Metal Mouth Message Board

Hi Everyone!

So, I have been to about 4 orthos in the last few years and have been putting off dealing with my overbite for several reasons...1) money! 2) insurance and all its issues; 3) just plain scared!

All but one ortho said I would probably need lower jaw surgery to correct my overbite. The other one said he could get me to about 80% (which would be fine with me, but would my bite be worse?)When I was younger it didn't seem so bad, but as an adult, I am getting crowding and now my teeth are starting to get crooked as well. On top of all that, I still have all of my wisdom teeth and when I went for a consult with an oral surgeon on THAT matter a few years ago, he said if they weren't bothering me to keep them in because the risks at this point because of my age outweigh the benefits of removing them. Okaaaayy.... However, he did say if I were to want braces they would all have to come out.

So, the dilemma here is 1) I am 46 and not getting any younger. 2) My jaw is starting to lock on one side from TMJ, which doesn't really hurt, but it scares the heck out of me. 3) Still money and insurance issues. 4) Still scared!

I am single and have no one to be with me post-op or at home after something major like this. My mom is getting up there in age and she wouldn't be of any help and my sister is married with kids...not like she could stay with me or anything.

I would just like to know if anyone my age has gone through this on their own and what the outcome was. Any regrets? I am pretty healthy now, no issues and don't want to create any for myself with these very NON MINOR surgeries! On top of that, these orthos only want to spend about 5-10 minutes in a consult and I have many many more concerns before I say ok, let's do it!

After all I've read about this and seeing pictures, etc., it scares the heck out of me. Just wondering if I should just live with this for the rest of my life...I've done it this long, except I hate my smile and profile. Feel like I'm just stuck between a rock and a hard place.

Anyone on here in their 40's or older with any advice or testimonies would be helpful! Thanks!

I am close to your age and had lower jaw surgery (BSSO) in February, although I had my wisdom teeth removed when I was in my 20s. I had an overbite, approx 7 mm, and excessive wear on my back four molars. No TMJ problems.

I asked the same thing you did: should I just deal with it, or should I have surgery? My upper teeth were very straight from braces earlier in life (call my uppers an A-) and my lower teeth had slight crowding (call them a B-).

I had consultations with two orthodontists and two oral surgeons in San Diego and all four agreed on what should be done. The consequences of doing nothing would have been that my back teeth would have worn away, and the teeth in front of them would wear such that I would essentially lose my back teeth and they could not be replaced. Your teeth basically wear in a way that reflect your bite geometry, and mine was off, as yours seems to be. In addition, my lower jaw being slightly undersize ('retrognathic') gave me a recessive chin, which for men in particular isn't aesthetically desirable. It didn't look abnormal, but it could have been better. So, serious long term dental issues plus cosmetic factors convinced me to do it.

Cost: If you're in the US, you'll need an initial exam/evaluation with the best oral surgeon you can find. If there is a legitimate medical need, they can submit the proper forms to your health insurer and it seems to be generally covered. I'm currently with United Healthcare and they covered it. But be careful -- if the purpose of the surgery seems to be primarily cosmetic then it will NOT be covered. It's possible that you might need to have a BSSO procedure on your lower jaw that would be covered, and might WANT a genioplasty for your chin which you will have to pay for out of pocket. There are huge cost advantages to having both done at the same time, if you elect to go that route -- i.e., the hospital/anesthesia costs would be largely or completely covered due to the approved surgical procedure, so genio could be done concurrently (it's far less complicated than BSSO, Le Forte, etc.)

Consults: I went to two orthodontists, and they can diagnose an overbite in 5-10 minutes -- it's very common. I wouldn't worry about a 10-15 minute visit, but I would recommend seeing 2-3 orthodontists. For the oral surgeon, I think I spent an hour in the office for each initial evaluation. They take x-rays, and I believe each evaluation cost $400 or so -- billed to insurance.

Fear/outcome/complications: I'm fairly healthy for mid-40s -- workout every other day, no weight problems, no real health issues, so I was judged a good candidate for surgery. Did the prospect scare the crap out of me? Yes. I took 4-6 months to weigh the options and make the decision. It's major surgery under anesthesia, and things can go wrong. On the other hand, the surgeon I ended up using has done several thousand of these procedures, so it isn't experimental or all that mysterious. Also, using the rigid fixation hardware (titanium screws, plates) available now the bone healing time isn't as bad as you'd expect.

