Should I have jaw surgery?

[Angel21]

Ok this is quite long so bare with me! I'm explaining everything in detail so anyone who can help me out please do! Thanks a lot!

A few months ago I went to see a private orthodontist. Let's call this one Ortho1. I finally wanted to sort out some of my crowded front teeth but really didn't expect the extremity of what I was about to hear! Basically he examined my teeth and discovered I had an underdeveloped lower jaw He wanted me to have surgery on it. I was quite taken back because I did not think I had a problem in the first place and even if I did that it was serious enough to require surgery. He made it sound like it wouldn't be a big deal but after learning more about it I've found it is a huge risky surgery.

Since then I've been totally dead set against it and angered why he would even suggest it for something so small and not needed. And everyone else thinks I don't need it. However very recently I've started to think more about it and somewhat considering having the surgery done... Even though it really scares me. Especially the fact of having your jaw taken apart and screwed together with metal plates. I really don't like that at all... I've already had surgery before but this one sounds even more extreme.

My teeth aren't that messed up, they are healthy and fine. Just a few of them aren't straight. My bottom set of teeth are pretty much perfect and straight.

My top teeth are tilted inwards at the back, and I think my bottom teeth are a little tilted too. So my bite fits fine and I don't have any problems or discomfort. However if I were to straighten the top out, it would not fit with my bottom teeth. So my bite would be off. This would probably require the surgery...

My other option, when I went to see another ortho prior, I'll call him ortho2 (who didn't even mention about my jaw ) wanted to remove 2 teeth from the back. Ortho1 seemed dead set against that. He mentioned how it would look better to have a full set of teeth, so it doesn't tilt inwards..

If I don't have the surgery and have 2 teeth removed, would I not be able to go back?

Ortho 1: I went to see him because I was considering an alternative to braces, a product similar to invisalign. He said the surgery would be 'free', yet quoted the total cost at £3,500!! I believe I needed some work to my bottom teeth to, I guess to make everything perfect and fit together.

Ortho 2: Wanted to remove 2 teeth, is the much cheaper option at £1,000. And no work done to bottom set.

I may see more orthodontists for more opinions. But from the 2 I've seen, ortho1 is more interested in making me look my most best, and to give me a more perfect smile.

Now I'm a perfectionist, and would love a perfect smile. To be told you have a problem with a part of your body that should be 'fixed' to make you look better, doesn't help my self image and makes me want to fix it. Yet at the same time it angers me because its classified as something 'underdeveloped' or 'not right' when that is more a matter of opinion. Something could even go wrong and it could make me look worse!

So my question is, do you think its worth it to have the surgery? Or should I just try to work around straightening my teeth without it? Regardless of how great my smile could look?

These(and more) questions I'm going to ask orthodontists, but right now I'm looking for other people's opinions.

Ok so, here is my profile. I actually like my profile, but now I can't help but notice about my jaw.

http://img165.imageshack.us/img165/2302/ghfhgfnc5.jpg
http://img165.imageshack.us/img165/5108/dfsfdfdfwn1.jpg
http://img341.imageshack.us/img341/6365/jaw004py9.jpg

[Angel21]

Hi, thanks for your informative reply. Atleast I know my post wasn't all for nothing!

It looks like your jaw is quite a bit like mine was - you have a pretty good chin button, and that does to a good extent disguise the retrognathic (i.e. set-back) lower jaw. But my bet is that your molars are in a Class II relationship, and once your upper arch was properly aligned, so too would be your canines, and you'd have an overjet - ie the upper incisors being too far horizontally in front of the lowers. I wonder, in fact, when you mention teeth being tipped inwards if you're describing Class II, div 2?

He did mention I have a good chin so it doesn't look bad or anything.
I'm not sure about them looking like the one in Class II. Because my back teeth tilt inwards and they aren't all straight I can't really tell. They bite together fine though. If I push my lower jaw forward the bite is off and it doesn't look right.

The distance between the top and bottom set of my teeth looks normal. It's not like these pictures where you can't really see the bottom teeth, as in it doesn't look like an overbite.

I don't look like the one in 'Class II'. I can look like 'Class I'. That's why I think surgery is too extreme for something so subtle, I mean I look normal:

http://img524.imageshack.us/img524/4201/profilenn2.jpg

Some pics I notice it and in some pics it looks perfect.

So that's why I feel it doesn't warrant any surgery, and can't really imagine how it would look after.

