Braces will soon go

Hi everyone, what a shock to hear from me!

My braces are still on but I think we are nearly there. Until tonight I wasn't sure if I was happy with my newly moved-over midline, but I took these photos and ran a ruler from the point between my eyebrows and down to the centre of my chin, and indeed it is bang on the middle. The reason it doesn't look it is because my nose goes off to the right! I can live with that.

The reason they're still on is because the bands and spring used in the moving over of my midline pushed some side teeth up and over and various little things that just have to be fixed now. All fixable though. I have no date for when they'll come off but I'm expecting it to be in the next 3 months or so. It will be a beautiful thing.

This was me just over a year ago... a month before my surgery.

Plus check out this link for some 'before' photos: http://jawtilting.blogspot.com/2009/07/16-days-some-beforeafter-photos.html It's the ones where I'm wearing a red shirt that are the 'before' ones. In the non-smiling ones, my back teeth are together and my lips are relaxed. They never touched unless I forced them down. I am LOVING the change. The function more than the looks (not that I dislike the looks).

I still have some loss of sensation in my upper right lip so I guess it's permanent. It's not totally numb. It's not a big problem for me although if I could wave a wand I'd fix it.

And how about that terrible jaw joint pain I had after the surgery: NIL. All gone. Phew.

Interesting how my cheek bones jut out so much now. Is it ageing... is it because my face is shorter.... is it because I don't clench my jaws at night now (I think! well sometimes I think I do but nothing like before) and therefore my overdeveloped muscles there have shrivelled... I don't know. I don't think they usually look as bad as they do in the photo - the flash accentuates them.

Headaches: still bad. Bummer. I am currently launching into a rather painful no chocolate stint to see if it helps.

The gap moves

Just more orthodontics progress. The gap has been moved forwards bit by bit and there is now one behind my right canine tooth (which is the official gap the ortho created) and one in front of the canine (which he was suprised about).

And as of today my canine is being yanked backwards by a very taut spring into the gap behind it. Pain. So over the next week or two, gap behind will move into gap in front and I will have my sum total of gaps, one big fat one together. Then I will be able to see how far my top midline will move over. So wish me a big gap.

On April 22nd I go back and my front four teeth, the incisors, will start to be dragged all together over into the gap.

Unfortunately although my top midline has not yet moved, the bottom one has done so. It has done it so well that it is now underneath my top one. In other words it too is over to the left and dentally my midlines meet well, i.e. with each other but not with my face. This is not ideal considering the top one's soon going to head east. But I can't be worried about it. The orthodontist is a bit surprised at how easily it's moved, I think, and is now aware of the problem and has at least stopped it moving further.

EVERY DAY I enjoy the way I can bite my front teeth together.

This gap-creating spring I have on has forced my right molars well apart, perhaps by intruding them, I'm not sure but I have no contact at all on that side. So I am still only chewing with half a set of teeth but I'm assured it's temporary.

Jaw joints feel absolutely fantastic, NO PAIN. My novement feels normal but I suspect I've lost 5-10mm of opening width, probably permanently. However, that would just bring me back to a normal person's opening as I could open my mouth particularly wide before surgery.

Moving teeth sideways

I saw my orthodontist yesterday and he is really pleased with the gaps his spring has opened up in my teeth. He seemed surprised by how much gap there is. So now we have room to move, and he is commencing the dragging the teeth around, pair by pair, eventually getting to the front four (which can all be moved together apparently). Had quite a bit of pain last night but only a little bit today. There is a hard plastic cord between my brackets of my top right back molars, and a spring. The back gap already feels closed when I try to push my fingernail in there. It's amazing how quickly these things can work, even on an old hen like myself! (Well 37 is pretty old compared to the teenagers going in and out of his rooms.)

No word from him on how long it will take but he will see me monthly.

Also no word from him on the more important question: whether the gaps have given him enough room to fully take my top teeth back to centre. But he really did

I didn't ask these things... whatever will be will be now. I'll just wait and see.

I'm longing to get these foul witchy things off my teeth though.

I thanked him for keeping on going with me even though this is going on so much longer than either of us expected. He said he just wanted me to be happy.

By the way, for anyone who is wondering why I've disappeared from the yahoo orthognathic surgery support site, it's because the darn thing won't let me post anymore. Something to do with email addresses not being right... I don't know what has happened but I doubt I'll bother doing anything about it.

