I need HELP....don't know where to go from here!

[ew112488]

Ok to make a long story short, these are my problems:

- severe lip incompetence (around 9mm or so)
- severe mentalis strain
- overjet
- somewhat of an open bite
- grind teeth badly, have ever since I was little
- TMJ problems and slight clicking in jaw
- I suspect sleep apnea due to teeth grinding and restricted airway but have not been officially diagnosed with it
- gummy smile (although not as much when I am "fake" smiling) and extremely gummy when I laugh
- long face syndrome/long top jaw
- weak chin/lower jaw
- short upper lip
- extreme dry lips and gums
- both top and bottom teeth show A LOT when I am talking and due to lip incompetence I have a slight speech impediment

I had braces for a little over 3 years from 7th grade to 9th grade and had some teeth extracted, I have also had all wisdom teeth removed. I am now 24 years old. A few years ago I saw a private oral surgeon who looked me over did xrays, measurements and what not and told me I would be a good candidate for jaw surgery and orthodontics again. He accepted insurance and said there was a good chance my insurance would cover it, so they sent everything in. I was denied, it was a huge let down for me because not only is it uncomfortable living like this feeling like my lips, cheeks, and jaws are always straining but also it is embarrassing! I love the way I look in pictures when I'm smiling but when it comes to real life I hate the way I look when I talk and I am mortified when I see videos of me or unplanned pictures. My profile is all jacked up and I just look awkward.

After dwelling on this letdown for 2 years, my insurance changed to Cigna/Metlife so I decided I was going to try all over again but this time I was going to see someone in network in hopes for a better chance of having it covered. I had an orthodontics appointment first, he understood my concerns but didn't really say whether he thought I would need jaw surgery or not. Instead, he referred me over to one of their oral surgeons and said if he thought I needed it then we would go from there. I met with the oral surgeon about 2 weeks ago and I basically left out of there crying. He told me that my smile was pretty and that if I went through with the surgery it would be for cosmetic reasons. Even though he said I definitely have a longer upper jaw and some bite problems, and of course my TMJ problems...he also noticed my extreme lip incompetence. This doctor is at a well known university/hospital with a huge dental school. He basically told me that the cases he has dealt with were far more extreme than mine but he definitely understood where I was coming from but he doesn't think I should do the surgery and that I should live with how I am. He then said he was going to go ahead and do measurements, xrays, molds, pictures, and impressions to get a better picture of my problems, he is then going to discuss my case with the orthodontist and a student class to decide on whether I really need it or not. Well, it has been 2 weeks and I haven't heard anything. I really am not happy with this doctor at all and I feel like he is just writing me off just because my case isn't as extreme as others...even though this causes me discomfort on a daily basis, not to mention the psychological and emotional effects it has on me as well! I just don't understand how I have now been to TWO oral surgeons and they both have had complete opposite opinions.

So where do I go from here? Should I just go ahead and schedule some consults with other orthodontists in the area that do surgery to get their opinions? I really hate that the last oral surgeon I saw was in network because I feel like if I schedule with someone else at the university then his opinion will probably negatively affect my case from the get-go with someone new. I'm so frustrated and upset, and I am so emotionally drained over this whole ordeal!

I have pictures I can post but I don't know how to do that...I am new here!

[katsface]

I had consultations that said I had no skeletal problems... and none of their explanations or plans seemed right to me. One of them was in a well known dental school. Then an ortho finally said that he could do braces, and my bite would come together technically, but my jaws still wouldn't work properly. They only way to fix, he said, was through two surgeries. I've finished and recovered from the first surgery, and am in the preliminary planning stages for the second one already.

Anyway, my point is, you know what feels right. Don't settle for a doctor who wants to push an easier compromise treatment on you if that doesn't make sense to you.

Did your first orthodontist leave you with a bad result or did your teeth drift? Either way, if your teeth migrate that much after they're corrected, I think that means they might not have been put in a stable position by the orthodontist. The more anatomically correct your jaw relationships are, the easier it is for the ortho to put your teeth in a stable position.

