2nd wire change for braces

5 November 2013

I just had my second wire change for my braces yesterday. And wow am I hurting today!  I know I was sore after the last one, but it still caught me off guard today.  I forget what gauge wire I am up to, but I was told that I am at a "medium level, the level at which they do most of the work."  And being the obsessive planner that I am, I asked again (like every time)...so how far out from surgery am I looking?  He told me that it is now looking like next fall at the earliest :(  which is fine, I believe in my orthodontist, I trust his outcomes, but I want this process over with! and he had told me upfront that it will likely be 1.5 years with braces before the surgery, but I did have the pipe-dream that I could graduate in May and get the surgery over with before I started a new job.

Anyways, my suggestions for the pain of a braces adjustment?  Take your pain medications regularly and on time. Ice packs. Take the day off after your get them adjusted (if possible! I say this as I head back to class). Definitely brush with Sensodyne toothpaste. And use your blender!  Your teeth are going to hurt so bad that you don't want them to come in contact with each other at all = no chew foods.

1st meeting with surgeon

September 23

Yesterday I had my first consultation with my maxillofacial surgeon.  I know its early out!  I just got my braces on 2 months ago and I was told to expect at least 1 -1.5 years before my teeth/bite/mouth are ready for surgery.  BUT... I just needed to talk to him.  All the website, journal articles, and blog research has only left me with more questions about what exactly will be happening to me personally and what I can expect as my prognosis.  I also really feel that its important to encourage my healthcare providers to act as a team.  To further that, I feel like if I'm on everyone's radar (or just somewhere in their patient files) they are going to watch out for me and something I may need is less likely to slip through the cracks.

So I met with the surgeon who actually put on gloves and looked at my mouth and my bite.  He then sat down and reviewed my x-rays with me.  And wow was that a shocker!  I knew I had a dental malocclusion and I thought that I had understood why this malocclusion led to my TMJ dysfunction. But what a difference an educated discussion made on my understanding!

Turns out I will need double jaw surgery.

There are typically 4 reasons someone needs this surgery (a part from trauma) and I've got 3 of the 4!  I've got the overbite, the overjet/open bite, and the asymmetry....wheee!  The only one I am missing is the underbite, which would be awfully hard to have at the same time as an overbite. The Dr gave me a brochure that looks like its from the 1980's "Your Orthognathic Surgery" I'll have to upload some pages next chance I get.  Essentially:
1. Serious Operation with all inherent risks
2. Inpatient hospital stay ~ 2-3 nights
3. I'll be out of work for 2-3 weeks
4. Liquid -> soft food diet for several months
5. My face/profile will change

Apparently I am still rather upset about the double jaw surgery, because I am really struggling and find myself reluctant to write tonight.  But I have about 1 year to a 1.5 years before the orthodontics will have done their work and my teeth will be where they should be for the surgery, so that should be plenty of time to come to terms with everything. 

1st Adjustment of Braces

9/20/2013

Well I went back to the orthodontist for my first adjustment of my braces yesterday.  They applied 1 gauge higher tensile strength wire on my top teeth and 2 gauges higher on my bottom teeth.  Here is a website I found that explains the importance of the wire: All About Arch Wires.  It was sore yesterday after the adjustment, but really the pain started when I woke up this morning.  It feels like my whole lower jaw is swollen, to the point where I feel like it should be obvious to everyone I meet. Of course I cannot see a difference in a mirror so there is no way that anyone else can tell, but I just want to wrap my whole face in ice and stop pretending that I am a normal person today... but that won't pay the bills!

Did I mention that they placed some composite material on my molars with the braces application in July? If not...they had placed a little composite material on my molars so that with my night grinding (bruxism) I would grind away the composite and not my tooth enamel (one of the reasons most people with TMJ disorders wear night guards). Well apparently I had managed to wear it away significantly (grad school= increase stress = more night grinding) so they added a lot more composite to my molars.  I know this sounds great in theory, but the composite material is all that can touch now, so its like have 2 pencil points that prop my teeth apart and my mouth open. Which brings me back to eating, one of my favorite hobbies and something I can no long do :(  Can you imagine trying to chew food with a pen tip? So needless to say I am really bummed to be back on a liquid/no chew diet.  Looks like I'm headed to the grocery store to stock back up on yogurt, mashed potatoes, protein powder, and pureed soups.

Now after I've complained enough, I did get some good news from the Orthodontist!  I asked if it still looked like we were on track to schedule my jaw surgery next fall (2014).  My reason for asking is that I graduate in May and I would really like to give my new employer a heads up that I will need to take some time off for the surgery.  And Dr R said that every mouth is different . . .*usual spiel*. . . BUT that there was a chance I could be ready for surgery in the Summer or even maybe May!  Which means surgery sooner, braces off sooner, new pain-free life sooner!!! My response was that if it was possible for him to crank on my teeth harder now I would take more pain today to get it all over quicker...unfortunately it doesn't work that way. But I left his office feeling a renewed sense of hope and optimism for my future life!

Here's an (unattractive) but upward view of my teeth as closed as they can get... which is to say not at all :(

Feeling Much Better!