But I will tell you this much: it is not just a matter of opinion - there is a certain jaw relationship that is necessary to bring the teeth into the proper occlusion.

Yeah, I understand that. But at the same time, it may be the 'proper occlusion' but right now my teeth fit together fine. So it's not as if its something that NEEDS to be fixed.

You ask about not being able to "go back" if you go the extraction route and do not like the results. You should take a look at iBorg's story. It's a little different in that he had not two, but four premolar extractions when he was young (one tooth from each quadrant of the mouth). He has felt for a long time that his smile was not good as a result, and he and his ortho are struggling to reverse that, and get him ready for surgery.

That's what I was afraid of, #1 was telling me about how he's had people come to him after having teeth removed. And didn't seem to want me to go down the same path.

As I mentioned, when my ortho suggested surgery, I told him that wasn't going to be happening, and agreed to treatment working towards the best possible results he could manage without that; extractions were not even considered. He did tell me, however, that I could postpone making the decision about surgery, since he'd be treating my case exactly the same way for the first year or so regardless of whether we were aiming at surgery or compromise.

Yeah that sounds like a good option IMO. I have actually been thinking of asking him to give me the best possible results without surgery aswell. I can't remember all the details of the consultation as it was quite far back. But from what I remember he didn't seem too happy about doing anything other than what he had in mind. Also, if I went with him it would still cost me the same amount. So in a way I think, why not go for the surgery aswell. I wouldn't want to spend £3,500 for something I could do for £1,000 with braces. Hmm.. Why does everything have to be so complicated? I don't think I'd be totally happy whatever I choose!

Well, I am a second-timer - had a removable appliance on my upper as a kid, and stopped treatment early. It didn't take me too long in braces second time around before I started to ask myself if I'd not regret it if I went after a compromise this time. I mention this, because I think I am hearing something similar from you already. It's a question to ask yourself.

Sorry, I got a bit confused with this paragraph. Do you mean because you went for a compromise with your first treatment, that you felt you didn't want to regret going for another compromise (for the surgery)?

Frankly, your greatest risk with a lower jaw advancement is that of permanent numbness in the lower lip and/or chin. However, when this does occur, it is usually limited to a very small area, and most people I've ever spoken to or heard from tell me that it does not now bother them at all.

That's exactly my greatest fear. To lose feeling on my bottom lip or tongue. To not be able to feel kisses properly. That would be horrible in my opinion and definatly not worth it.
I think if I had a severe case, some numbness wouldn't bother me as much. And by severe, I mean noticeable. Like this:

Anyway, my advice would be that you do a bit more reading about the risks, so that you are better informed there, and can make a better decision whether or not at least to consult with a surgeon - if you did have a consultation I'd strongly urge you to ask that surgeon his own particular rates for the complications that most worry you, as many of them do seem to have wide ranges, and surgeon skill and experience seems to play a big part in that. There is, by the way, a lot of information in the References post in my Braces Story - there's a link below.

Thanks for your advice. I haven't had a consultation with any surgeons for it, only saw those 2 orthodontists. But if/when I do, I'll be sure to ask a lot of questions and definatly mention about the risks. I don't want to have any nerves cut!

As you've doubtless gathered, I changed my mind and opted for surgery. The procedure went flawlessly, and I was very lucky to enjoy a laughably easy recovery.

Lucky you. I didn't think it would be easy for anyone. It sounds to me like one of the worst possible surgical procedures you could have! The mouth/jaw is used ALL the time. Not being able to talk properly, eat at all. What about after you wake up from it? How would you vomit? Or even something as simple as yawning? Where you need to open your mouth? How could you live all those weeks with syringes and all that? It just sounds terrible!

I'm just wondering if you have any pictures available of you before and after your surgery?

One other thought: are you in the UK? (You mentioned prices in £) If you're in the UK and if your occlusion is bad enough that you'd qualify for surgery on the NHS, you might explore whether there is any chance you'd qualify for the entire treatment on the NHS. There are quite a few folks here who have.

Yeah I live in the UK. I was thinking that aswell. Do you mean just the surgery right? Because I don't think I'd be able to straighten my teeth aswell with the NHS. As I mentioned before, #1 said the surgery would be 'free of charge'(probably meant with the NHS). Even though it still adds up to a lot.

Thanks again for replying.

[loulou123]

Hey Im the loulou meryaten refers to above!

Im in the UK and had lower jaw surgery, with alot of problems afterwards. My blogs at the end of this post, so feel free to read it and please ask me any questions youd like to know.

