The Plan

Why I am a Horrible Blogger
Looking over previous posts I realized I've never outlined the plan – what my surgeries will entail. From the picture you can tell I have a Class II Malocclusion (overbite instead of underbite). You might also suppose that the person taking the picture needs surgery to correct their one abnormally shorter leg that causes them to list to one side. But you can read more about that in another blog.

As a side note, I have noticed that the Class III Malocclusion patients (underbiters) have done a much better job with the blogs. Come on Class IIs!!! We have to fight the stereotype of being buck-toothed hicks!!!! For those of you who don't know, the Class IIs and Class IIIs have a fierce rivalry resembling that between werewolves and vampires in the Twilight series. (Almost exactly mirroring it actually. In fact, I am brooding about it right now.)

The Actual Steps
So after consultations with a handful of various doctors, here's the plan:

1. Braces Get braces to increase my overjet (decrease the distance my jaw will be moved in surgery) and widen my narrow upper arch. (done)

2. Wisdom Teeth Extraction Remove three severely impacted teeth early. The gaps left in my jaws need time to fill-in before the jaws are broken in surgery. Also, have excess irony removed. (done and done)

3. Orthognathic Surgery Break upper and lower jaws and move them forward. Set with titanium screws. Use braces to hold in place. My mother is very concerned that I will lose too much weight. I am concerned that I will not be thinner than my arch rival – Abraham Lincoln.

4. Rhinoplasty and Septoplasty Straighten septum. Remove my "dorsal hump." (Before you get excited, that is just the bump on my nose. I am not a mutant, half man/half fish crime fighter. That would be a "dorsal fin". I hope that cleared up any confusion.) My doctor told me that everyone with a recessed chin has a dorsal hump on their nose. Would you like to obsessively look for that on everyone in the subway like I do? Go for it.

Also, when I try to breath through my nose, the sides collapse. So they will remove some cartilage from a rib and use it to strengthen the sides of the nose. (I have encouraged them to remove as many ribs as necessary. While my heart would be largely unprotected, I'd fit into size 29-waist pants. I know. Medical decisions like these can be so difficult to tease apart.)

5. Throw Pillows and Candlesticks The final bits will involve finishing my orthodontics and cosmetic dentistry stuff and I should be a breathing sleeper-through-the-night.

From the Runways to Your Incissors

Ladies, I know you've been waiting for this. The must-have accessory is here. Previously, I have not opted for colored elastics (orms as we "in the know" call them). Until now, I simply went with silver – the "nude" of elastics. This time I went with teal. It's my summer look.

You'll be delighted to know when you select your color, they present a little palette with the options. My concerns: a color that mimicked trapped food in your teeth. Forrest green? No, sir!

What color should I get next? I'm considering a pattern. Rainbow? What should I get?

False Alarm

My surgeon suggested that rather than an infection, my braces may have just seriously irritated the tissue in my mouth causing swelling. I have noticed that my cheeks can rub a bracket and get raw/sore. Alcohol can make it worse. Well, that's one more reason to give up drinking. 45 more reasons and I'm finished!

Check-in #1 Post Infection

My smile is infectious infected. Specifically, my jaw. It's weird for me to have gotten an infection two weeks after surgery after seemingly being out of the woods. So, Dr. Kaban ordered x-rays to make sure I didn't fracture my jaw. Fracture my jaw? How is that even possible. Cut to...

[Ack, ok I asked for the x-ray on my thumb drive, but it didn't work. I'll get the picture which depicts A HUGE HOLE IN MY JAW.]

I'm on a course of penicillin. Let the lack of drinking and irregular bowel movements begin.

Infection

My extraction was more than two weeks ago and everything went well – holes closed. So this was a surprise. They said after the extraction that I was at risk for an infection because the tooth was so deep and the procedure more complicated. At the time they gave me a course of antibiotics as a precaution.

I woke up this morning to a swollen face and bulge in my jaw. I called Dr. Kaban's office from work and they told me to come in right away.