September 17
So I have been feeling MUCH better with my braces.  I still have a couple really sore teeth that ache when I try to bite into something hard like a cracker (or push on them with my fingers), but overall the last week has been so much better.    I go in for my first re-tightening with the orthodontist in two days and I am not looking forward to it.  I guess I should make a batch of jello and mashed potatoes in anticipation. . . Did I mention how nice its been to eat anything but mashed potatoes?  SO  NICE!

Phase II: Braces

July 25, 2013
I had braces for both the upper and lower teeth placed on by a technician.  Everything I read online told me to expect about an hour for each application so I was planning for the process to be absolutely miserable.  I took 800mg of ibuprofen before I went in and braced mentally for another ordeal.  Surprisingly though, the application went very quickly and very smoothly. I was in and out in about an hour and that included the counselling time including what I cannot eat.  I'll post some of the list below for anyone else who is curious (or so that you know everything to eat before you get them on!) But truthfully the list did not impact me much as my jaw (and now teeth alignment) really didn't let me eat most of these foods even before the braces!

My webcam is a little grainy, but you can see that the top ceramic brackets really are a little more inconspicuous. I'll post a better pic of top and bottom brackets later for comparison.

Braces Contraband:

• Taffy, Toffee, Caramels
• Tostitos, Doritos, Tortilla Chips
• Corn on the Cob
• Apples (without cutting them up)
• Gum (which is HORRIBLE for TMJD anyways!)
• Hard Candies (they can get stuck and break a bracket)

Day 2 of Braces I was miserable. My jaw ached, my teeth ached and when my teeth touched together I got an electric-like pain that made me want to scream. I was taking 800mg of ibuprofen every 4 hours (not recommended if you want to preserve your GI tract)
Here is my post from Facebook:  "I REALLY want to take some pliers and rip these braces off of my teeth...grrr!"  

Day 3 of Braces: same as above . . . and now the brackets are ripping up the inside of my mouth. I've got so many sores lining my mouth even though I now have all the brackets coated in wax. As a note on the wax, the orthodontist told me to "try not to use the wax to allow your mouth to toughen up"  HA!

2 weeks of Braces:  FINALLY doing a bit better with the braces. I started attempting soft foods yesterday and have weaned off the 800mg of Motrin. Thanks everyone for the support it was a surprisingly rough start to a 2.5 year process!

CT Scan results

After I decided to go forward with the braces, I received my CT scan radiology report in the mail.

To sum it up I have degenerative joint disease (DJD) in both of my TMJs. With the Right TMJ showing increased signs of flattening and sclerosis. Also the right side of my mandible is shorter than the other!

Here is my scans:

This is what a normal TMJ should look like at my age :

And I thought this was a neat reproduction of the mandibular asymmetry that they put in my report:

The radiology report essentially confirmed that I made the right decision to proceed with getting the jaw corrected.  I was not expecting the DJD and especially not expecting the right TMJ to look that bad at 30 years old, I can only imagine how bad it will be in another 20 years if I don't take care of it now.

Results of Splint Therapy

June 16th
I went into Dr R's office and had a CT scan, x-rays and new molds taken to see how everything was looking.  Having the new molds taken were not any better than it was the first time!

July 2nd
I (very nervously!) had my consultation appointment with Dr R to review my results of the 10 month splint therapy.  Below are the molds that were created:

As you can see the splint allowed my muscles to relax and eliminated my headaches, but totally screwed up my teeth. As in, my teeth do not even touch except the very back 2 teeth on one side and I can make 2 on the other side touch if I concentrate. How the heck is a girl suppose to eat?!?!

Also here are the pictures that they took:

At the time of the consultation we were still waiting to hear the radiologist's analysis of my CT scan and results.  So based on the x-ray, molds, and imaging and my orthodontist's prior experience he recommended that I proceed with TMJD treatment in the form of braces to realign the teeth which would take approximately 18 months.  Then once the teeth were straight (and most likely touching even less) he has a maxillofacial surgeon that he trusts/refers to (and has excellent results) to correct my jaw alignment.  By "correct" he meant break the lower jaw (mandible) to align the bottom teeth to the top teeth and if needed break the upper jaw (maxilla) as well for palate expansion.

AAAHHH!!!

I asked what other options I had.  And he told me that there has been no permanent change to my mouth/jaw structures at this point so I could certainly take out the splint and my teeth would gradually readjust back to where they had been 10 months prior. Which meant I could go back to eating all the foods I was able to eat before the splint, but the headaches, migraines, and pain would likely return.  OR I could consider the splint a permanent friend and just try to wean down the number of hours in the day that I wore it.  This second option is what he recommended if I was not ready to commit to the braces yet.

After talking with my supportive husband, we figured if we were already in it this far we might as well continue with the process and the hope that one day I would be both painfree and eating normally.  So I agreed to get the braces put on in two weeks.  That gave me two weeks to wean out of the splint and eat all the caramel and toffee that my two teeth could manage.

Phase I: Splint Therapy

October 8, 2013  I received my splint from Dr R.  All the research online has told me that there is no general consensus on the best splint type.  Mine was a hard splint for the upper teeth. It looks almost the same as the night guard I've been wearing for the last 5 years (for the night grinding) except it is longer/thicker in the front and overlaps my bottom teeth. I was told to wear it 24/7, that I should only take it out to brush my teeth and that it was very important that I use it while eating.