[Angel21]

But I do wish we'd got things right when I was a kid

I heard you could fix the bite if your younger (before you've finished growing) without surgery. Which annoys me to think my dentist didn't even mention the problem to me to give me the choice, yet she knew about it.

Numbness in the lower lip and/or chin are due to damage to the IAN (inferior alveolar nerve). This is more common, but it is also very common for the numbness to be temporary. Note too that it is numbness, but no loss of mobility, so it would be entirely unnoticeable to anyone else. As I mentioned, even if it is persistent, the area is almost always extremely limited - for example, I know someone with a patch the size of your little finger tip on one lip, and another person with a patch maybe the size of a half pence piece (if you remember those!) on the chin - neither is at all bothered by these.

Oh I know you'd be able to move the areas that are numb, its just not being able to feel parts of my face properly that scare me. Especially the lips, they are very important! I've looked online and quite a few people seem to have had this happen to them, or know someone that has had it happen to them. I know its probably a small chance, but if it happens to you it is a big deal. I don't like the feeling of numbness you get when having an injection in the mouth, and I heard its similar to that.

I personally had no problems with nausea post-op, and generally speaking not everyone does. In fact I'd go as far as to say that, considering lower jaw procedures, rather fewer on this Orthognathic Surgery community have experienced nausea post-op than the number who have not, and very few indeed (sorry to be blunt) have actually been sick. I think that the surgeons who specialise in this type of work have become experienced in avoiding that: blood loss in lower jaw procedures is minimal, and they also use appropriate medicatins to help avoid nausea.

I thought it was quite common to have post op nausea from the anesthetic. Especially as blood will be going into your stomach, and the stomach does not like blood at all. As I mentioned before, I've had surgery and I vomited up all the blood. It was horrible. But having surgery in the MOUTH I could imagine would be even worse. If you can't even open your mouth to vomit! And being sick is bad enough as it is!

Take a poke around in my story - they're in there somewhere ... in fact right about here. If you want to read about my own personal experiences post-op, pick up my tale around here - there's even a pic of me sitting up in bed just a few hours post-op.

Thanks I'll have a proper look eventually, and everyone else's stories too. I saw those pictures in that link you gave me, but I don't see any before pics? I'm sorry for saying this but the x-ray picture of all the screws look really invasive. I've always hated the idea of having artificial objects permanently inside/on me. And the idea of it being in my face bothers me a lot, cutting the jaw apart, metal plates, screws?? Doesn't sound good at all... And it angered me that I was suggested to go through all that for something unnecessary. Just to look and be 100% 'perfect'. You know? But then I think maybe I should go through with it. If it would give me a more beautiful smile, and an overall better result. Maybe if I had digital imaging of what I could look like with or without the surgery it might help. I doubt it would be that much of a difference though.

No, indeed - there are a good scattering of UK folks here on ArchWired who have qualified to have both the surgery and the orthodontic treatment covered under the NHS.

Maybe its more for severe cases? When I went to see ortho2 I was an adult so couldn't get it free on the NHS. Hmm.

But I still think that generally you are perhaps thinking this is worse than it truly is

Well, judging from what I've heard so far and studied about the operation it does to me, sound really extreme. People go on about how bad it is having braces, wisdom teeth being removed, etc and this is just way beyond that. Everyone I've spoken to thinks I don't need it, and cringe when I tell them what's involved. They agree with me that if its really noticeable and/or causing you problems then yeah but otherwize not to.

Hey Very Happy Im the loulou meryaten refers to above!

Im in the UK and had lower jaw surgery, with alot of problems afterwards. My blogs at the end of this post, so feel free to read it and please ask me any questions youd like to know.

Heya, thanks I'll take a look.

[OneGuy]

I would seek advice from another orthodontist who, hopefully, can break the tie. That’s just basic common sense. If Ortho #3 suggests something totally different from the first two, you would then seek advice from Ortho #4 and so on. It’s that simple. In fact, I would not even make a decision until I consult with a combination of few orthodontists and oral surgeons. For example, prior to my brace treatment, I spent one year educating myself while consulting 4 oral surgeons, 1 facial plastic surgeon, 4 orthodontists, 2 periodontists, in that order. I then saw an ENT after I had braces on for few months to check for my airway and to have a sleep test. Trust me. By the time you consult few orthodontists and oral surgeons, your conclusion will become more and more apparent. If the problem was properly diagnosed (and it often is), you would eventually see a convergence of advices from 3 - 5 different ortho/oral surgeons. When you see ortho #3 (or #4), do NOT tell him or her about what ortho #1 and ortho #2 have told you so that ortho #3 can make an independent and objective evaluation about your situation. Tell him or her that s/he is the first ortho you see if s/he ever asks you. That’s the key point to remember.

