Metal Mouth Message Board

Hello, I had double jaw surgery on February 1st, 2017. Specifically, I had a multi-piece (I believe it was 3 piece) lefort 1 osteotomy advancement for my upper jaw, and bi-sagittal split osteotomy advancement for my lower jaw. This surgery was to correct a huge open bite and jaw asymmetry/canting. I have been panicking a lot due to several things I have done that could've ruined my results. Because I had a multi-piece lefort, I had a splint wired to my upper jaw after the surgery. The problem was that the splint had intruded my upper molars - namely my second molars; my second molars were pushed deeply into my gums and my ears and joints were in excruciating pain. The pain drove me crazy, I literally felt like I was going to faint. My surgeon's office wasn't helpful at all, they kept on telling me to take more painkillers and that I needed to keep the splint on for a month. This was not the kind of pain that could be alleviated by painkillers! On day 9 after the surgery, I felt like I had to do something. I reached inside my mouth (which felt weird and painful as it is difficult to open your mouth wide after surgery) and tugged on my upper second molars (on the right and left side). Basically on the lingual side, I managed to grip the tooth, and on the outside, I gripped the bracket/splint (not quite sure what I was tugging at). It immediately felt better, but not good enough. I did it several more times that day. At the end of the day, I realized it could've been harmful and that I shouldn't be playing with things at that early stage. I was worried sick and decided not to do it anymore. When I saw my surgeon two weeks post-op, he said everything looked good and the x-rays showed no signs of damage. I still worried I could've caused some minor shifting (maybe a millimetre or something) that the surgeon couldn't notice or the x-rays wouldn't be able to show.

On day 20 after the surgery, I made the mistake of biting down hard/clenching the left side of my jaw for some reason, and then my second upper molar (on the left side) felt like it was pushed deeper into my gums and the pain was driving me crazy again. So the next day (day 21 after surgery), I tugged a bit on that tooth. I also gently tugged the other side as I'm pretty OCD when it comes to things being even all the time. It still wasn't enough, I was still in pain when I was sleeping. So the next day (day 22 after surgery), I tugged on my left upper molar many times. And because of my OCD about evenness, I tugged the right upper molar many times as well. I think I went too far that day, it was no longer about easing the pain but more about evening out each side.

The next two days after that (day 23 and 24), I gently tugged each side again because they didn't feel even. I realized it had become a vicious cycle, and my mom forbid me from playing with my teeth. I have stopped doing it now. I really regret it, I worry so much that all that tugging could've ruined or altered my jaw surgery results (which were absolutely amazing, my surgeon is truly a magician). Do you think the force of tugging my second molars could've pulled my upper jaw down a bit or loosened the screws and plates? Could I have also loosened my splint? Like I mentioned before, it felt so weird and painful to force my fingers into my mouth as I generally can't open very wide. I also wonder if forcing my mouth open that wide could've shifted things and/or messed up my jaw alignment. In order to put my fingers in, there was some pressure put on my lower jaw. I'm seeing my surgeon again in a few days, but I worry about any minor shift I could've caused that the surgeon might not notice or care about. It just kills me that I could've interfered with my jaw surgery result. I know that since I am so paranoid, I shouldn't have taken any risk at all, but initially it was because the pain was intolerable and later on it was because of my OCD, which I couldn't control. I have had an issue with tugging and pushing my teeth for over a year now. It started because of my receding gums, so many of my teeth feel quite loose (especially my upper molars) and the ones with lots of gum recession sometimes look like they are coming out, so then I would pushed them back in. But often when I push too hard, that really hurt so I would tug the tooth. Especially with my upper molars, it's insane how easily they get intruded and extruded now.

Anyways, does anyone know how easy it is for your jawbones to shift after jaw surgery? Specifically if it is easy for the upper jawbones to be pulled down? How strong are the plates and screws? It's not like there are plates and screws covering the whole jaw, they are only fixed on a few areas, so I worry that the back (where I pulled) could be moved somehow. Also, I have this terrible habit of pressing the sides of my nose all the time (sometimes it's because it feels dry and itchy) and pushing the tip of my nose up (just a weird habit I had for years), and I have been wondering it that could also be bad for my jaw surgery results (since my upper jaw was cut from under my nose and advanced). Moreover, could pressing the sides of my nose have loosened the alar cinch that was put in? I noticed that the more I press, the wider my nose seems to look.