Anyway, I'm back on antibiotics and need to keep a close eye on things. They prescribed exercises to help me get my jaw to open more. For a more detailed medical explanation of this, please consult this not-too-technical and inspirational video.

Two-Days Post Wisdom Tooth Extraction

Recovering from Wisdom Tooth Extraction

I have to admit I am doing much better with this surgery than the previous one.

I enjoyed yet another Fribble today (ordered extra thick with a Peanut Butter sauce rim) with my Fribble-buddies Paul and Maura. I also enjoyed a fairly solid dinner – cheeseburger and fries.

My body seems to be getting pretty thin although my face is quite swollen making me wonder if I am actually the love child of Renee Zellwegger.

Uncanny isn't it?

Wisdom teeth extraction, you incomplete me.

Bye #17

As you probably immediately recall (or can quickly verify on your personal calendar), my last wisdom tooth extraction was March 31. They took two teeth. Today, I noticed that those holes have closed. That's nice because when I rinsed my mouth a salad bar fell out. Braces + Wisdom Teeth holes = nooks and crannies. If I also grow a mustache, I can probably take my lunch to school without a lunchbag.

In preparation for today, I stocked up. Lots of pudding, yogurt, and smoothies. (Last night I ate a calzone.) I learned the hard way to avoid lemon flavored food for a few days. Zing! Also on the way home, Tara (my adult escort) and I stopped for Fribbles at our favorite Fribblerie, Friendly's. I'm already planning to get another one tomorrow. Another cool food I recently found was GoGo Squeeze Apple Sauce. It's only 1 point and frees you from the oppressive need of carrying a spoon. Thumbs up.

I was awake for a good part of the procedure again. I liked listening to the doctors discuss what to do. They said something about drilling a hole in the tooth to grab hold and pull it out. They said it was "more involved" and "very deep". They had to chip away at my jaw to get the tooth out. My surgeon informed me that my recovery may be a bit tougher.

Last time, he gave me Oxycodone. I wasn't sure if that was what gave me the fever and nausea (I barfed). So I asked for something lighter. I went with Vicodin.

When I got home, I ate my Fribble, took a Vicodin, and started up the DVR (I've been saving episodes of Ruby, Taboo, and Extreme Couponing. Quality TV – although I fell right asleep.

I have to admit, so far so good (knock on wood). Less bleeding, less nausea, less pain, but more swelling. I'm pretty sure they surgically implanted Jiffy Pop in my cheek. The left side of my face suggests I might be another Arnold Schwarzenegger love child. (Fingers crossed.)

Bottoms On

 
Before/After
It's been three months since I got my top braces on. Mostly there's been no pain. In the beginning I was a little sensitive, but I got used to it. There has been some movement. Mostly my teeth are just lining up in the arch. The wire seemed a little wimpy. I like my braces to be like conversations about other people's dreams or pets – painful. Seriously, I want my braces to have some kick.

They put on the bottoms and added bands to the top. They also gave me a thicker, stronger wire on top. I'm pretty sure they pulled it off a spiral notebook. It was thick all right. I definitely felt it and my gap started closing right away. 

I had to include this picture because, well, it's kind of hot. You might be saying, "Is that really you? Did you rip a fake pic off the internet?" No, it's all me. Because of the goggles and my extended cheeks, I like to picture me on a motorcycle going really, really fast.

Now, I'm fully braced. Three months down. 15-21 months to go. Next step in the extraction of #17 next week.

You've Got a Little Something Between Your Teeth

About a week before you get braces, you get spacers. The orthodontist uses dental floss to jam little blue rubber bands between your teeth. He wiggles and presses then SNAP. You can tell how satisfying it is for him. I saw stars. Then it feels like you have a little Thanksgiving Turkey in your molars... for a week. They don't go around your teeth they stand up between them like this |O|.

My bottom braces go on next week. They claim to do them apart so you "have one jaw to chew with." That makes as much sense to me as leaving me one hand to clap with.

At any rate, I went back for a second round of spacers. I'm getting used to strangers putting their fingers in my mouth. I should've worn thigh-high leather boots. I could've charged $5. You like bicuspid action?

