Should I confront my Ortho about this??? (pics now up...eww)

This forum is for discussions relating to oral surgery for orthodontics.

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jonathon003
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#16 Post by jonathon003 »

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picture number 2 here I took just to show u what my bottom permanent retainer has done to my bottom teeth. u can see how they are shifted outwards at an angle. also possibly due to just not enough room in my small mouth for all my teeth?

....more coming

jonathon003
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#17 Post by jonathon003 »

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it also seems like my back teeth, both bottom AND top have moved or tilted inwards, maybe also signaling too much teeth for my small mouth? like instead of a nice rounded half circle for my teeth (ok i know it's not really a half circle shape, narrower or whatever) my formation is more triangular only obviously no point at the top but the tip chopped off. if that makes any sense...

jonathon003
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#18 Post by jonathon003 »

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ok so anyone with anymore advice?? i have my app with my ortho this Thursday. You can see my mouth is just a complete mess right now, imo anyway. I seem to think my lower jaw needs to be pushed forward, not sure about the upper jaw really. You can see my chin or lack thereof is weak and receded. In fact if I shave all my hair to the skin with a razor it looks really weird and even more disgusting. I'm forced to have stuble there at minimum for life or until this is fixed! Also does it look like I need extractions?? I know it might be impossible to tell from the pics I showed though. I just pray after all this my mouth can look normal and it can be comfortable to keep closed.

PS. noticed how going up from my chin to my lower lip, it jet's way out to get around my gums/teeth?? can this be fixed too?? possibly my gums pushed back with my lower teeth? or will that always be present? looks really weird at times.

jonathon003
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#19 Post by jonathon003 »

Meryaten wrote:I believe that OHIP covers hospital fees, anesthesia and so forth, but you'd need to pay the OS's fees.

As to the normal resting position for the mouth - it should be with the teeth slightly apart, and the tongue would normally be resting on the roof of the mouth (not the back of the teeth); the lips should be closed and unstrained.
really?? that's kind of a downer. how certain are you? and do you have ANY ballpark figure of how much the surgeons fees would run?

and hmmm it feels awkward for my tongue to "rest" (doesn't feel like resting) on the roof of my mouth, and seems oftly close to the edge of my front teeth if not touching them.

i wonder if my speech problems (just find it strenuous to pronunciate and socialize in general, as if i need to EXAGERATE my mouth movements in order to pronunciate effectively) are due to my jaw issues, or a toungue issue, maybe being too large? ahh man.

Audra
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#20 Post by Audra »

I'm in Alberta and I believe it works the same way re: surgery in that hospital anaesthesia etc are covered by provincial health care (mine is), but surgeon's fees are paid out of pocket. My surgeon is charging $2000 and his initial fee was $190.
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Spiral
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#21 Post by Spiral »

Hi Jonathon003,

My orthodontist also didn't mention my jaw at any time when I had braces the first time round. It was only when I went back to him a few years later because I wasn't happy that he said he'd known I would need surgery to fix things completely. I was a bit annoyed about that as well, but I think he was hesitant to point out the problems to a young teen who probably hadn't noticed them yet. Plus, I assume I needed to stop growing first.

From your photos I can't really see much of a slant in your bottom teeth, probably because mine was worse! Both my top and bottom teeth were slanted slightly outwards. As far as I know, your retainer didn't cause this, it's just the way they grew, possibly because your mouth is small... I had to have a few teeth removed and braces to pull the slant in.

As for your chin, I have often wished I was male so I could grow a beard to hide mine :) Yours looks kind of similar to mine, and mine is basically because my lower jaw didn't grow far forward enough. I'm don't know exactly why your lower lip jets out like that (mine does the same), but I sometimes wonder if it's because the bottom jaw and chin hasn't grown far enough forward to actually fill it out enough and give it shape... If that makes sense.