Since then I've been totally dead set against it and angered why he would even suggest it for something so small and not needed. And everyone else thinks I don't need it.

I can see why you got angry by what your first orthodontist suggested. I was kind of taken back too when my surgeon diagnosed my condition as jaw deformity. I was somewhat offended initially. It turned out he was right after I had few more consultation and done some more reading. I suppose the truth does hurt. Is it possible that ortho #1 simply told you what he really believes in based on his medical education and experience even it may have hurt your feeling? What if he was just brutally honest with you? After all, a doctor is supposed to ethically tell you what medical problem you have based on his diagnosis instead of telling you what you want to hear. It’s up to you, the patient, to make the informed decision.

My top teeth are tilted inwards at the back, and I think my bottom teeth are a little tilted too. So my bite fits fine and I don't have any problems or discomfort. However if I were to straighten the top out, it would not fit with my bottom teeth. So my bite would be off.
...
The distance between the top and bottom set of my teeth looks normal.

The true overjet should be measured when your top and bottom front teeth are in an uncompensated state. What I mean is that your lower front teeth should form about 95 degree angle inside your month if they were in ideal positions. Otherwise, it would not be a true overjet. Let me tell you why I said that based on my personal experience. My lower jaw is about 10 – 12mm set back, and I’ve never had braces while growing up. Logically, you may think that I would have 10 – 12 mm overjet. You would have been right except that you would not be able to see an overjet just by looking at my front teeth. How could that be? Well, just like one of my surgeons said that dental compensation is a mother nature way of camouflaging the defect. Because my lower jaw was small and set back, my bottom front teeth have to tilt outward to meet my top front teeth. (This dental compensation process happen over years as a child grows up into adulthood.) Before I had my first braces as a full grown adult few years ago, my bottom front teeth were around 125 degree tilted outward to create a seemingly perfect overjet of 2 mm which was really an invalid overjet (for lack of better term). You see. My first mediocre orthodontist (who was somewhat anti surgery) thought that my overjet looked ok and normal. He was wrong or inexperienced. I didn’t see the problem until I got an X-ray taken by my oral surgeon office. The X-ray shows that my lower teeth flare so much that he calls that procumbent incisors. Another surgeon called that bimaxillary protrusion although my top front teeth are relatively normal in the horizontal direction. Here I’m – never thought about needing this kind of surgery in my life – ended up having 4 bicuspids extracted and is 8 months in braces and waiting for surgery.

The bottom line is this. You should consult at least one more orthodontist. Take an X-ray or CAT-scan of your jaws in profile view, and then consult with few oral surgeons. Let the surgeons explain to you with your X-ray what your jaw problem is, if any. Keep an open mind. You would make a better decision after you’ve done all of that and understand the implication as many posters here have suggested. Make sure to educate yourself in the process by reading articles, medical journals, online groups, and the like. Sometime in life, it’s better to do what is right than what is easy. Good luck.

[brendan]

i think it looks good how it is right now and im usually quick to point out recessed jaws. i mean, it may be a little recessed, but your profile is fine and you look pretty hot etc

[ohmyjaw]

Hi Angel,

I had jaw surgery 14 months ago, and like you I was very resistant to the idea at the beginning. Basically, my orthodontist (as well as two others) told me they would be very reluctant to treat me if I did not have surgery, because the result would not be stable. My teeth would likely go crooked again when the braces came off. And, like you, I was offended when my surgeon rattled off the list of "deformities" I had. I thought my face was actually not bad looking

Anyways, I went ahead with the surgery and I would say it's not much fun for the first week or so. I was also wired shut, and that didn't help any. But by the time two weeks had gone by, I was up and around, carrying on with life as usual. So, in the big picture, I think it's a relatively small inconvenience.

On the topic of numbness, I am one of the unlucky ones who still has some, and I think it's probably permanent. I have a numb spot right at the corner of my mouth, and along the side of my tongue, and some parts of my gums feel all wierd and prickly (maybe those nerves are still recovering). Does it bother me? Not really. It certainly doesn't interfere with kissing or any other functions.