TV... Fribbles... That's it.

Um, Ow.

Do I have a mark on my face? It really hurts. My shoulder doesn't hurt, but my face sure does. Right here. Not so much on the left. Right here on the right.*

It's weird that the lack of wisdom teeth makes one side of my face look fat. Because I'm pretty sure I lost at least five lbs. I might be being a bit dramatic, but it was fairly unpleasant. You can't open your mouth very far because of the swelling and you can't use a straw. Suction = bad. The negative pressure can cause something called dry socket if your blood clot comes loose early. (Yeah, I just typed that sentence.) When I went to the orthodontist he asked about my next oral surgery and said, "That one will be much more involved." Good. I'd hate to have a surgery that seemed disengaged or indifferent.

My Poor, Poor Food Hole

Third Molars, Third Wheels
I had three wisdom teeth that were seriously impacted. Do you know how to tell when they're seriously impacted? When your very experienced surgeon says, "Wow. Those are DEEP! You're not going to make this easy on us are you?" He wanted to extract them asap so that my jaw would have a nice long time to heal and get strong for when he breaks it. (Not kidding.)

For the first surgery, he wanted to take out teeth #1 and #32 (on my right, your left). See that white line extending from the top of tooth #32? Fun Fact: THAT'S MY JAW. Despite that, I didn't think it would be that big of a deal. I mean, everyone gets their wisdom teeth out, right?

The Big Day
Dr. Kaban's scheduler, Debbie, is one of the few people who gets my inappropriate (and stressed induced) humor. She advised me not to eat after midnight and to bring an "adult escort". I told her that I'd see if Candy LaFontaine was available. She laughed. I love her for that.

I got an IV with Versed (vər-sěd) and something else that I forget. The first needle "hit a valve" and closed up. We went for the other arm and it hit a nerve. I felt it all the way up my arm. Yisch. It gave me the same feeling as when I look at MRSA infections on Google images. (I don't know why I do it, but I do.) Check me out (below) in all my glory. Thank God I didn't get hair in my mouth.

They put a sheet over me with a cut out for my mouth and I conked out pretty quickly. I did wake up once during the procedure. I remember one of the doctors dropping pliers or something in my mouth. (Seriously) When I groaned, he said, "Oh. Sorry." I mumbled the inflection for "That's ok." I also groggily remember the sound of a drill or something.

Afterward, I perked right awake. The nurse asked me if I could walk into the other room and I said, "Oh sure!" Ok. It was harder than I thought it was going to be, but overall the procedure seemed not that bad. One of my teeth had to be broken up to get it out, but one of them came out whole. It is creepy looking. It looks waxy or plastic. I'm pretty sure they got it from a novelty shop.

They gave me gauze, ice packs, and prescriptions for Oxycodone and a mouth rinse – and my tooth in a baggy.

Recovery Day 1
I took two Oxycodone and laid on the couch. I could not eat. Now keep in mind that I had not eaten since dinner the night before and for me that's like a week of no food... basically. Later that afternoon, I started to have a slight fever and nausea. I decided I'd better eat – rice pudding, then a little chocolate pudding. Three, two, one: barf. Yeah. I barfed it up. Sure, I'm a step closer to skinny jeans, but I'd have preferred a little sustenance. 

Day 2
This morning, I could barely open my mouth far enough to brush and not well enough to insert a spoon all the way. My only option:  a coffee ice cream Fribble from Friendly's blended with peanut butter sauce, of course. The best part was not barfing it up. Ah.

Overall
This sucks. My poor food-hole aches and is ready for some personal pan pizza. It blows my ever lovin' mind that I have to do this again for tooth #17. Scroll back up and have a look. It's completely embedded in my jaw... and SIDEWAYS. Yeah. That should be no big deal. You might want to buy stock in Friendly's and Jell-o pudding. What am I going to do when they break my jaw in four places? It could be worse. I'm excited to be a few steps further in the process.

Oral Maxillofacial Surgery

How Did My Face Measure Up?