I had surgery almost exactly 4 months ago, and apart from the nuisance of braces (half of what I eat seems to come out in my toothbrush...) it hasn't been that bad. The first few days ARE that bad -- liquids only, swollen and immobilized lip, compression bandage on my face to control swelling. You will look and feel atrocious. On the plus side, I had no pain from post-op through now, so I was overly worried about that when it wasn't an issue.

The idea of a liquid diet for 4-6 weeks sounds miserable, but bone heals very quickly and what I found was that by the time I was bored to tears of milkshakes, tomato soup, yogurt, etc., I could go back to eating soft stuff -- pasta, fish, etc.

What I "under worried" about were some of the lingering effects of surgery. You will almost definitely have numbness in your chin/lip, and as the rest of you heals that lingering numbness will be annoying. My right side is nicely recovered, left side is taking longer, and it feels a bit like I'm wearing a chin strap on that side of my face. No effect on eating, and no one seems to notice, so it hasn't kept me from eating, going to meetings at work,etc., but it is annoying.

The other worrying thing will be the limited range of motion you'll have in opening your jaw. Initially you'll probably have elastic bands that limit your jaw opening to help it heal in the proper position, but when you're able to take those out during the day you'll feel like you're still wearing them -- difficult to open your jaw far. It takes a few months to recover, and for people who don't there may be physical therapy needed. At 4 months, I feel pretty normal in that regard -- can brush, floss and eat fairly normally. But I still don't order tall sandwiches when I go out to eat.

Doing it solo: I'm single, live alone, no kids, family is across the country. Depending on how independent you are, you will probably be fine without a circle of caretakers. I asked a friend to drive me to and from the hospital (stayed the first two nights post op) because there's no way in hell you could/should drive. I stocked up on liquid diet groceries beforehand, and after 6-7 days post op looked presentable enough to drive over the grocery store for another round of shopping. But for the first days at home I spend a lot of time in bed (on my back), or watching long movies on TV, reading, gaming, etc. While company would have been nice, frankly having someone around the house making food that I couldn't eat, and having conversations when my mouth barely moved would have been a mixed blessing. It's kind of your decision.

Hindsight: Would I do it again? Yes. I'm not quite George Clooney-esque, but my profile looks much better. All my teeth meet properly now, so despite still being in braces I can chew properly. As a I mentioned I have lingering numbness after 4 months, and I wish I didn't have it, obviously, but I used to destroy bite guards at night (all pressure on only 4 teeth...) and have a hard time biting into things. Wrong is wrong, and if you plan on living to 80 or more (I do) you're probably going to want to do it with your real original teeth.

Good luck.

Hi,

Thanks so much for your post...it's very helpful. I have been doing some research and I've read about some cases where the jaw actually was advanced with power chains in adults. I know most orthos agree it can't be done, but I've read some cases in adults where it actually has. I guess it depends on the bone and how soft it is. My overbite is about 5mm and I think, according to what I read in my insurance documents, that the surgery might be covered. It would just be nice to hear something from someone who got treatment without surgery. It just seems to be the "jump" most orthos want to make. I guess it probably is the most stable procedure, with little chance of it ever receding again. I also got an opinion from an ortho online that said he has moved teeth without pulling wisdoms in adults and the reason why most want to pull them is so that all their work doesn't get undone by not wearing a retainer. I just don't know what to believe! Seems everyone has a different outlook.

In any event, would you care to share any before/after pictures?

Thanks again for sharing your story!

I hadn't heard that power chains could actually lengthen the bone. I'm skeptical that for those of us in our 40s that the bone would still be developing or could be changed in that way, although for a 10-12 year old I believe that jaw growth can be encouraged that way.