6 month update & before/after photos

Before

After

Before - lips relaxed

After - lips relaxed

My bite before (back teeth were together - could not get front teeth closer)

Now: Teeth over to the side, but a beautiful lack of open bite! My surgeon also straightened that bottom bit of nose between nostrils.



Profile before

Profile after

Hello after a long time!

All is pretty good. I wish the braces could go NOW but I know they're on for a good reason, and that it could be months yet until my top midline is brought as near the middle as possible (I see my orthodontist next in February and I think I'll find out how long then).

From the photo below you can kind of see the spring thing that's dragging my teeth over. I don't wear any elastic bands, just the spring on my right side. Amzingly it's pretty easy to wear. I can't remove it. It's making gaps that, when pulled together, will pull my front teeth across. There's the gap you can see at the front there and one at least as big between some molars at the back.

My canines have moved so they allow my jaw nice side-to-side motion now. Important for chewing!

The jaw joint issue: still pretty good. My opening at full stretch is 4mm. So, well within normal, and side to side and forwards and back is pretty normal too. I stopped taking the nortriptyline for a couple of weeks and remained at ZERO pain. But then it returned ever so slightly. More of a stiffness and a very slight dull pain, with pretty much no effect on range of motion. I started the nortrip again but it hasn't made any difference (altough probably would if I increased the dose). I am pretty sure my physiotherapist could eradicate it with accupuncture but just out of curiosity I'm going to see how it goes by itself.

It is an enormous change to the awful pain I got from my jaw joint for many weeks after my surgery. The biggest improvement came with the first lot of nortriptyline.

I am a bit shocked to see in my 'no smile' photo above that my lips are still not touching evenly on both sides. On my right upper lip there is still some numbness but it really doesn't worry me. Possibly the slightest-ever sneer of my top right lip is due to some nerve thing but I honestly think that was always the shape of my top lip - not quite symmetrical - but it wasn't so noticeable when my lips never came near touching each other without muscular effort. I am fairly confident that when my lips don't have to stretch over braces they will be fine. And to be honest mostly my lips do touch evenly both sides, it's just that in this photo I was making a super effort to make them totally relaxed in order to give an honest representation of the degree of change.

I still have some numbness in my upper gum. It's hard to tell exactly where but certainly above my front teeth. And the roof of my mouth is numb in patches and super-sensitive in patches where the new nerves have grown back. These things don't bother me at all though.

When I look at these before and after photos I am amazed! It looks like a big change to me, but now when I see people I haven't seen since before the surgery, NONE of them comment on it and if I ask they all say they can't see any difference!

Five months later

Here we are nearly at the end of the year. School finished for my son today and it's time to move into holiday mode, yay! It feels to me as though my surgery and the fallout dominated my year.

Things are looking good though. I still take the nortriptyline every night (25mg) for the pain in my left jaw joint. At first I took 10mg and not much happened. Then when I was told to increase the dose I went to 15mg. No pain... then a few days later it returned. So up to 20mg - no pain - then a few days later it returned. Then up to 25mg and the same thing happened. It was as if my body was adjusting to the increased dose.

Then I saw my physio last week. He did some accupuncture in my jaw muscles. Yes it hurt a bit! As a result, the pain at night disappeared again - WITHOUT any further increase in dose - and hasn't returned. It didn't seem to improve my range of motion though (which I must say is pretty good anyway!).

Now I can get 3 fingertips in my mouth at a squeeze (which is normal for some people but less than what I used to have). I can really easily get my incisors together, and once I am warmed up I can easily get my lower jaw out beyond my upper. I can move my lower jaw over to the right but not as far as to the left. (I had zero movement there before the drug).

The physio said I can put the dose up much further if I want. It's only at about 50mg that it has any real brain effects. I notice absolutely no side effects at this dose. 25mg is actually considered to be the minimum effective dose. I think I'd probably give it up if it was affecting me in any other way.

Braces: damn those ugly things. I saw my orthodontist last week. He said not to worry about there not being enough contact between my molars on the right hand side. Once my braces are off the teeth will move together of their own accord. Also he said he can put some rubber bands on to make it happen and it will only take about a week. And he said that since we're trying to move the upper teeth around to the left it's a good thing that there's no bite there to impede that.

