Braces for a second time, opinions?

[Toothygrin92]

Hi everyone,

I'm a newbie so please be nice! I've lurked for a while before to get an understanding of how this forum works so hopefully I've picked up the right stuff!

Basically, I had orthodontic treatment when I was 11-14, starting with what I believe is called a functional appliance which was basically a plastic thing on the roof of my mouth with a wire bit going around my two front teeth, two bits that held onto 2 molars (one either side) and a springy part (basically a wire with a loopy spring) on the left. I also had a headgear (which by the way I hated passionately!) I then had full metal braces top and bottom to correct a deep bite and to straighten out my front teeth (which by the way were horrendous, teeth in all directions!) I had them removed after about 2 years and was happy with the appearance just about. My midline was off by about 2.5mm and one of my front teeth still stuck out ever so slightly.

I wore my retainer every single night for 4 years (it was a plastic one that looks like invisalign) before it broke. I had a small amount of movement but nothing significant. I have had a bit more movement since my retainer has broken but again, they are pretty much the same as before, only slight movement.

My problems come from three areas:
1. Open bite. there is only one point of contact between my teeth, when I try biting eg lettuce it just slides right out.
2. TMJD. 100% sure it's because of my othro treatment. Never had problems before, it's getting worse and worse now.
3. I have a feeling my general facial appearance has changed. My jaw is slightly crooked and my smile is higher on the left than the right.

I have had absolutely enough and have decided to get braces again. I will probably attempt NHS treatment again since my problems started because of the poor job my ortho did though it's doubtful I'll get it, so I do have some savings I can use.

My question is, what can be done about this, and is it serious enough to warrant treatment again? I will probably still get it either way because I am unhappy but I would like some opinions.

Many thanks.

http:// i45. tinypic .com/1217msx.jpg
Normal smile

http:// i45. tinypic .com/bio5tz.jpg
Bitten together, view from below (shows overjet)

http:// i50. tinypic. com/o6egdy.jpg
Shows open bite

http:// i48. tinypic. com/2n3t03.jpg
Bitten together, view from right (sorry I have awful skin haha!!)

http:// i45. tinypic. com/spc2l2.jpg
Bitten together, view from left

[Toothygrin92]

My apologies, I forgot to mention, I'm 20 years old :)

[denferb]

in my opinion your smile looks great and it doesnt need to change.

for the cost of braces im not sure an orthodontist could give you much better results.

[Toothygrin92]

Thanks for the reply :) It's not necessarily just the appearance that bothers me (though it plays a part) it's more the function ie the open bite and the pain I get in my jaw. I wonder if it's because wisdom teeth have moved my teeth around but it's almost like there's no comfortable place for my jaw to sit in :-s If the dentist says 'bite together' there are literally three different positions I can bite in and none are comfortable :o

[plugnickel69]

In my opinion treatment will definitely help and not only give you a pretty smile, but also a healthy bite. Without treatment I would expect that your problems will continue to worsen. Teeth tend to do that when they're not properly supported or retained after treatment, as you and so many of us have learned. I wish you luck.

[Toothygrin92]

Thank you also. That is one of the main things that made me decide to get started again now, my overjet has probably increased because I never noticed it before. I didn't have an open bite when my braces first came off (imagine my shock and surprise the first time I tried to bite through my lettuce and it just fell out of my mouth haha! :P) And of course TMJD which was initially just clicking on one side and not painful, whereas now it's both sides and gives me headaches and jaw pain all the time.

I'm not going to pretend my teeth don't look 100% better than they did when I started out first time, the middle incisor stuck out around 4 mm, my left canine wasn't even anywhere near where it was meant to be, instead it was just poking out from somewhere above completely out of sight! I'd carry on but I don't think anyone will read it ;)

I forgot to mention, my arch isn't actually even, it's further back on the right than on the left and the left had side is actually wider than the right if that makes sense? It's not skeletal though because there's like a "shelf" of gum on the inside so I presume for some reason my ortho decided to make that side wider.... :-s

I was just wondering, as everyone here seems so educated!! What exactly would they do this time round? I presume they wouldn't use a headgear, I always thought that was for children....? If they do I'll probably suggest those TAD screws, they seem like they do the job and I'll still be allowed to sleep on my side :P

[Glandyover]

I'd totally get braces again if I were you. I doubt headgear as well but I'm sure they'd close your bite up and take care of your overjet. Good luck and get more than just one opinion if you can!