Anyways, I hope this is helpful, and good luck with your decision.

[sparkles]

Hi Angel21
I think it is a very big decision to make so I'd firstly say go and see at least one more orthodontist (as has already been suggested) because right now you have 2 different viewpoints from orthos. It must be hard to choose which one to go for simply because 2 professionals have differing opinions.

Secondly, no one says you MUST make this decision right NOW. You have time to think about what you want to have done. Take the time to weigh up all the pros and cons. Take the time to let your initial hurt feelings and confusion subside. Write it down on paper if need be. For me sending a friend an email with all my options helped me to decide what I wanted to do, seeing it in black and white really hit home for me.
I took 8 months to fully decide what treatment I was going to have. I am 'lucky' in that I get all my treatment on the NHS because I was born with craniofacial abnormalities but it doesn't mean that I'm any more a more serious case than other people who need treatment in my eyes.
Although I have craniofacial abnormalities I was kinda the opposite to you and worried a great deal that people would think I was only having it done because of cosmetic reasons or vanity. Yet I knew I hated how I look and the fact there is an underlying reason for it didn't seem to register too much in there somehow. I too had people thinking/saying I don't need surgery/braces and people say they don't notice how squint my face/teeth are (I actually think they must have eyesight problems )

As for the scariness of the surgery and the post op numbness, that was a big put-off factor for me. But I figured that I'd rather look better and live with numbness than live with how I look now. I guess for you, you need to weigh up what you can live with and what will happen to your teeth in the longterm (would not having surgery mean an impact on your dental health etc?) I don't think the surgery is any more risky than any other surgery. I think it maybe just seems more brutal cause it is going in there and breaking bones. I think perhaps because we are in the UK and this sorta thing seems to happen more often in the US shown on our TV screens that there is a different attitude towards this surgery here in the UK. I've been told 5 days in hospital, 2 months recovery time and a 10% chance of permanent numbness. I've had previous oral surgery (4-5hrs in theatre) which was far more risky yet didn't think twice about it.
You are entitled to feel the way you do but give yourself time. You will make the right decision for you in the end

Fay

[Angel21]

First I'd like to say thanks to everyone here for taking the time to read my post and replying.

I would seek advice from another orthodontist who, hopefully, can break the tie. That’s just basic common sense. If Ortho #3 suggests something totally different from the first two, you would then seek advice from Ortho #4 and so on. It’s that simple. In fact, I would not even make a decision until I consult with a combination of few orthodontists and oral surgeons.

Yeah I will see more, it just annoys me the amount of work that seems to be involved.

If the problem was properly diagnosed (and it often is), you would eventually see a convergence of advices from 3 - 5 different ortho/oral surgeons. When you see ortho #3 (or #4), do NOT tell him or her about what ortho #1 and ortho #2 have told you so that ortho #3 can make an independent and objective evaluation about your situation. Tell him or her that s/he is the first ortho you see if s/he ever asks you. That’s the key point to remember.

I don't see why it needs to be kept such a huge secret? I don't want to have to act suprised if this other ortho I see tells me a similar thing, or doesn't even mention the problem at all. They won't change their opinion if I discuss what the other ortho's said, and if they do then they wouldn't be a good orthodontist to me. I want to know how all the ortho's I see feel about any surgery.

Is it possible that ortho #1 simply told you what he really believes in based on his medical education and experience even it may have hurt your feeling?

It felt more like he wanted it for perfection rather than my well being. He kept telling me how there shouldn't be much of a distance between the chin and nose, even told me to look at magazine's to see what he meant!

The bottom line is this. You should consult at least one more orthodontist. Take an X-ray or CAT-scan of your jaws in profile view, and then consult with few oral surgeons. Let the surgeons explain to you with your X-ray what your jaw problem is, if any. Keep an open mind. You would make a better decision after you’ve done all of that and understand the implication as many posters here have suggested. Make sure to educate yourself in the process by reading articles, medical journals, online groups, and the like.

Thanks, that's something I think I will do. Actually seeing an oral surgeon would be good, and taking X-ray's.

Sometime in life, it’s better to do what is right than what is easy.

Yeah but that doesn't mean its right having surgery, to be 'perfect'. Infact looking at it for my case it sounds like it could be the wrong thing to do.

I was talking about this with my friends recently, and they feel as though ortho's make up anything they possibly can and make the situation a lot more complicated than it actually is. I remember seeing a program on tv once, where a woman's teeth were really good and they wanted to give her veneers!

i think it looks good how it is right now. and im usually quick to point out recessed jaws. i mean, it may be a little recessed, but your profile is fine and you look pretty hot etc

Thanks!

