Open bite extractions, small mouth, big tongue, and a vague oath

[CCinBraces]

Hi all!!!

Ive been browsing this place for a while now but haven't posted till now...so how you all doin'? :)

Prob will get lengthy but heres the deal...

I had braces for over 4 years as a teen which included an expander to make room for some crowding (which worked!) and a tongue spike in order to "teach" my tongue thrust to cut the crap. (didn't work) At the end of treatment, teeth looked nice and straight but I still had my open bite. (couldn't tell if I was smiling--but lips didn't/dont close when relaxed) That ortho recommended organathic surgery but my parents wouldn't agree to it. When braces were taken off, I had lots of compliments on my smile. Even though I had the open bite still, it just looked more like I had a big smile.

Few yrs later...all wisdom teeth removed.

Now Im 30 and back in braces. I wanted to get them on because my dentist was concerned about my cross bite (didn't know I had one) and the fact that I was only properly biting down on TWO teeth. Of course, he mentioned the open bite as well. I was already looking into potential ortho treatment because I seemed to have developed a type of speech impediment.

Turns out, my top teeth had flared out quite a lot due to the tongue thrust which caused the speech issue. Of course, that maybe my open bite look WAY worse and the bite was a lot more open on one side than the other--you could see my tongue moving about as I spoke. Eek. Beyond that, my teeth are still mostly straight with just a couple slightly turned--not a huge deal. Ortho confirmed a cross bite too.

Braces have now been on since early Fall...Where Im at now---the flared teeth have been pulled back with the braces and the speech issue is gone. The teeth are "level" or "stacked." SO basically, Im back to where I was after my first round of braces, except for straightening out a couple of teeth. But theres the cross bite and open bite. Now My understanding IS...the cross bite will be corrected with rubber bands...doesnt seem to be a big deal. The open bite--ortho started out saying I needed jaw surgery on both the top and bottom, then just the top, then said might need premolars removed, then said TADS but fifteen minutes later said premolars again. Goodness. Can you see why Im stressed?

I told him I wanted to think about it for a while and expressed my concerns...but that same day they removed the wire and the necessary brackets anyways and told me, "you better make an appt quick or these teeth are going to start moving." I was not happy. I also attempted to schedule an consult with him but when I arrived, they claimed I did not schedule one. The ortho simply told me not to worry about extractions and that his only concern is with my tongue being too large. I asked what we would do about that and his reply was, "It'll probably retract itself and be fine." When asked again, "Don't worry about it. You'll love your smile." Sounded like a car salesman.

The hygienist attempted to find a pic of someone who had it done but apparently they no longer have the photo so I was advised to google it. Is it just me or is this not quite right????!!!!

I am concerned about the extractions because I already have a small mouth and a big tongue and a tongue thrust. I am worried my teeth my flare out again and I do know that its quite possible, even likely, to occur again Im also not made of money so I cannot simply hope I don't need more procedures to pay out of pocket and have no idea what would be done regarding a "too large" tongue for a mouth made smaller.

My appt for extractions was today and I cancelled. Ive only had two weeks to even think about this which seems horribly rushed but am stressed about the fact that IM not wearing my whole set of braces right now either. I am wondering what the damage would be if I just left the open bite as is...Im not sure if its medically necessary to fix it or will result in damage? Plus my hubby used to tell me the open lip thing was cute and he's gone now :'( so I think I may be holding onto it. I know, probably weird.

I attempted three other consults before starting treatment but found out the all three of those would only take X-rays for free and then told me to reschedule in order to discuss the potential treatment plans (aka FINISH the consult). But that would come with a $200-300 fee per ortho. SO it gets EXPENSIVE QUICK.

Now Im lost. Im a very anxious person going through a lot right to anyways and Im about to have one of my little freak out breakdowns because I don't know what to do. (really Ive been through a lot of loss lately--am not just cuckoo)

Would love feedback/advice/opinions/someone to make a decision for me.

Thank you....

[CCinBraces]

*****a vague ORTH, not OATH. goodness.

[Mimo1985]

Im so sorry about all of you issues with orthos - I know it can get really expensive really quickly.

Regarding your tooth being extracted - feel free to clarify if I didnt understand this correctly but did you try and get a second opinion already and all of the orthos said consults would be around $200? I dont know if its possible for you but I would try and find an ortho who can give you a consultation for free - be able to give input on your situation and then you can decide.

I have an open bite and my first ortho suggested either surgery, or one tooth extracted and braces - neither of which sounded appealing. But then I found an ortho who said just braces and some IPR would do the trick.