[Toothygrin92]

Thank you, its reassuring that you think they'll be able to fix it. I went to an ortho about 2 years ago and they said itd be too complicated to bother but he was an NHS ortho so I presume it was just not worth it from their point of view at the time. It has got worse though so it the NHS don't do it I'll just use my savings (the car can wait!!)

[shekhinak]

My daughter is 16 years old, and is somewhat in the same boat. She had braces between ages 11-14, and then she developed terribly TMJ problems. Our general dentist and orthodontist just shrugged their shoulders and said, "Just try warm compresses, and see if it goes away in a month." Needless to say, it never did.

Our nurse practitioner sent us to a local TMJ specialist, and he gave her a special type of retainer - which alleviated the pain, but it completely trashed her bite, and now she has an "open bite." The TMJ specialist went to our orthodontist and recommended braces again to fix the problem, but the orthodontist locked wheels. We went to another orthodontist, and she said that an open bite is notoriously difficult to treat. She also refused to take the case, unless the first orthodontist would give her permission.

Orthodontist #1 sent us to a TMJ specialist at Mass General Hospital. The earliest appointment we could get would be for about 6 months later, so we asked to go on the waiting list. Long story short, one day I received a call at 10:30 AM, asking if we would like an appointment at 4:15 PM. The answer, naturally, is "YES!!!" Mind you, I live quite a distance from Mass General, so it was quite a hassle to get there.

The MGH TMJ specialist did not recommend braces right off. Rather, he said to stabilize the problem first. He gave her some stretching exercises to work on, basically by putting her fist in her mouth. He also advised her to stop using the retainer, and gave her a medication to take before bed, so that she wouldn't grind her teeth while she was sleeping. She took the medications exactly once, because they were SO strong that she couldn't even function the next day. She is normally terrified of bees, but when one landed on her, she didn't even care!

We went in for a follow up appointment in a month - and things had improved. However, he recommended waiting at least 6 months before going into braces again, to make sure the problem was settled.

The MGH TMJ specialist said that many private practioners try to treat TMJ pain with braces, but it often doesn't work.

So... that has been our experience. Hope you can benefit from it

[Toothygrin92]

Wow, than you so much for your story, it has really helped actually. Is your daughter going to be in braces again? Also, did the stretching exercises help? I was also given a retainer thingy which hasn't helped me and has also worsened my open bite (as soon as I noticed I stopped wearing it).

I am going to go down the same route as you I think, by referral from my dentist. But in the end I think I will definitely go back in braces, whether or not the NHS will put me in them, quite frankly because aside from TMJ my bite doesn't fit and my teeth make me self conscious!

Please keep me updated with your daughters condition, I hope I'll be able to benefit somewhat from your experiences. Thanks again!!!

[shekhinak]

Oddly enough, the stretching exercises do seem to be helping. She is supposed to be doing them 6 times a day, and the idea is essentially to put the fingers in the mouth, for increasing widths. He also told her that she has to make a conscious effort during the day to not bite down hard. So he told her to give herself reminders (put sticky notes everywhere) to tell her to check herself, and if she was biting down, to open her mouth a bit to stop.

All things considered, it seems like a surprisingly non-invasive approach. This TMJ specialist had been in the US Air Force for 20 years, and he was specifically recruited by the Harvard Dental School! Apparently, they like what he does. He said, tongue in cheek, that they could solve the problem surgically, and have it fixed almost immediately - but neither my daughter or myself are willing to do anything quite that drastic yet.