Anyways, I went ahead with the surgery and I would say it's not much fun for the first week or so. I was also wired shut, and that didn't help any. But by the time two weeks had gone by, I was up and around, carrying on with life as usual. So, in the big picture, I think it's a relatively small inconvenience.

On the topic of numbness, I am one of the unlucky ones who still has some, and I think it's probably permanent. I have a numb spot right at the corner of my mouth, and along the side of my tongue, and some parts of my gums feel all wierd and prickly (maybe those nerves are still recovering). Does it bother me? Not really. It certainly doesn't interfere with kissing or any other functions.

Hi ohmyjaw,

I understand what you mean, a few weeks of suffering for something that'll benefit you for the rest of your life. But during that time is when it's difficult, and it'll feel a lot longer at the time. I really don't like the idea of having my mouth wired shut either (if I had to). Difficultly in even the simplest of things like talking or yawning. There's so many things about it that bother me. A website I found even mentioned how you would probably feel regret to having the surgery for awhile.

But its not even that, its the after permanent things that bother me the most. The metal plates and screws permanently inside my face. The risks and complications, etc. Permanent numbness is not something I want at all, and a 10% chance sounds pretty high. I've even heard of jaw problems after like clicking, locking, etc. When right now I have no problems with my jaw.

Sorry to hear you got some permanent numbness. But your also lucky in the fact its not on your bottom lip! If it was, I think that would interfere with kissing. Would it not? Does the numbness feel like what you get when having an injection in the mouth?

That risk is something I wouldn't like to take, everyone wants beauty and perfection yet they lose sight on what really matters. You know?

I guess for you, you need to weigh up what you can live with and what will happen to your teeth in the longterm (would not having surgery mean an impact on your dental health etc?)

Hi sparkles,

I doubt anything will happen to my teeth in the long term, never really get any problems with them at all. And as I said right now the bite is fine and I have no problems.

I think it maybe just seems more brutal cause it is going in there and breaking bones. I think perhaps because we are in the UK and this sorta thing seems to happen more often in the US shown on our TV screens that there is a different attitude towards this surgery here in the UK.

Well as I said I've already had surgery before, with bone breaking involved. This just sounds a lot worse.
I think the UK is becoming more and more like the US.

[Steph-in-WI]

Angel,

You have received a lot of good information here. I would especially heed the advice of others regarding seeing more Orthodontists and Oral Surgeons. I know the time commitment can be "annoying", but that is what it takes to make an educated decision. YOU are your own best health advocate. YOU are the only one who can make this decision for yourself. So it is in your best interest to educate yourself on this situation as much as possible and see several specialists until you feel you are properly equipped to make an educated decision. You have come to the right place, this is a very supportive group that will help guide you through the decision making process.

I was told seven years ago that I needed to have Orthognathic surgery. I have a class II bite and have had some troubles with my TMJ since my mid 20's. I had braces as a child, and when I go back and look at my dental records just 2 years later my dentist recorded that I had a severe overbite. So although my Orthodontist significantly improved the way my teeth looked, it did not improve my bite. When I was told seven years ago that I needed Orthognathic surgery, I didn't proceed because it was denied by insurance. I gave up and did not pursue it further.

I went back to the Orthodontist last summer, and they did a tomography which showed me the wear and tear my bad bite has done. My right condyle is degenerative, basically it is being worn flat at the end where it comes into contact with my skull (at the TMJ). Seeing that damage, I realized that I needed to consider this surgery for health reasons, it was no longer "cosmetic" as I had once viewed it, because it would lead to long term health problems. My lower incisors were already wearing, and I face the possibility of loosing teeth down the line if this continues. As my condyle deteriorates futher, this could also make my overjet even worse.

So I did all the research I could possibly do, and decided that I was going to have the surgery with or without insurance, although for financial reasons that would postpone my decision some. Insurance denied me, and I appealed armed with a great appeal letter from my OD and a good one from my OS. I got it approved, and several weeks later (last November) got my braces on. I will be having my surgery (upper, lower, and genio) in September.