This spring hasn't opened up gaps showing that my teeth are moving around, but my midlines are closer. However the top midline is still well off to the left (how could they make such a mistake?). I made it clear I would really like it to be in the middle of my face. He still doesn't know if it will work or not. It depends how much gap this spring can open up between my top back right molars and then he can drag the neighbouring teeth around but doing that is really going to extend my treatment time.

However, I feel there is no option but to just put up with it and wait. Six months more.... a big drag but worth it in the long run. I have spent SO much money and been through so much that it's worth getting it totally right.

Every day I think how neat it is that my lips come together at rest.

I notice a habit of rubbing my incisors together. It's like my brain is really still a bit wierded out by them touching. I try to stop myself doing it because I'm scared it might lead to a night time habit. My brain sure isn't missing that feeling at the back with only the back left molars touching at rest though. Talk about ANNOYING. Getting rid of that is the absolute best thing about the surgery.

I talk about my brain as if it's separate to me there. It's as if there is a kind of primitive bit of my brain monitoring my bite that is a bit separate from my conscious brain. Am I alone in this? That's the bit of the brain that the night clenching used to come from (and according to my husband still does but just one click at a time, occasionally, not repetitively like before the surgery). It was trying to grind out the annoying bit. There was no other way to get rid of it (apart from surgery! My primitive bit didn't know about that!).

Also, when I think about different things or move different parts of my body I can feel which part of my brain is being used. Hmmmmm. Can anybody else do that?

Enjoying my new jaws

Yes, I am at last feeling relaxed and happy with this new mouth. The pain in my jaw joint is 99.9% gone. My physio told me to up my dose of nortryptiline and the night pain has disappeared accordingly. My jaw mobility is awesome! Well, in comparison with what it was. I can jut my lower teeth out beyond my uppers, and can open 33mm (and have further to go yet, I know). I can also move my lower jaw out to both sides.

My top teeth haven't moved over to the centre much but then it's only been about 3 weeks since the spring's been in. I've realised that for proper chewing it'll have to happen. I can't slide my lower jaw over to the right with the molars together (ie chew to that side) because the canines bang into each other. They in fact need to slide over each other but can't because they're not positioned correctly in relation to each other. My ortho was talking about this from straight after the surgery and I didn't know why he kept going on about it. Now I am functioning normally again I realise why.

Will I ever be satisfied?

So what is my new problem.... oh dear... well it's been around since my surgery happened but I haven't really noticed it until now. I can only chew well on one side of my mouth because my molars don't touch on the right side. My orthodontist was worried about this from the start but I didn't care. Now that my mobility has improved so much (I can even incise easily now), I realise that chewing meat and hard stuff is only successful on my left side.

The surgeon told me before the surgery that after the surgery my incisors would meet but my molars wouldn't and the ortho would have to bring them down. When I asked him if he still had to do that he said 'That's happened now'. But now I will have to ask him again if there's anything more he can do. I'm afraid I have been more work for him than he bargained for.

My pain continues to decline and I am working REALLY hard on my exercises. I am forcing my jaw well into the pain threshold and it is yielding results. Coming up to the 3 finger opening.

Medication and new spring

I got the new spring in my mouth to pull the teeth over to the side. No big deal. Sore teeth as you can imagine! I'll put in a photo soon. It's hard to see unless I pull my lip to the side.

The crazy bit is that as soon as I got it in my mouth I knew it wouldn't interfere with my jaw exercises. Remember that I delayed having it put in by 6 weeks because I thought that would be the case. I could have had the braces off before Christmas, because it is only meant to be in 3 months. Grrrrr. However he did say it could open up some gaps that would then have to be closed with power chains so I am thinking I could still have more than 3 months to go.

Today I went to a GP to ask for a prescription for the amitryptiline. WELL. I ended up with a registrar and it was AWFUL. She wouldn't prescribe it, didn't believe I have a TMJ problem. I said how come my jaw mobility is so awful. It's the braces, she said. I've noticed braces mean children can't open their mouths properly. I told her that was absolutely WRONG.

I could rant on about her but really have been so wound up it would not be good for me!

I got home and rang my surgeon. He wrote a script straight away.

The $40 I paid the GP would have been better flushed down the toilet.