I wish I had realized all these things earlier and had been extra safe. It's only afterwards that the regret sinks in and I feel devastated and anxious. I know I should rely on my surgeon for these answers, but it is embarrassing to tell him all these things and I doubt he will have much time to listen anyways (my last follow up appointment was really short). He may just say it's really hard to move the bone or something and not really understand what I did. But what if I caused a small change/damage that is not visible to the naked eye? Or even a change that wouldn't be noticeable on the x-ray? Even if it doesn't affect the quality of my life, it's so upsetting that I could've caused any change just because of my stupid habit of tugging my teeth and playing with my nose. I must've gone too far, I remember before, my second molars on the left side touched perfectly, but after the last time I tugged the left side, they no longer meet perfectly and there is a tiny space between them now. Also after tugging the right side so many times, my bracket or wire has started to poke my cheek. Since I did pull my molars down a bit and messed up my bracket, could that force have also been enough to shift my jaw? I didn't think I pulled too hard, but I can't trust my memory Rather than always plaguing my mom with these implacable concerns, I wanted some other opinions. Please.

Your maxilla sections are fixed using titanium plates and screws (or at least the 2 side sections are). Simply tugging on them or accidentally chomping down shouldn’t have any effect. If anything, it could crack the bone around the screws or possibly contribute to a fibrous union, but if your surgeon is updating your scans and says they look good, then you’re golden. Any issues with bone placement would be due to your surgeon’s procedure, not any tugging you did.

[quote=snapdresser post_id=500787 time=1520517386 user_id=24383]
Your maxilla sections are fixed using titanium plates and screws (or at least the 2 side sections are). Simply tugging on them or accidentally chomping down shouldn’t have any effect. If anything, it could crack the bone around the screws or possibly contribute to a fibrous union, but if your surgeon is updating your scans and says they look good, then you’re golden. Any issues with bone placement would be due to your surgeon’s procedure, not any tugging you did.
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Thank you so much for taking the time to read my post! That makes me feel a bit better. Last time I saw my surgeon, he didn't take any x-rays. Hopefully he will when I see him next month.

I don’t think the union will be complete for another several weeks, at which point they may take another scan to be sure you’re completely healed. There’s not really any point to doing it before then, IMO, unless you badger him for it and he acquiesces

[quote=snapdresser post_id=500821 time=1520609972 user_id=24383]
I don’t think the union will be complete for another several weeks, at which point they may take another scan to be sure you’re completely healed. There’s not really any point to doing it before then, IMO, unless you badger him for it and he acquiesces
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I live four hours away from Toronto (where my surgeon is located), so I don't get to see him often. I wish he would answer my questions better and be more thorough in my follow-up appointments. Another thing I have been worried about is the fact that I always tend to massage/press the base of my nose (around the area where they would have cut my upper jaw and added screws). I've stopped now because I realized it could be a problem, but I did it a lot during the first four weeks after my surgery. Could doing something like that potentially move my upper jaw or cause some kind of damage?

Unlikely. Relaaaaax. If anything, the poking and prodding affects the swelling, either positively or negatively. Regardless, it’ll go down over time.

[quote=snapdresser post_id=500840 time=1520649801 user_id=24383]
Unlikely. Relaaaaax. If anything, the poking and prodding affects the swelling, either positively or negatively. Regardless, it’ll go down over time.
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Thanks. I really hope I didn't ruin anything. I've been so nervous and scared everyday, I worry about how every thing I do might affect my new jaw.

That anxiety is totally normal during recovery

[quote=snapdresser post_id=500858 time=1520778139 user_id=24383]
That anxiety is totally normal during recovery
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I know, but I keep doing things that most people wouldn't do after jaw surgery - like tugging on my upper teeth. Initially I don't think about it much but then after realizing how I shouldn't try anything unusual after getting surgery, I feel so bad.

More people than you think mess with it. Whether it’s clenching or chomping down or sleeping on their side or chest, and we all thought we screwed it up. Our surgeons checked our scans and either the union and screws were good or they weren’t. Your surgeon says yours look good, so party on

[quote=snapdresser post_id=500879 time=1520905466 user_id=24383]
More people than you think mess with it. Whether it’s clenching or chomping down or sleeping on their side or chest, and we all thought we screwed it up. Our surgeons checked our scans and either the union and screws were good or they weren’t. Your surgeon says yours look good, so party on
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Thank you. Unfortunately now it seems like my appointments are getting farther and farther apart - my next one won't be until April 6th. Last night I had a bit of a scare. For a few weeks now, my brackets and wires on my upper molars have been very sharp and scratching my cheeks, so often I will try and stretch/pull my cheeks away from them. Every time I do it though, the sides of my face (especially my joints) hurt so much afterwards. Last night, after stretching the inside of my mouth, there was blood coming from the back of my upper jaw. Hopefully it wasn't from where the surgeon made the incisions. I feel so stupid for continuously touching the inside of my mouth, especially when it already hurt.