Does This Sound Familar? & Your Comments

[Round2inAZ]

Hello all,

Okay, I'm sitting here working (I telecommute), not eating, drinking, chewing, or doing anything with my mouth. Suddenly I realize that my lower face is kinda achey and my jaw (the lower portion, not the joint) feels "tired." Then I get up feeling like I need to eat, but I'm not really hungry. So I pig out, eating well past satiety, and then return to work.

A little while later, again sitting at the computer working, doing nothing with my mouth, jaw, or lips. Then I realize that my left TMJ (the side with the click) starts feeling achey, and my head has a generalized "tightness," so I get up, thinking "I've been sitting here too long; time for a break."

Bottom line: I have a lot of facial pain!! I have been blocking it out. It was easy to do, as it's not excruciating or anything that would make me go take something for it. Also, several very painful conditions are in my history, and after years and years of chronic pain you sort of "shut down" to it and stop feeling it (or at least deny it to yourself). Looking back on it, this has been with me since childhood.

Here's the problem: I have been pursuing orthognathic surgery for cosmetic reasons. Every time an oral surgeon or orthod examined me, they kept asking if I experienced any pain, and I answered (honestly, as far as I was concerned) "no." I could have made up all kinds of stuff to try to get them to do the surgery and/or get ins. to cover it, but I told the truth.

There is a local OMFS here who only charges $4,000 per jaw. His patients go into the hospital where I work (and get an employee discount). But he just recently examined me and I told him that I had no pain. He filed a claim with my insurance company for that workup, and I am not sure what diagnosis he put down, but they denied payment for the consult.

This guy is very good for "functional issues," but refused to consider me as a candidate because I was "cosmetic." Technically I still do NOT have functional (chewing, biting, breathing, speaking) issues, but I do have some pain problems.

If there is any way this guy would do the surgery, that would be great! It would save me a ton of money too -- I have pursued this all along as self-pay, and I am assume that these minor pain issues aren't severe enough for ins. to cover my surgery anyway. Even if they were, becoming embroiled in that kind of battle doesn't appeal to me.

I would like to go back and see this guy again (to see if he would reconsider) and tell him about my facial/head/TMJ pain, but he will probably think I'm some kind of nut!! Also, what if it turns out that I really DO have some kind of underlying problems? Now my insurance company has me down as "seeking cosmetic surgery!"

Any comments?

[Elspeth]

Did you have x-rays done? They'd be able to tell if there are any underlying issues with them...

I'm kind of similar. I know that my jaw problems effect my appearance and I'm more conscious of that than I am of how it affects my functionality! I have a crossbite and asymmetric jaw and constant TMJ popping/clicking/pain and I used to have an underbite/edge on edge before I had braces in the past, so I think I have reason enough... (I hope... going to be consulting an ortho very soon). But I *can* function and sometimes I worry that that will work against me.

I think it'd be okay to reapproach that guy, but I do agree that your sudden realization of pain might sound flakey to him. Buuut... give it a try anyway! If you haven't already get x rays and see if there is a real problem. Sorry to not be much help. Good luck!

[suetemi]

Just curious -- who determined that you were "cosmetic" ? Is that something you assumed based on there being no pain? If an OMS examined you and took x-rays and sees that there's a skeletal misalignment of any kind, I'm sure he would not have put down "pursuing for cosmetic reason" on your chart. One could have a major malocclusion and feel no pain...yet -- but it's a degenerative disorder, and any professional in this regard who sees an x-ray won't be brushing off a patient's malocclusion because there happens to be no pain.

There seems to be a lack of communication between you and the doc -- didn't he tell you his opinion after examing you? I mean, he's the professional in this matter.

[Round2inAZ]

Just got back from the doctor.

It seems that I had an acute TMJ "attack," the second in my life. Not fun. In addition to the left TMJ, my upper teeth were killing me!!

My dentist had gone for the day but called back with instructions. My MD couldn't be reached. My chiropractor wasn't in his office. But the naturopath was in, and he squeezed me in.

He did some "sound therapy" and reflexology (sole of the foot). It sounded kooky, and I was very skeptical. But it worked!! No meds or anything. Everything is fine now. Cost me $85 but was well worth it.

[Round2inAZ]

Just curious -- who determined that you were "cosmetic" ? Is that something you assumed based on there being no pain? If an OMS examined you and took x-rays and sees that there's a skeletal misalignment of any kind, I'm sure he would not have put down "pursuing for cosmetic reason" on your chart. One could have a major malocclusion and feel no pain...yet -- but it's a degenerative disorder, and any professional in this regard who sees an x-ray won't be brushing off a patient's malocclusion because there happens to be no pain.

There seems to be a lack of communication between you and the doc -- didn't he tell you his opinion after examing you? I mean, he's the professional in this matter.

Negative. The communication is just fine. And I've already told you the "professional's" opinion. TWO OMFSs (in two different states) have told me that my situation is "cosmetic."

They also told me that Dr. Arnett in Santa Barbara, whose practice does more cosmetic work, WOULD do my surgery. But he is out of my price range.

[Round2inAZ]

Just out of curiosity: how large is your overjet?

Shame on me for not having this stuff memorized. I had to go pull out the stack of records.

Overjet is described as "moderately increased" at 3 to 5 mm.

[Round2inAZ]

Hm.

If it's at the 3 end of that I can see where they'd be classing it as cosmetic then (1 - 2 mm is considered normal). If it's at the 5 end, then you're in teh realm where some insurance plans kick over from not paying to paying.

At least that sheds some light on the reluactance on the part of local surgeons.

Aha! You probably hit the nail on the head with that one.

Here are the two guys who said "no go." Nothing to sneeze at, 'specially the former (Harvard-educated):

http://gsm.utmck.edu/oral_surg/faculty/gotcher.htm

http://sazoms.com/klemedson.asp