New Year, New Bite

The date is set: January 13, 2010. It has been a long time coming but now it's only ten days away. Yikes! I will undergo BSSO (Bilateral Sagittal Split Osteotomy) and LeFort 1 or, in other words, double jaw surgery. I previously underwent SARPE (Surgically Assisted Rapid Palatal Expansion) on October 28, 2008. When all is said and done, I will have underwent two surgeries, the extraction of eight permanent teeth (as a child), and seven years of orthodontics to correct my bite.

How did I arrive here? As a kid I had braces from age 10 to age 14, nearly five years. The day my orthodontist removed my braces he announced that I would need jaw surgery in order to correct my bite. Ker-wham!, there had been no mention of surgery prior to then. He told me to just pick a good time, "spring vacation, Christmas break, summer," and then proceeded to inform me of how the procedure would involve breaking my jaw and being wired shut for six weeks. I wanted nothing to do with it and left in tears.

I did not realize then how correcting my bite is much more than a cosmetic issue. My bite, or lack thereof, has affected my chewing, eating, and speech for as long as I can remember. My bite has issues, functional ones.

When my retainer broke in college I went to see a new orthodontist about getting another retainer. This new orthodontist told me a retainer would not help to maintain the alignment of my teeth due to the relationship between my jaws. He explained how my lower lip would likely push my front teeth right back to where they had been prior to braces, all because my lower jaw set back so far. In assessing the severity of my case he asked me to pronounce my name, "Suzi." He was quite surprised to hear me enunciate my own name as well as I could. Unknowingly, I had adapted. My tongue had accommodated to my bite. This orthodontist too recommended jaw surgery. Still, I could only see jaw surgery as a cosmetic fix and not as way to correct the function of my bite. In my mind I could pronounce my name well enough, thank you!

A few years later my dentist suggested I see an orthodontist because of how my teeth were wearing. He explained how my molars, which bore the brunt of my chewing, had worn flat already and that this could be expected to accelerate as enamel is worn away. For me chewing consisted of crushing food between my molars or simply using my tongue to mash food against the roof of my mouth. What? Are you telling me that's not normal for most people? I had done this for so long I didn't know it wasn't normal. It was all my mouth knew and it worked.

By this time though I had begun to get the idea that my chewing technique was not as effective as it could be. I accepted the referral from my dentist and went to see yet another orthodontist. Sure enough, I was told I needed jaw surgery right along with what was stated as fact "insurance never covers it." The mis-information of how insurance never covers orthognathic surgery was enough to plant a question of doubt in my mind. Did I really need surgery to correct my bite?

It was not as if I couldn't eat, only that chewing was impossible and my incisors were dysfunctional. I could still swallow barely chewed chunks of food and quickly wash everything down with lots of water. I had even figured out how with some softer foods it was possible to press the food against my upper incisors with my tongue and thereby "bite" off a piece of food, sometimes. Though anything harder than a peanut butter and jelly sandwich required tearing or cutting the food into pieces. Pizza was a knife and fork affair.

My teeth failed at their very purpose of biting, tearing, or chewing because my jaws did not line up side to side nor front to back. My upper jaw was narrow and tapered and my lower jaw wide and broad. With the exception of my two molars which actually made contact my teeth served largely as mouth decor and went unused. In fact, until about eight weeks ago my incisors still had the little projections (mamelons) at their edges, just like a child's. Those ridges had never worn down because my incisors had never bitten into food. My current orthodontist saw fit to grind off the ridges of my undefiled teeth!

But back to my story, the orthodontist my dentist had referred me to sent me to see an oral surgeon. There, again, I heard how jaw surgery was essential to correcting my bite and the familiar refrain "insurance never covers it." As a young teacher there was no way I could afford out-of-pocket surgery so I did nothing.

Fast forward ten years to winter 2008. I'm tired of chewing with my tongue, almost choking because I do not chew my food well, and with not being able to bite into a sandwich or slice of pizza! I'm ready to take out a second mortgage if that's what I need to do in order to have the surgery. Back to the orthodontist, yet another orthodontist. Yes, I'm told I need surgery and once more "surgery never covers it." This time though, when I frown disapprovingly, the last statement is amended to "well, surgery rarely covers it and they never approve it the first time." I'm again referred to an oral surgeon.

This time I go to the same office but I see a different oral surgeon. In questioning me he is surprised to learn I actually had braces as kid! No surprise to me when I'm told need surgery, but I am surprised when he tells me I will more than likely need two surgeries. When I ask about the chances of insurance covering the procedures he informs me that unless my policy specifically excludes orthognathic surgery, "insurance will cover it." He was absolutely right. My bite or lack thereof is severe enough to be considered "medically necessary" per my insurance.

In October of 2008 I had an expander placed in the roof of my mouth followed two weeks later by SARPE surgery. I expanded the entire month of November for a total of 45 turns, the equivalent of 9mm. My gap was wide enough that it looked as if I had lost my front teeth. I discovered quickly how uncomfortable it makes others to look directly at you when you have a big, goofy gap between your front teeth. Aside from family and friends, the store clerks, fuel attendants, and other people with whom I interacted generally avoided eye contact. That is with the exception of the man who nearly got whiplash as he jerked his head around to be sure he'd just seen what he had thought he had seen. "Yes, I lost my front tooth." Closing the gap began when I got my upper braces in early December 2008.

With a mouthful of metal, a palatal expander, and the equivalent of no front teeth my speech was rather unclear. When I would try to explain my situation I may just as well have said I had "saw jurgery." "What?" Anyone who goes through this should buy a puppet and consider a second career as a ventriloquist!

Sometime last spring my lower braces were bonded. In July my expander was finally removed. I had, by then, grown quite adjusted to it. I was even a bit afraid to see it go due to the chance of relapse and, more than that, because it meant my tongue had to learn new tricks. Eventually my tongue stopped doing gymnastics around where my expander had been and learned the new landscape of my wider and unfamiliar palate.

Since then my orthodontist has been working to line up my teeth as best as possible for jaw surgery. At the last adjustment before my surgery the final SureSmile custom archwires were placed and, in addition to the hooks some bands already had, four more hooks were added to my mouthful of metal. Two hooks were placed in front on my upper wire and similarly two in front on my lower wire. All the more points to rubberband me closed!

Now it's only a matter of waiting.