[CCinBraces]

Thanks for responding.

What is IPR?

I attempted a 2nd, 3rd, and I believe even a 4th opinion....but you are correct...the orthos say that it is a free consult. However, the hygienist/nurse takes the X-rays and then they say I need to schedule another appointment in order to speak with the doctor...which comes with a fee of between $200-300, depending on the orthodontist. Of course, this means its NOT REALLY a free consult at all...they just like to say it is. I was stunned the first time...

I wouldn't feel so bad if it was just one tooth...but the ortho Im seeing, who was the only one with an actual free consult...is saying I need all four premolars removed. He has been so indecisive though as well, even changing his mind in a matter of minutes. Jaw surgery simply isn't an option for me financially or due to the major loss of time off work.

Im concerned about taking out teeth but also wondering if its even worth it...he is saying the result will NOT be perfect. Im actually ok with the open bite as is, cosmetically.

[CCinBraces]

Also, did you have any tongue thrust issues beforehand?

[sandiego88]

It seems weird that they aren't giving you a free consult. We're probably in different locations but I went to get 2 consults and both were free. Maybe you can explain to the ortho that you are hesitant on your current orthos plan and would like a second opinion. Consider researching a new ortho and switching if you have the means to do so. I had a terrible ortho the first time around and had invisalign for 2.5 years. I;m now 1/2 year into braces with another year to go. I wish I had switched when I first began to feel uncomfortable. Good luck. You can also try posting your info on the website real self for opinions from other doctors. It was very helpful for me. I also found that my dentist was helpful in urging me to continue after the inviaslign mishap and he's been checking up on my alignment during each cleaning.

[sirwired]

Thanks for responding.

What is IPR?

I attempted a 2nd, 3rd, and I believe even a 4th opinion....but you are correct...the orthos say that it is a free consult. However, the hygienist/nurse takes the X-rays and then they say I need to schedule another appointment in order to speak with the doctor...which comes with a fee of between $200-300, depending on the orthodontist. Of course, this means its NOT REALLY a free consult at all...they just like to say it is. I was stunned the first time...

I wouldn't feel so bad if it was just one tooth...but the ortho Im seeing, who was the only one with an actual free consult...is saying I need all four premolars removed. He has been so indecisive though as well, even changing his mind in a matter of minutes. Jaw surgery simply isn't an option for me financially or due to the major loss of time off work.

Im concerned about taking out teeth but also wondering if its even worth it...he is saying the result will NOT be perfect. Im actually ok with the open bite as is, cosmetically.

Those x-rays belong to you. You only need them taken once, and then you can request a copy (they are almost always digital, and they can e-mail them to you or put them on a thumb drive.) It costs money to take records (and yes, sometimes they are needed prior to the treatment plan being delivered) but you don't need them taken at every office.

[CCinBraces]

I will check out that site for sure.

It seems to be the norm here to charge for the consult. They don't charge for the X-rays and most insist on taking their own. There is no such thing here either as a "free estimate" when it comes to car repair.

Ive already paid in full and am not interested in switching orthos. At this point it sounds like my only decision is to remove four teeth or not. Just hoping there would be another option.

[jfriend33]

can you post some photos of your smile here? you should check out the amazing progress ive had with my open bite from myofuncitonal therapy as well as TADs, braces, and elastics!

http://www.archwired.com/phpbb2/viewtop ... 13&t=48027

[CCinBraces]

I do have pics, yes. However, ended up talking to another ortho today who agrees that Tads will not work for me..as they are usually for a moderate or mild open bite. UGH. He doesn't think removing my biscupids will do much either and says it will be mostly just cosmetic, leaving the actual skeletal issue in tact. He recommends jaw surgery and gave me a referral for an oral surgeon. He went over some of the major issues that could/will occur due to my open bite in the future. This sucks.

[mmkay]

I do have pics, yes. However, ended up talking to another ortho today who agrees that Tads will not work for me..as they are usually for a moderate or mild open bite.

If you do need surgery, it may be because closing your open bite non-surgically will not do enough for other problems that commonly go with open bite e.g. lip incompetence, excessive facial height.

Molar intrusion can work for some pretty severe open bite cases - lower molars have to be intruded as well in such cases, though.

Search for "severe open bite skeletal anchorage". The literature on this stuff dates back to late 1990s. Example URL:
https://www.linkedin.com/pulse/treatmen ... an-morteza

Orthodontists who use these techniques is who you need to be dealing with. Others may fob you off and revert to what they know.