Obviously, I'm far from being an expert and this is just conjecture. Your orthodontist is really the best person to speak to!

jonathon003
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#22 Post by jonathon003 »

Spiral wrote:Hi Jonathon003,

My orthodontist also didn't mention my jaw at any time when I had braces the first time round. It was only when I went back to him a few years later because I wasn't happy that he said he'd known I would need surgery to fix things completely. I was a bit annoyed about that as well, but I think he was hesitant to point out the problems to a young teen who probably hadn't noticed them yet. Plus, I assume I needed to stop growing first.

From your photos I can't really see much of a slant in your bottom teeth, probably because mine was worse! Both my top and bottom teeth were slanted slightly outwards. As far as I know, your retainer didn't cause this, it's just the way they grew, possibly because your mouth is small... I had to have a few teeth removed and braces to pull the slant in.

As for your chin, I have often wished I was male so I could grow a beard to hide mine :) Yours looks kind of similar to mine, and mine is basically because my lower jaw didn't grow far forward enough. I'm don't know exactly why your lower lip jets out like that (mine does the same), but I sometimes wonder if it's because the bottom jaw and chin hasn't grown far enough forward to actually fill it out enough and give it shape... If that makes sense.

Obviously, I'm far from being an expert and this is just conjecture. Your orthodontist is really the best person to speak to!
hey curious to know whether u saw a noticable change in your facial appearance after getting teeth extracted? i seem to be just learning of this scary possibility of your face sort of caving inwards or just changing noticably. I was initially pretty cool with the idea when my ortho brought it up b/c i DO feel my teeth have shifted so much probably b/c naturally they're just too big/need more room than my mouth can give. But after hearing a couple stories about how tooth extraction can "ruin faces" I'm a little put off.

Yeah who knows about the lip thing. I'm sort of hoping if and when my lower teeth get pushed back a little, my gums might follow and will reduce the the amount it jets out, but probably won't be enough to make a noticable difference. BUt as long as my chin/jaw get moved forward enough so that it lines up with my upper, I'll be happy. And you're right I'm definetly really lucky I can grow facial hair to give an illusion of a more pronounced chin...BUT, at the same time, imho, women don't have the same pressures to have a strong jaw and pronounced chin. Some men would consider such a weak chin on a girl kind of cute I'm sure. But no I'm not trying to downplay your case, because EVERYone wants a nice side profile. Thanks a lot for the feedback and sharing your story.

jonathon003
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#23 Post by jonathon003 »

Meryaten wrote:I do see what you mean about your chin. It's hard to say much about how the bite/teeth fit, because it's hard to tell what is your natural bite and where you are "posturing" - jutting the chin forward. It does look like you can close you lips (that's good - sme people can't even do that) but to do so, are you straining? Is that first pic in the third post with pics your lips at natural rest? i.e. are they open if you just relax your mouth?
Yeah definetly it's a strain. Let's put it this way...I cannot KEEP my mouth closed if I'm not consciously thinking about doing so. If I'm closing my eyes on the subway, and 'uncomfortably' close my mouth, as soon as I take my mind off my mouth it will open. It's very frustrating. And yes that 1st pic in the 3rd (or 4th) post is my mouth at natural rest. So i'm not sure if surgery can even correct that or what. I mean what if my top lip is just too short? No knowledge on how easy this problem can be fixed. I do know that it DEFINETLY affects my speech though. Pronunciation seems like a chore. I could have a sentence all ready to go lined up in my head and want to get it out quickly, but because I must move my mouth farther to pronounce different sounds (with lips closed...such as "B" sounds" it makes me not only self conscious about it, but a struggle to get everything out and sounding very proper.

jonathon003
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#24 Post by jonathon003 »

Meryaten wrote:Here's what this non-dental professional thinks: your ortho gave you a decent functional bite first time around, but clearly the results have not been as stable as would be desired, and that treatment addressed neither your dissatisfaction with the appearenace of your chin, nor the functional issue of lip incompetence/lip strain.

I am confident that surgery could give you a more favourable aesthetic: lower jaw surgery would not only improve your chin, but would probably also soften your nose a little, and would (I am pretty confident) relieve the lip strain issue too. What I don't know is what sort of orthodontic decompensation would be needed prior to surgery, so that a functional bite would also be achieved.