What orthodontists can sometimes do, in the case of very slight overbites, is to close the overbite by 'slanting' the lower teeth very slightly forward, which can also improve crowding and give a presentable cosmetic result. BUT, my orthodontist said that any time the teeth are moved off their vertical axis (relative to the mandible) the result will be less stable. If you have a 5 mm overbite, that isn't too bad, so your decision will probably come down to other signs/symptoms: TMJ discomfort, irregular tooth wear, etc. I was very opposed to surgery until I got the "You will lose your back teeth, develop joint problems and need frequent dental implants" message.

Given that you're in your mid 40s (as am I...), whatever you do I would suggest not waiting another 5 or 10 years. My recovery has been going very well, but part of me wishes I'd taken care of all of this when I was a wee lad of 30.

I would definitely explore every option, but don't rule out surgery due to fear of it. As I said, even with the annoying lingering numbness I've experienced, and the inconvenience of braces (hopefully off in August), I wish I'd done it much sooner.

Before and after pics: The only useful ones will be the ones my oral surgeon took before and will take in a couple of weeks at my next appointment. I'll try to post those. I've been conscious of my profile all my life and have made a heroic and successful effort to minimize and avoid photos of myself. So mercifully there is little photo documentation of my "before".

Thanks again for your reply. You sound exactly like me regarding photos, LOL. I'm still doing some investigating, found a TMJ/ortho specialist I'm going to call Monday. He's an expert in cranio facial orthopedics and esthetics, and uses all the advanced methods including Wilkodontics. Right now, I would just like to alleviate some of the pain I've been experiencing. Stress makes me grind my teeth and I just went through a breakup and it's making things worse. Ugh.

I do believe you're right in not waiting any longer...guess it's now or never.

Hi Gem,

Welcome to the fourms, this is a great place to start. By you even coming here and spending the time to see ortho's tell me that this is something you have always wanted?

I may not be in my 40's but i can relate somewhat your going through, I'm 28 years old and share the same problems of yours. my case is very simliar. i have a receeded lower jaw, it had stopped growing when i was a kid. by the time i was 10 i started to developed "Buck Teeth" i was teased a lot in school because of this, but my parents where not wealthy people. at this age i did not know why my teeth where bucked.

Years went by and it got worse, by the time i was 20 my bottom teeth were hitting the roof of my mouth and my jaw would seize up. my dentist had recommened that i see a orthodontist and off i went, this is when i found out that in order to fix my teeth i would need to have lower jaw surgery with the combination of Braces. also with a hefty price tag.

when i got home from that appointment i knew i was in no position to afford to go through with it,plus i was really affraid to go through with the surgery. more time passed. i got married and had a beautiful little girl and my teeth got worse!! like Bull my teeth where starting to wear down and my bottom teeth had made a indent in the roof of my mouth.

so here i am now 28 and really regretting not getting my teeth fix earlier, it is always something i have always wanted since i was a kid, and i have 8 years to think about it. i said to myself i spend so much money on foolish things and when it comes to spending money on myself i am questioning it! kinda silly as we all work hard for our money and deserve to treat ourselfs.

that being said i bit the bullets over a month ago and started the process, my othodontist did molds of my mouth with x-rays and a panorex as well as some measurments. and from there i had a consult with a really good surgon doing jaw surgeries for over 35 years. he explained the risk involved, theres a chance you may lose feeling in your chin and lips perm. he also told me that i needed both my lower wisdom teeth removed becase that is where they need to cut the jaw.

so last month i had my wisdom teeth removed and 2 weeks after i had my braces put on, they showed me my digital photo's of before and after and i almost cried seeing them. braces take awhile to get use to. they really cut up the inside of my mouth for the first week, but my mouth seams to have toughened up now, and your teeth may hurt when they tighten them for the first week or so, so be prepared to be on soft food for a bit and loose a few pounds, ive lost 15lbs so far.


there are lot of great stories on here that have helped me get use to haveing braces and have eased my mind more on the surgery. my surgeon told me because when they cut your jaw it is where the main nerve is that gives the feeling censation in your chin and lips that because it is streched so much that 90% of his patients do not feel any pain at all because the nerve is all out of whack. he said that doctors all around the world find it interesting.

all in all i wish you all the best is whatever decision you make

Good luck and would like to hear an update.
Cheers
House

Thanks so much for your post...it's very encouraging to hear other people's stories. I know I'm not the only one going through this. I'm just still very afraid of surgery! Just a wimp I guess! Really not sure which one would be worse, the wisdom teeth removal or the jaw surgery.

