Author Topic: A dentist's opinion on jaw surgery.  (Read 726 times)

strongjawman

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A dentist's opinion on jaw surgery.
« on: September 29, 2013, 06:20:33 PM »
Thought I'd post this as I thought it was interesting as it gave me an insight into another professionals opinion on jaw surgery and orthodontics as a whole, not that I agree with it at all.

I went to the dentist last week to get a general cleaning and a mouthguard made up for when I sleep to prevent further grinding as my bite has changed again.

During the cleaning she asked me why I wanted a mouthguard, and so I explained to her that my bite was off as a result of my jaw asymmetry and that it was causing one side to grind against each other and flatten the teeth on that side. She then asked me how I knew that, to which I told her I had been to two surgeons who explained this was the case.

She then told me that my bite has changed because my wisdom teeth have been pushing against the rest of my teeth, thus causing the the lower incisors to push out slightly. She then told me my upper incisors were inwards slightly as a result of my lower lip pulling against them - the combination of the two giving me a slight open bite (now edge to edge due to the teeth grinding).

Her solution was to extract my wisdom teeth as it is "the obvious and sensible solution" as they were the cause of my malocclusion, and to then use a combination of bands and braces - to pull my upper jaw forward and pull the bottom teeth back, not really sure what she meant.

She then told me to be wary of jaw surgeons as they tend to be limited to their field, and don't see the same things that "a good GP or dentist sees on a day to day basis", also mentioning that these surgeons that gives lecturers are too quick to cut people open and break jaws for repositioning. "A good orthodontist can fix your bite with some appliances, I've been a dentist for 40 years and come from a long line of orthodontists".

She was a lovely lady, but I'm not sure if I agree with her idea that orthodontics can fix everything. She was so quick to suggest pulling out my teeth.

Anyone else have any experience talking to dentists or orthodontists about jaw surgery?
« Last Edit: September 29, 2013, 06:36:10 PM by strongjawman »

candle1112

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Re: A dentist's opinion on jaw surgery.
« Reply #1 on: September 29, 2013, 07:01:20 PM »
My dentist said a similar thing. He didn't believe that I was considering jaw surgery until I showed him a picture of my ceth xray on my phone in all of its glory with its obvious display of recessed mandible with very small airway and steep plane and clearly showing my 8mm overjet. He looked very surprised and said he never would have guessed that I had such a skeletal jaw discrepancies and stopped trying to talk me out of jaw surgery.
I don't think anyone jumps into jaw surgery lightly. How can we? It usually requires a whole year of thinking and rethinking and researching and obsessing about it (or is that just me?) while we do our pre-surgery orthodontics, and spending that year trying to prove to the insurance that we really do have functional problems that can't be fixed by simply moving some teeth forward or back. Most of us have spent years trying to find alternate ways to fix our issues without having to resort to a complex, expensive surgery.
Orthodontics and dentistry can do a lot of wonderful things within a smaller range from the norm; however, our ceths tell the real story.
I do appreciate your dentist's more conservative philosophy; however, it might be interesting to show her your ceth and see if she still feels that it can be fixed with some extractions and movement.

CK

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Re: A dentist's opinion on jaw surgery.
« Reply #2 on: September 29, 2013, 07:02:57 PM »
orthos have spent a long time pretending they have the ability to grow jaws in a meaningful way.

the fact is for most people the work is done during childhood, and the results aren't seen until adulthood. so no one has ever really had to own up to their treatment. and if things go bad they can just write it off as genetic.

i am far more suspicious of orthos and dentists than jaw surgeons. ive never met a surgeon who said they could fix everything, but plenty of orthos have told me just get braces, bands, this little metal thingy on your lower teeth and you'll never need surgery!111 then the objective was to preserve my bite and face, the thought that it would not only get worse over time but in fact may have done some harm was never communicated to my family at any point.

and these orthos were sincere and probably believe - and still do - what they do is the gold standard. i dont think they were malicious or necessarily incompetent.

a lot of contemporary orthodontic practices were debunked 30-40 years ago. headgear for example. extractions. in fact the more conservative orthos i have met with are more recently educated. many with 30-40+ years of experience are stuck in their ways.

but what do i know.


Tiny

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Re: A dentist's opinion on jaw surgery.
« Reply #3 on: September 30, 2013, 05:10:08 AM »
Her solution was to extract my wisdom teeth as it is "the obvious and sensible solution" as they were the cause of my malocclusion, and to then use a combination of bands and braces - to pull my upper jaw forward and pull the bottom teeth back, not really sure what she meant.

Red flag.  How is it possible to significantly 'pull the upper jaw forward' in an adult patient?  It's tricky enough in a kid!