If you can afford it, and you have the time, keep getting second and third opinions until you hear a plan that makes sense to you. Are the only in network Dr.'s at the university? Orthos and surgeons don't necessarily talk to each other. But, if you think the Dr's at the university might have a disposition to dismiss surgery when it might actually be necessary, then I would try to schedule some consults with Dr's outside of the university as well.

There's a board called "How do I?" here http://www.archwired.com/phpbb2/viewforum.php?f=20 You should be able to find out how to post pics from a post in that section. But you have to have at least 7 posts to be able to post pictures (it's to prevent spammers).

[ew112488]

Thank you for replying....I am going to go ahead and schedule a few consultations outside the university. The first time I had braces, I'm guessing everything checked out ok as far as where my teeth were but I was like 14 or 15 when they came off, so I don't really remember. I didn't really start realizing that I had a true skeletal deformity until I was a bit older and I started noticing things, especially when I had to tape myself giving a speech for college...when I saw the video I was like WTF. Then that's when I started researching and realizing there is a lot of people out there like me and what I thought was normal for myself, actually was not.

I'm guessing the oral surgeon and the ortho at the university communicate a lot because they are right beside each other and work together a lot because of the dental school. After 2 weeks, I finally heard back from his office the other day and they left me a voicemail saying they wanted me to come in for a "second evaluation". I'm assuming he looks over my xrays and molds and all that and has decided I'm worth a second look? However, when I called back to schedule, the scheduling coordinator was like so have you talked to your insurance and figured out your coverage? I said no, I did not know I was supposed to do that, I thought that was their job to get all the documentation together and to send it in to see if I was. So then she is like, ohhh okay and acted all confused...then she says she will get everything straight and give me a call back. Never scheduled me or anything like the voicemail had said they wanted to do, now it as been 5 days and again I have heard nothing. Ugh, so frustrating!

[sirwired]

Some advice:

- When dealing with a busy academic surgeon's office, nothing happens quickly. My oral surgeon (a professor at UNC-CH) send me through the UNC Dentofacial program for a cross-dept evaluation of my case. Scheduling that took a month. This involved another set of molds and x-rays, a photo series, evaluation by an ortho student, and simultaneous evaluation by both my surgeon and one of the professors from the ortho dept. It then took another month for my case to come up in the "conference" (where I guess they gather both professors, the resident, and a pile of oral surgery residents and ortho students in a room to discuss a pile of cases. Dental schools (even when you are paying) often have long waiting periods as their services are in high demand, and the surgeons can't spend full time performing treatment, as they also have teaching duties.

- When they say "check your coverage" they mean you need to pull your medical plan documents and make sure it does not exclude orthognathic surgery. Some do. This is plan-specific, not insurance company specific. If your insurance is "self-funded" (the norm for large employers) the company writes the plans themselves and your HR dept. should have the plans. Smaller employers will get the plans from insurance companies.

- Cigna. My sympathies. I had to wait to shift from Cigna to BCBS before I even bothered submitting, as I would not have met Cigna's criteria. However, with your TMJ and Apnea, you may have no problem. Google Cigna Orthognathic and the first thing that comes up is their coverage criteria. Give a copy to your surgeon and ask him if you'll meet them. The TMJ and Sleep Apnea can work, under certain conditions. (BCBS's criteria don't require functional impairment, just certain discrepancies being two standard deviations off.)

[Breakingrachael]

Hey there - So I joined this site JUST so I can reply to your post! It sounds like we are in the same boat. I have nearly all of the same issues as you, except for the TMJ. I also had braces for 3 years in junior high/high school. My jaw is so narrow that things are just starting to move again. I have an appt. with an orthodontist on Feb 14, where I'll be asking for a referral to the surgeon. I'm so scared that insurance won't cover, or that they won't recommend surgery. Please keep us updated!!

[ReoSity]

Go meet other surgeons, in particular one's with good reviews and who focus on the aesthetic aspect of surgery. You should feel comfortable with the doctor who's going to re-arrange your jaws. If it's possible, it wouldn't hurt to meet with docs outside your state. Some suggestions of well regarded docs...Posnick, Arnett/Gunson, Kevin McBride, Dr. Schendel, Dr. Relle.