So the appliance the local TMJ specialist gave my daughter, really did trash her bit pretty badly. However, she also said that her bite was never really all that great, even when she was first out of the braces. But yes, she will have to have the braces again, and she's not happy about that at all. This time around, I'll pay for the ceramic braces for her (which is what I have). Her original orthodontist said he'd be willing to treat her again, but only after the Mass General TMJ specialist gave the go ahead. From what the consulting orthodontists said, if you have to be re-treated, the one who did the original treatment is usually willing to try to fix things for little or no cost. We'll see if that's true.

Anyway, I'm glad my story helped Keep me posted on how things are going with you, and likewise, I'll keep you updated with what my daughter is dealing with

[Toothygrin92]

I'm curious to know what these stretching exercises are! :P I'll have to do some research :) Actually I've been doing the not-biting-down myself, cos effectively it's the same thing as the appliance just without the further damage to my bite. I'm kinda hoping my mouth will just get used to it though and I won't have to consciously do it any more! And yes absolutely, I don't see the point in having crazy surgery on a perfectly healthy joint when all I need to do is make a few very simple changes to my lifestyle (if you can call it that!)

The orthodontist that treated me initially is quite far away since I have moved 6 hours from where I was before..and besides, I can't remember who it was (and quite frankly don't think I'd trust him anyway). Do you think you'll pay for it privately or try for NHS again? I suspect there's no real difference between the quality of NHS and private ortho's (other than within those groups) so I guess it just depends how long you're willing to wait?

I have one other question by the way, you said that open bites are notoriously difficult to treat, do you happen to know why that is? I'm no dentist but I would assume that because there's only one place where my teeth meet it would just do to move that one tooth, even if just to make my teeth a bit closer together at the front...

I must say it sounds like a bit of a cop-out saying that they're hard to treat, I would imagine that a lot of ortho treatments can be very difficult!! :)

Again, thank you so much for telling me all about your daughter's situation. I'd love to know what happens. I have an appointment with my regular dentist next week so hopefully will get a referral too. I'll definitely bear what you've said in mind as well when I talk to them! :)

[Toothygrin92]

Also, it's probably weird but I actually loved having braces first time round, I thought they looked wicked!

[shekhinak]

Well, if the NHS pays for the braces, that would be wonderful. I'm in the U.S., and dental insurance here typically covers less than half the cost (they usually pay about $1,500 to $2,000, out of the total cost of around $5,000). And usually they have a lifetime limit, so if we took my daughter to another orthodontist, we'd have to pay the entire cost.

To be honest, I have no idea why an open bite is difficult to treat. I almost went to dental school myself, and times like this, I really wish I had!

The stretching exercises were basically, open your mouth wide, stick your fingers in your mouth - with your palm going off to the side. Hold it for about 60 seconds, give yourself a little time off, and then do the whole cycle 5 more times. She was told to do that a total of 6 times a day. When that gets easier, he told her to do the same thing, only bend her finger tips in - so that she's using the first joint of her fingers. I think he said to start with using only three fingers first, and then go up to four.

I really have NO idea what good the exercises could do, and I would think the specialist to be a complete kook, except for the fact that he's a professor at Harvard Dental School. That said, my daughter says the pain has gone down considerably, so apparently he knows what he's talking about.

I have 4 siblings, and I'm the only one in my family who didn't have braces when I was a teenager. As of today, I have had braces on for 1 year. I hid them pretty well, as I thought I would get a lot of teasing for having them on at my age (I'm almost 50), and most of my relatives never even noticed them. However, I went to a week-long family reunion a few weeks ago, and one of my sisters spotted the wires. It turns out that my fears of being discovered were entirely unfounded, as all of my brothers and sisters were very supportive. Further, my older sister's teeth have gone horribly wrong over the past 8 years, and now she's thinking about getting braces again

[Glandyover]

Also, it's probably weird but I actually loved having braces first time round, I thought they looked wicked!

I couldn't agree more. I mostly got braces again because I love 'em. I couldn't wait to go back to work "flashin' the silver" as a co-worker put it.