In the mean time, I continue to learn so much about this process and have come across some amazing stories. This is not something to take lightly by any means. When you say that your teeth fit together fine, is this your opinion or the opinion of a dental professional (i.e. orthodontist)? Because what we as laypeople think and what is actually true according to the textbook may be different. It is also possible that when they try to straighten your teeth, it actually makes your bite worse. I would try to understand through your Orthodontic consults what your potential risks are if you do not have the surgery, this may help you better understand if your issues are more cosmetic or more medically necessary. It sounds like this is the part you are most struggling with. I think if you do indeed find out that it is indeed cosmetic, you will not be inclined to have the surgery. But I think this is something you need to find out from professionals, not based on your own opinion that your teeth come together fine. The professionals will help guide you to make the best decision in your case.

Regarding not sharing other professionals opinions when you seek a new consult, I tend to agree with this. The reason is, if you go to a new Orthodontist for a consult and tell him that you had been to another who said you needed surgery and just can't accept that, that might bias his opinion to find a compromised result for you. My OD basically gave me 2 options, braces with surgery or just braces. But if I did just braces, I would have a compromised result, that would not be stable long term, and I could have the same health risks long term that I face right now without braces and surgery.

I agree that there are a handful of unethical health professionals practicing out there that are possibly looking more for the money than the well-being of their patients, however I definately think this is the minority rather than the majority. That is why it is important to get several opinions. And just because they suggest something different doesn't mean they are just trying to add things on to make more money from you. Different professionals have different levels of experience and training. I don't fault my OD as a child for not taking care of this issue 20 years ago. Even though I wish I would have gotten my issues sorted out sooner, I don't think he had the knowledge or training on these surgical issues to sort them out. And if there is one thing I have learned, one of the most important pieces of this surgery is that your OD and OS are on the same page with your treatment plan because you OD has to set you up for surgery and for that they need to have very close coordination.

Any health issue can be time consuming, and yes, annoying. My malocclusion is due to a congenital deformity (it sounds harsh, and yes it was hard to hear, but that is what the technical term for it is). I never thought of myself as deformed, and I don't think I am unattractive, although I believe that moving my jaw forward and having the genio will certaily give me a much nicer cosmetic outcome by eliminating the recessed chin.

Also, regarding the risks, weigh them carefully. Although the chances are relatively small for complications, they do happen, and you have to be willing to deal with that. As others have said, the numbness is the most prevalent side effect. If you say that you absolutely won't accept that, then that pretty much excludes you from having the surgery. It is a possibility. But talk to others who do have permanent numbness. In the year that I have been reading other people's stories, I have never seen anyone who regrets having the surgery because of numbness.

Try to keep an open mind and listen to others who have been through this. Friends are good to bounce things off on, but unless they are educated on these procedures as well, they tend to have a bias towards the fact that you look fine and don't need it. But if this is related to your health, than the fact that your appearance "looks" fine shouldn't be the determining factor.

Good luck in making your decision, I know it can be quite a shock at first, it is a signifant investment in time (if you take the time to be quite informed) and financially for many. The one thing that I would say is that a positive attitude seems very important to get through this whole process. If there are a lot of things that you absolutely won't accept, than it is going to be a bumpy ride full of disappointments. Knowing what your in for is very important, but with that said, everyone's experience is different. I have seen numerous people post in the first couple weeks after the surgery is over that they are not sure that they did the right thing, but almost always after the first couple of months they are glad they went through it. In almost all instances, I do believe that it is important to have a compelling reason to go through with this surgery, so the benefits outweigh the risks.

[Angel21]

You have received a lot of good information here. I would especially heed the advice of others regarding seeing more Orthodontists and Oral Surgeons. I know the time commitment can be "annoying", but that is what it takes to make an educated decision. YOU are your own best health advocate. YOU are the only one who can make this decision for yourself. So it is in your best interest to educate yourself on this situation as much as possible and see several specialists until you feel you are properly equipped to make an educated decision. You have come to the right place, this is a very supportive group that will help guide you through the decision making process.

Hi Steph, yes I'll take that advice.

When you say that your teeth fit together fine, is this your opinion or the opinion of a dental professional (i.e. orthodontist)? Because what we as laypeople think and what is actually true according to the textbook may be different. It is also possible that when they try to straighten your teeth, it actually makes your bite worse

Isn't this about me? I feel my bite is perfectly fine, I've lived with it all my life and didn't even notice there was anything wrong and it hasn't effected me negatively. So what anyone or anything says, it shouldn't change that fact. As I said, right now its fine but if I were to straighten the teeth out perfectly, without the back teeth tilting inwards as it does right now then I think that's when the bite would be off. Then maybe then I may get problems. But I could just straighten the teeth that bother me and leave the back teeth so the bite is the same.