Again though: I am not a dental pro - have consultations and be clear about your goals.
Alright, appreciate all the help. I will continue to update with my progress as I'm pretty certain I'll be going through with this whole thing.

When you say soften my nose, you mean make it LOOK less pronounced I assume?? Cuz i'm unaware of how lower jaw surgery would affect nose structure or mechanics.

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bb
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#25 Post by bb »

I live in Ontario too and OHIP does cover 100% of the surgery. But you have to pay for records.
I'd advise you to get a consult with an oral surgeon or two. Since braces were not entirely successful, perhaps there's an underlying bone structure issue that a surgeon would be entirely familiar with.
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jonathon003
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#26 Post by jonathon003 »

Meryaten wrote:Take a look around at a few of the before and after pics of people who have had lower jaw surgery only. Where the lower jaw was initially set quite far back, you will often see the nose initially appears almost rounded - how can I describe it ... almost as if the skin is pulled too tight. When the lower jaw is brought forward (and there is generally also a rotational component too) it tends to let the skin in the lower part of the mid-face "relax" a little, and the nose will often look a little softer as a result.
wow thats crazy. cuz i definetly have that, where my nose is rounded. I will try to find before and after pictures. I just had no clue that the lower jaw being back could affect that. Although I KNOW that when I smile, it becomes even more rounded, which might explain the skin being pulled thing. So hopefully what your saying is that might fix itself too? Thats awesome! Man I wish I could get this NOW.

and "bb" thats great news. As long as majority of it is covered I'm satisfied; so from all accounts i've heard it seems like that is the case.

jonathon003
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#27 Post by jonathon003 »

just a small update. going to see the oral surgeon tmrw afternoon. i chickened out and didnt "confront" my ortho about the past, but did find out info on why he probably didn't inform me about my jaw issues. We were talking, after I brought up the possibility of orthognathic surgery, b/c he basically showed me the xray and how my jaw was basically tilted downwards (picture a vertical line rotated clockwise about 30 degrees or so)...and anyway he told me how braces wouldnt obviously correct the jaw problems, and so I asked do you think it would be a good idea to have surgery then? He basically told me he NEVER recommends surgery, unless it's a pretty severe case as he would never want his own children to take on such risks if it were not absolutely necessary. but after telling him how much these things stress me and how I just want to be able to close my mouth comfortably etc, he agreed that it would probably be a good idea.

anyway after initially getting an appointment scheduled for Feb 10 with 1 of the surgeons he recommended (the less busier of the 2) I called my ortho back asking for the other number today. to my amazement they had a cancellation tmrw afternoon...so that is where I stand right now. so excited to shave 2 whole months off the whole process, already a good start!

jonathon003
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#28 Post by jonathon003 »

oh and if anyone has any advice as to things to ask him or find out about that wouldnt be as obvious, don't hesitate to fill me in! thanks.

ohmyjaw
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#29 Post by ohmyjaw »

I agree with Meryaten. While surgery does come with some risks, major complications are extremely rare, and in most cases the benefits of the surgery outweigh the risks. Your ortho did you a disservice. It's possible that he just doesn't know enough about what jaw surgery can achieve for the patient, and when it should be recommended.

I also think this illustrates the importance of seeking several opinions before you begin orthodontic treatment. Not that I am being critical of you for not doing so originally. I also had orthodontic treatment as a child, and we trusted the ortho to do the best thing. I found out years later that he was wrong, and I basically had to start from square one.

Figamentation
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#30 Post by Figamentation »

Maybe I missed it in this thread, but unless there's some underlying reason not to, I would seriously recommend looking for other orthodontist options. Your ortho has already said how reluctant he is to recommend these surgeries and that would really make me wonder how effective he would be at getting your mouth ready for the surgery...the ortho plays a vital role in ensuring placement of the teeth are ideal and if he's that against it, I just wouldn't be entirely comfortable with him handling my case. If he's your only option, then so be it...but if not perhaps consider looking elsewhere, maybe even asking the surgeon what orthos he works best with.

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