Physiotherapist

Had the physio visit today. I went to it in a lot less pain - things have been continuing to improve on that front.

The outcome really surprised me. I came away with antidepressants! Well, a recommendation for my GP to prescribe some. Called amitriptylline - which as an antidepressant is used at about 75-100 mg whereas I will take about 5 mg.

I'll try to explain why but can't remember all the details. He says it is my lateral pteragoid muscle not moving the TMJ disc properly, and at night time it gets worse due to build up of metabolites and that the pill will break that cycle.

What an honest guy... he could have kept charging me $40 a visit for many visits, and that's still an option, but he really thinks this will work.

He did stick a needle in my muscle and I think there was some loosening afterwards.

Orthodontist tomorrow for the bizarre teeth-to-the-side-moving device. Since it has a spring as part of it, I can only imagine that it will take me to even deeper depths of foul food catching.

Feeling good

I am still waiting for my physiotherapy appointment next week but it is amazing how much my pain has reduced with time. My body is obviously working hard at fixing itself. My opening hasn't changed much, still at barely 3cm with terrible forwards and right-sided movement. But that is of small concern to me compared to the pain. The noise is disappearing too.

With summer coming on I am really really enjoying eating tomato sandwiches. Only someone who has had an open bite will appreciate what I mean. And I am very much enjoying the way my lips touch at rest.

Sadly two nights ago my husband heard me clenching in my sleep (just 3 clicks though) and I woke up with a terrible headache which lasted all day. Could have been stress induced cos my son has been really sick (chest and ear infection) and our car wasn't working so I couldn't easily get him to a doctor. Fortunately our neighbours babysat and lent me their car, they are so kind. Jack's much better now and the car is fixed.

He is the loveliest boy and such a joy to me. He made me a card for my birthday today that said "I love you so much Mama!"

I have lots of other stuff going on which I am loving. Our 3 Orpington hens are thriving, we have had them 2 weeks and they have almost doubled in size I think! They are SO funny and we love watching them and having them with us.

Also I have started Zumba dancing and yoga. These are fairly expensive hobbies. But they make me feel GREAT and of course are fantastic for the health and fitness. Zumba tonight, can't wait. Remind me NEVER to do another aerobics class. As my dance studio's website says, 'Ditch the workout, join the party!'. I love dancing!!

For 'before' photos, see the last July post.

(or the first July post for a summary of what was wrong to start with)

15 week photos

Here I am 15 weeks later.

Feeling pretty good. My chewing is improving I think. The changes are gradual so it is hard to know. The TMJ joint is still a problem but I have made an appointment with a physiotherapist for 11th November. He specialises in TMJ and sounds very sure he'll be able to fix it for me, probably in just a couple of visits. He says he'll probably do some accupuncture as part of the treatment.

I had an awful headache today. I had hoped they'd all vanish after my surgery but they haven't. I have had hardly any though. I think some, like todays, are migraines. I do feel a bit 'spaced out' during those ones.

These photos make me very glad I've kept the braces on to have the top teeth moved over to the centre. I get the necessary device put on on Nov 12.

By the way, my bite is still feeling GREAT. I really, really appreciate it, too.

My new blog

I have another blog as well, as of tonight! It's about our chickens, which arrived yesterday. We have three backyard chooks (NZ word for chickens). How's that for a good distraction from a mere jaw. It is lots of fun and I have been far too busy watching them to worry about my disc.

Here's the link: http://ourownchooks.blogspot.com/

3 1/2 weeks after arthrocentesis: update

The pain in my joint has returned a bit. Bummer. It's maybe a third of what it was before, so that's not bad, but it has got worse gradually and I am very scared that the decline will continue.

My mouth opening's a bit better now though. I can easily get two fingers in (but not two knuckles). I know it's still pathetic. I have slightly more side to side and forwards and back. Probably even more pathetic in those areas though.

It makes eating a bit hard. I can chew but not well. I am probably at 70 or 80% of full chewing capacity. Even fibrous stuff like an orange is difficult.

The scraping noise in the joint has been mostly replaced by something that sounds a bit like a thick gel with small crystals in it moving around. And even that is on the wane now, things are quieter in there (as the pain increases! Bizarre!).