Hello,

I'm 41, and I went to the ortho. about braces and was told to consider
SARPE. It was only two days ago when I didn't even know such a thing
existed, so I'm still in shock

I don't anything to contribute at this point, but I wanted to say hello.

Please keep posting, and I hope you feel better stress wise soon.

Hi gems4deb,

I am 50 (51 in September), live alone, no children, family on other side of the county, etc. I will be 3 weeks post op on Tuesday. I had upper jaw advanced and moved up, lower jaw moved 7mm on one side and 8mm on the other as well as a genioplasty. I am one of the unfortunate ones that did not have insurance that covered orthognathic surgery.

I chose to have my surgery done in Costa Rica and just got back Tuesday of this week. For those of you considering this option, I would be happy to share my experiences with you.

That being said, if you are going to move forward with surgery, make sure you prepare yourself both mentally and physically. It will make a huge difference in your recovery. Since I am only 3 weeks post op, I still have a way to go before I can speak to the end result (it takes up to 6 months before your jaw/muscles settle in). So far, it has been positive and I can see now that I won't have to worry about my mouth hanging open all the time.

Now that is is done, I don't have to spend the next 30 years wishing I did it.

I would be happy to assist with any questions you may have.

aussiere

I am 59, and am now 26 days post-op from double jaw surgery. I had an upper impaction and advancement, and advancement of lower jaw.

I feel like my recovery has been right on par with those in their 30's. I had more bruising, related to the age factor, but I expected that. I am quite pleased with my progress so far.

This type of surgery is scary, for sure. I urge you to educate yourself as much as possible before you make a decision either way. I am so glad I did not succumb to fear and back out. In the end, I still had doubts, but decided to trust my ortho and OS, who both said I would do just fine. They were right.

I had my husband's help, but I was tending to my own needs after about the second day. I needed to be up and walking anyway, so I saw no reason to have him waiting on me any longer than that. He did do all the errands that were necessary-getting meds and food, and taking me to my first follow-up appointment.

Good luck with your treatment, whichever direction you decide to go.

Wow! Thanks so much all for sharing your experiences and stories. It certainly is encouraging. I would like to continue reading your post-op recovery blogs.

Rizzie, when you say you had an upper "impaction", do you mean wisdom teeth? Did they do that the same time as your jaw surgery?

Thanks again! I hope you all continue to heal just great!

My wisdom teeth were taken out years ago after my first round of braces as a teen. In this case, impaction, means moved up.

Hello Aussiere,

[quote="aussiere"]Hi gems4deb,

I will be 3 weeks post op on Tuesday. I had upper jaw advanced and moved up, lower jaw moved 7mm on one side and 8mm on the other as well as a genioplasty. I am one of the unfortunate ones that did not have insurance that covered orthognathic surgery.

[/quote]

Did you have all that done at the same time, and how long after the surgery were you able to travel?

Sorry to slightly hijack the thread when I'm 32, but did any of you who had surgery later in life get warned about saggy skin after having jaw surgery? It's an issue that's cropped up a few times on the board but no surgeons ever seem to mention it. It seems logical that if your bone structure is made smaller (I'm due to have Lefort 1, BSSO and genio) then of course there will be excess skin - but is it really noticeable? In my case my bite wasn't bad enough to need surgery until my mid-twenties, past the 'prime' time for healing and skin still being elastic enough to recover, but it's an issue that concerns me more than post-op pain and discomfort because I know that will improve every day whereas my skin could just get worse and worse. Any advice would be much appreciated.

Hello,

I don't know if the following info. will be of any use to you ( I'm still a newbie),

but I've read it this morning, so here it goes:

" ...The muscle layer can be reattached to the chin using Mitek anchors. We prefer using two Mitek anchors to secure the mentalis muscle to the bone. Alternatively, simple reapproximation with two horizontal mattress sutures is acceptable. This prevents ptosis of the mentalis muscle. Nonfixation may result in a 'witches chin.' A comprehensive chin dressing is worn for five days postoperatively. The oral mucosa is closed with a running 3-0 suture."