an emergency situation and need surgery, then you don't have a choice.  I walked in ready for World War III, I walked out confident that I was going to do the surgery....  And that's where this blog truly begins.