My oral maxillofacial surgeon is Dr. Leonard Kaban at Massachusetts General Hospital. Before meeting up with him, some of his colleagues did a bunch of pictures, measurements, x-rays, and scans.

<--- What adjectives do you like to hear when people look at your face? I got "moderately convex." That's ok. At least my face isn't severely concave.

In my profile x-rays (below), you'll see in the first one that my profile is relaxed and my (endearing) overjet is hanging over my lower teeth like a prominent dental awning. In the second film, they asked me to jut my lower jaw as far forward as I possible could. (Then they told me to "try harder.") Notice the diameter of my trachea indicated by the red crossbar. My airway is significantly closed off by my recessed jaw and opens when I move it forward. I've even learned to do this now. When I take a deep breath, I move my jaw forward and I can breathe easier.

What is the Medical Term for F#@ed Up?
As one of the fellows measured my facial landmarks with odd tools and dental floss, he mumbled distances and comments to an assistant who took notes. "Mr. Shull presents with hypothelorism and diastema," he stated indifferently.

"Just so you know," I interjected, "I know what those words mean and I'll try not to be offended. (A little medical humor on my part). But, I was surprised by the first. Hypothelorism is abnormally close-set eyes and diastema is a gap between the two front teeth.

Knowing I'm a speech pathologist, he added "Oh, you must've learned those terms in your Craniofacial Abnormalities class." Wow. Really? Ok. Then I really was offended... a little.

The Plan(s)
During my follow-up with Dr. Kaban, he presented three options. The first step in each required getting braces (done) and the extraction of some impacted wisdom teeth. The goal of the braces is to move my teeth so my bite will align post-surgery. He also wants to open my narrow upper arch and move my upper teeth as far forward as possible to reduce the distance my jaw will have to be displaced. In essence, increasing my overjet. To which I replied, "I'll look like a rake!" Yeah, I got nothing. I suppose it's good to have surgeons without senses of humor.

Once my teeth have been sufficiently moved forward, they will break my lower jaw (and probably upper jaw) and move them forward and set them in place with titanium screws. 

I am fourteen-years-old again

Today was a big day. Dr. Murthy put my upper braces on. They gave me the option of ceramic or metal. The ceramic ones are slightly bigger and are more likely to break. So I opted for the less vain/ more Ugly Betty, metal ones.

Orthodontics for me are necessary. No, not only to prevent me from looking like an extra in The Hills Have Eyes. They're part of my prep. for surgery. So I thought they might be covered by insurance. They're not.  In total, the orthodontics will cost $7,450. I'm lucky, though. My dental insurance actually covers up to $2,000 for me (not just my non-existent, presumably buck-toothed children). So it's like I got a coupon for braces. I put $2,235 down and will pay $160-something per month. That covers everything from impressions and x-rays to retainers.


The whole process was a piece of cake. I had heard that the spacers felt worse than braces and that was true for me. It was quick and painless. (I did, however, make sure to take a massive dose of Advil™ before I left for my appointment.) Another blog suggested making sure your lips are moisturized so I slathered them with Vaseline™ in advance as well. That was a good tip, because they tried to tuck my lips behind my ears. [See below.]

The process brought back vivid memories of the last time I had braces. "Wait," you say, "You had braces before?" Yes, insensitive reader. I did. During one of my regular visits, my dad went back into the orthodontist's private office for a long time while I waited up front. When they came out, they announced, "Your braces are coming off today." Looking back I guess that the doctor told my dad that I needed jaw surgery and my dad declined. I was in high school, so I was glad to get them off. But no follow-up care was given. My teeth separated faster than Brittany and Kevin (or Charlie Sheen and anyone.)

So, what do you think? Should I use that photo as my new Facebook profile picture? When it was all done, the assistant gave me a bag of goodies and said she wanted to go over some issues regarding care of the braces. I asked her if we could speed it up because I was meeting a friend to go to a taffy tasting. (No, she didn't laugh either.) At any rate, I will have these sexy metal numbers for 18-24 months. The bottom set goes on in May.