I would try to understand through your Orthodontic consults what your potential risks are if you do not have the surgery, this may help you better understand if your issues are more cosmetic or more medically necessary. It sounds like this is the part you are most struggling with.

There wouldn't be any risks if I stay the way I am now, because as I've said I have no problems. This is the thing I'm trying to explain, it is not medically necessary. Unless I want absolute perfection. Really I'm struggling with choosing between an option that's...

Easier. Trying to gain the best possible result without going so far as to having surgery/basically working around the problem. But with what would most likely not look as good.

Or...

Doing everything, have my teeth straightened perfectly and with surgery to correct the bite if needed. For what would probably look the best.

Regarding not sharing other professionals opinions when you seek a new consult, I tend to agree with this. The reason is, if you go to a new Orthodontist for a consult and tell him that you had been to another who said you needed surgery and just can't accept that, that might bias his opinion to find a compromised result for you.

I kinda see what you mean, I don't see how it would change anything though. I'll be open minded and prepared to whatever they say and what they think is best.

If you say that you absolutely won't accept that, then that pretty much excludes you from having the surgery. It is a possibility. But talk to others who do have permanent numbness. In the year that I have been reading other people's stories, I have never seen anyone who regrets having the surgery because of numbness.

A part of me wants to have the surgery, and if the chance for permanent numbness was gone I would be more inclined to having it done. But because my case isn't extreme I would feel way worse if I had the surgery and something bad happened, than if I didn't. Because quite frankly I'm happy with the way I look now. And I don't want to have this as a huge regret for the rest of my life. But then at the same time, I may regret not having it done.

Try to keep an open mind and listen to others who have been through this. Friends are good to bounce things off on, but unless they are educated on these procedures as well, they tend to have a bias towards the fact that you look fine and don't need it. But if this is related to your health, than the fact that your appearance "looks" fine shouldn't be the determining factor.

Yeah, I understand how they would be more biased. But that's the thing, it isn't related to my health. If I had health problems because of it, the surgery would be more worth while.

I do believe that it is important to have a compelling reason to go through with this surgery, so the benefits outweigh the risks.

Definatly, I need to find out as much information about my case from more ortho's and surgeon's to outweigh the pros and cons. And hear what they think I should do.

[Lovely Rita]

There wouldn't be any risks if I stay the way I am now, because as I've said I have no problems. This is the thing I'm trying to explain, it is not medically necessary. Unless I want absolute perfection.

I think the thing is that you have no problems NOW, and it is not medically necessary NOW, but the way your mouth works NOW could cause serious medical problems in the FUTURE. I do NOT know what your exact problem is so this is something you have to talk about with a professional, but that is what my case was like.

Before I had braces and surgery, my teeth looked ok and my bite was functional. But if I had NOT had surgery, 10 years from now I would be in dentures. The proof is in the pudding: me, my mom, and my grandmother all had the exact same jaw problem. Me and my mom both had the surgery. My grandmother didn't. She lost all of her teeth by the time she was 30, specifically because of her unresolved jaw problem (as in, it wasn't because she just never brushed her teeth )

I'm pretty sure that your problem and my problem are entirely different, but the point I'm trying to make is that you need to consider the present AND the future of your oral health. What's fine now may become a real problem later on. Ask your OS/OD if this is the case for you.

[loulou123]

Can completely understand all your concerns, numbness, pain etc etc, but speaking as someone whose had just a few issues after surgery! i can honesty say that it hasnt been all that bad. Even at the time it wasnt aweful (no fun of course, but i can imagine worse things) i just concentrated on getting though it, day by day.

The plates being left in my jaw was of no concern at all for me. In fact as i had one removed, i worry about that side being "fragile" now, whereas the side with the plate in gives me no concern at all.

Honestly, no one can tell you what to do, it has to be your decision, but if it was that bad then i dont think wed all go through it!

[Angel21]

There wouldn't be any risks if I stay the way I am now, because as I've said I have no problems. This is the thing I'm trying to explain, it is not medically necessary. Unless I want absolute perfection.

I think the thing is that you have no problems NOW, and it is not medically necessary NOW, but the way your mouth works NOW could cause serious medical problems in the FUTURE.

No one so far has mentioned to me that it may become a problem in the future, but yeah I will see more orthodontists and oral surgeons so I understand everything more clearly.