The first 2 months of wearing the splint were just awful.  My headaches were worse, my jaw pain was completely horrible, and I couldn't eat solid food.  The first month I did not know how to talk with all the plastic in my mouth.  I lisped, I slurred, I could not pronounce the word "hypothesis"! I did not leave my house apart from going to class and studying; I was minimally functional. 

But thank goodness I was a PT student!  My wonderful classmates worked on some of my trigger points, applied ultrasound to my masseter muscles, and I had a steady supply of hot & cold packs to get me through the day. 

I saw the Orthodontist every 2 weeks for a splint adjustment.  The theory was the splint took my current teeth occlusion out of the question and would allow muscles to relax and my jaw to fall back into its "natural" position. By seeing him every 2 weeks, it allowed an adjustment of the splint to a more optimal position and permitted the facial muscles to release their tension.  Dr R told me that he anticipated needing to wear the splint for 6 months.

It was about December that I started working on chewing very soft foods. Until then it was all smoothies, mashed potatoes and oatmeal!  The most difficult aspect about chewing was the hard smooth surface of the splint that really just allowed me to just mash my food against a flat surface. Leafy greens were definitely out of the question!

But then when February began, I looked back and realized that I had not taken any pain medication in a month! No headaches for a month! It was an incredible realization! The splint therapy was helping!!!

24/7 I wore that splint, I do not think I've ever been more compliant with doctor's orders in my life, it was helping and I was going to soldier on, even looking (at least I thought so) ridiculous with a chunk of plastic in my teeth. Well 6 months came and went and my jaw was still resetting itself.  I ended up wearing that splint until July...10 months later... 

Possibly the only pic of me in my splint. And I think that al you can see is that my teeth don't touch because of the plastic between them.

Splint Fabrication

The splint fabrication visit was NOT fun.  If you are a little claustrophobic and/or have an excellent gag reflex... hang in there for this step!    My orthodontist took photographs, an xray and then had molds taken. Making the molds were by far the worst part.  They fill your mouth with a foam and then set the foam with a special light (all told about 5 mins for each the top and the bottom) but it felt like an eternity and the foam in the back of my mouth kept creeping back toward my palate and it was all I could do not to vomit or completely panic when the mold set and did not just slide right out!
I might be mis-remembering but it felt like I had to hold my jaw open for almost 2 hours, which of course flared up both of my TMJs for several days after.  My advice take pain/anti-inflammatory meds before you go in for the fabrication.

<I'll add in my "before" pictures if I can get them from Dr  R>

Meeting the Orthodontist

In September 2012 I met my orthodontist, Dr R.  During the first consultation, Dr R  spent time walking through the mechanics of the TMJ with me.  We then discussed my symptoms like the clicking & popping noises that you can hear from across the room, lateral deviations of my jaw with opening and closing, muscle spasms and tension that lead to days of nothing but migraines...etc
We also discussed potential causes of my TMD. I have bruxism (night teeth grinding/clenching) that increases with stress (not that there is any of that in graduate school!!).  I had a traumatic fracture of my zygomatic arch (cheekbone) in high school. I had braces for ~1.5 year when I was 7 years old for an overbite (potential overcorrection?) ..etc

Dr R explained to me that he has been able to help many people with TMD.  He was very honest  and upfront with me and said that many people with TMD require surgical correction, but that there is a small percent who can benefit from conservative methods and end up not needing the surgery.
Conservative method?? That might get rid of my headaches?? Sign me up!!  Only problem is that TMJ problems are not typically covered by insurance. Dental insurances claim its part of the face and so refuse it and Medical Insurance claims its part of the mouth and so refuse it.  Of course! Why would something that causes me chronic pain be covered by insurance?!?!  Luckily I have a very, very supportive husband who is all for having a happy, pain-free wife and jointly we decided that it would be worth it to switch back to ramen noodle dinners to give this conservative method a shot.

So I called and scheduled my appointment for a CT scan, x-rays, and to make molds of my teeth.

Background on my TMD

After searching the web for blogs and other people's experiences with TMJ correction, I decided to write my own to share my experience...
I am currently a physical therapy doctoral student and I was diagnosed with Tempromandibular Disorder (TMD) or more commonly referred to as "TMJ" about 11 years ago.  At the time the specialist I saw told me that there was a surgery available but it was only 50% effective and so I should essentially "suck it up" until I could not stand the pain and then he'd operate.
So... 11 years later I was still "sucking it up."  I was accustomed to migraines that lasted 5-6 days at a time and I was forever massaging my jaw because of the muscle tension. I could not chew tough foods like bread ends or caramels.  I would take Ibuprofen like it was candy and I thought it was just normal.
Last August,I found a new dentist who highly recommended that I speak with a specialist, as there have been some medical advances in the past decade, (which made sense!) so I made an appointment to see a new orthodontist.

Here's a "before" picture of me with my husband.  If you look close you can see that my jaw is asymmetrical and the left side juts out kinda weird.