It's hard not to get down about it. I do NOT want to be someone who had orthognathic surgery only to destroy her otherwise healthy jaw joint. This HAS to get better. It has been over 3 months since surgery now. But I guess that's really still early days.

On the bright side, my bite is still excellent.

Note to Cece: I know October 13th has been and gone. I wait in suspense and check your blog nearly every day!

Goodbye pain!

Yes, indeed, my jaw joint pain has all but disappeared! That arthrocentesis really did the trick! And my bite - lovely, centred, comfortable - I am blessed. I absolutely love the way my lips come together easily and my jaw can sit relaxed, nearly closed, and when I do close it all my molars fit together beautifully.

My mouth opening is a bit better now with hard exercising of it. I can get a big fat grape in between my front teeth without bursting the skin if that is any indication. But still forwards and sideways is fairly dismal.

I can still hear the bones in my joint scraping.

However, I think it will come right.

And Dana, yes the time does seem to have gone really fast. My life is full and busy and it is nice not to have my mouth totally dominating it!

These braces will come off!

I saw my orthodontist today. He wanted to take the braces off "while the going's good", he said! Yes indeed, that is how good my bite is! But no, said my vanity, this 'off' midline at the top needs moving over.

It will take 3 months and involve wearing a funny spring thing instead of a rubber band, which can't be removed. So we decided to wait 6 weeks so I can work on my jaw exercises without any restriction. On November 12 I will have it on, which means the braces will come off mid Feb! Yay! Hopefully my horribly sensitive upper teeth will have calmed down by then.

Also, he said it might not work and the teeth might not move. But I am convinced they will.

I'm a bit sad the braces will have to stay on for the summer/festive season and I will have to go through all those barbeques and general social things with the food-in-braces problem. But it will be worth it in the long run. It will mean I will be in braces for 18 months total - not bad.

My noisy joint

Ah, maybe I was too optimistic. The bones of my jaw joint still rub/scrape when I chew or talk or do my exercises. It is quite horrible know ing your bones are scraping together when they shouldn't be. And how do I know.... of course it's right by my ear so I can hear it!

If my disc was in its correct place, it would prevent the rubbing.

And I can only move my lower jaw forward about 1mm - seriously pathetic - which is apparently a classic 'disc is in the way' problem (because the disc displaces forwards and prevents that forwards sliding movement).

Still, my bite is great. I see the surgeon (a back up one, my one is on holiday) again in a week so I guess I will get the verdict then.

I keep swallowing the rubber band I'm wearing on my braces at dinner time!

My lovely centred bite

Great news, since the joint was flushed on Friday my bite has stayed centred right where it should be, all teeth fitting together like nature's jigsaw puzzle. And to touch the joint has lost its strange bump. These are excellent signs that the procedure has been a success.

It's still pretty sore though and my jaw mobility remains pathetic. I remain dedicated to exercising it.

The jaw flushing

I had the arthrocentesis procedure yesterday to shift my left jaw disc back into place. I'm not sure it's worked.

They gave me iv sedation but I do remember at least part of it (not the full 45 min it took though). I specifically remember the surgeon grabbing my upper and lower incisors and pulling my mouth really wide open, and it hurt a lot. I cried. I remember everything at the end and when I came out.

The surgeon said the disc was definitely in the right place when he finished. But now my range of motion is just what it was before and the joint still hurts. I am meant to launch back into my jaw exercises now.

But my bite does seem to be centred, and not just when I lie down. So that is a very good sign - maybe the joint is still unhappy from being so manipulated. I have been given painkillers so I guess some pain is expected.

So, outcome is still pending.

10 week photos

Hey, my face has got even skinnier! And saggier!

It'll be good to get those top teeth moved to the centre. I shudder to think what the rubber band configuration for it will look like! I see the ortho next Tuesday.

But tomorrow I have my jaw-flush procedure. I am really looking forward to a normal healthy jaw joint again. 10 weeks of pain from the damn thing. And to be able to open my mouth more.... mmmmmm, lovely. Wish me luck.

My top teeth are pretty sensitive still, and some of them sore to touch. I couldn't bear to have my braces removed yet, even if it was option. I would need some local anaesthetic! And I still have the patch of numbness on my top right lip, near the centre. It itches at times.

Other than that, all is good. I am definitely happy with the cosmetic changes. Roll on happy chewing days.