A lot of orthos don't like jaw surgery as then they have to admit that there is stuff that they can't find

I've seen 2 orthos and 2 dentists.  One ortho told me she could fix my bite with orthodontics.  No idea how she would have done that considering I have a deep bite and extrusion isn't possible, and intrusion would be a terrible idea

The other ortho and both dentists told me to get surgery

emisch

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Re: A dentist's opinion on jaw surgery.
« Reply #4 on: September 30, 2013, 09:24:08 PM »
that is an interesting story and really shows how much the schools of thought can diverge.  if you are class I with only minor issues with no underlying skeletal problem that should be fine to fix with only orthodontics.

extracting the wisdom teeth should be okay too no matter what class you are... however if any other extractions are proposed i would head straight for the door

Lazlo

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Re: A dentist's opinion on jaw surgery.
« Reply #5 on: September 30, 2013, 10:09:17 PM »
Thought I'd post this as I thought it was interesting as it gave me an insight into another professionals opinion on jaw surgery and orthodontics as a whole, not that I agree with it at all.

I went to the dentist last week to get a general cleaning and a mouthguard made up for when I sleep to prevent further grinding as my bite has changed again.

During the cleaning she asked me why I wanted a mouthguard, and so I explained to her that my bite was off as a result of my jaw asymmetry and that it was causing one side to grind against each other and flatten the teeth on that side. She then asked me how I knew that, to which I told her I had been to two surgeons who explained this was the case.

She then told me that my bite has changed because my wisdom teeth have been pushing against the rest of my teeth, thus causing the the lower incisors to push out slightly. She then told me my upper incisors were inwards slightly as a result of my lower lip pulling against them - the combination of the two giving me a slight open bite (now edge to edge due to the teeth grinding).

Her solution was to extract my wisdom teeth as it is "the obvious and sensible solution" as they were the cause of my malocclusion, and to then use a combination of bands and braces - to pull my upper jaw forward and pull the bottom teeth back, not really sure what she meant.

She then told me to be wary of jaw surgeons as they tend to be limited to their field, and don't see the same things that "a good GP or dentist sees on a day to day basis", also mentioning that these surgeons that gives lecturers are too quick to cut people open and break jaws for repositioning. "A good orthodontist can fix your bite with some appliances, I've been a dentist for 40 years and come from a long line of orthodontists".

She was a lovely lady, but I'm not sure if I agree with her idea that orthodontics can fix everything. She was so quick to suggest pulling out my teeth.

Anyone else have any experience talking to dentists or orthodontists about jaw surgery?

yeah she was from a long line of orthodontists entrenched in gruesome and barbaric processes of disfiguration. Trust me buddy, anyoe who suggests extractions (wisdom teeth, okay, but not biscuspids, don't go there!).

PloskoPlus

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Re: A dentist's opinion on jaw surgery.
« Reply #6 on: October 19, 2013, 06:35:23 AM »
Years ago, when I asked my dentist about getting veneers to fix my weak smile, he said "first you'll need surgery to move your lower jaw back".  I thought he was nuts and did not raise it again.  Now I understand he meant that any veneers would get sheared off due to my underbite.

I saw a bunch of orthodontists earlier this year.  All said surgery within a minute of seeing me.  The first surgeon I saw said you've got an 8 mm gap there, so the upper jaw should be moved 6 mm forward, the lower 4 mm back.  The other 2 said they don't see such a gap ("but you can't really make an exact surgery plan before the teeth are more or less straight), and I will probably manage with the just the upper jaw getting moved forward*. (My upper teeth just scraped the lower ones pre-braces).

When I told my dentist about maxillary advancement being the primary (if not the only) surgery being proposed, he said that since I have a sloping profile, he would have thought that moving the lower jaw back would  have been aesthetically better and "maybe upper jaw surgery is an easier operation for them".

*I've had braces for less than 2 months and only on my lower teeth, and the top and bottom teeth already no longer touch at the front.  Maybe the single-jaw theory was just to get me to commit to treatment.

EDIT: Forgot to add.  One of the orthos I saw was very cool on the whole idea.  "Surgery has minimal effect on how your teeth and face looks.  Your bite is good enough.  You can bite  a hair!  So you'll spend all this money to look different, not better, but different.  If you haven't had any functional issues so far (36), you are unlikely to develop them."  The surgeon that works with him has a very good reputation. One of his patients is one of the best looking underbite cases on youtube.  He told me that the difference would be slight, positive and definitely noticeable to myself.  I was happy with this consult, but since the ortho was so unenthusiastic, I went elsewhere...  To the surgeon that trained that surgeon.  (That's how it is in Melbourne.  Every ortho pairs up with one or two surgeons and vice versa, and you can't mix and match them.  Which, I suppose, makes sense from a case management point of view.  ie. every surgeon and ortho can discuss all their cases once a month instead of scheduling multiple appointments.)
« Last Edit: October 19, 2013, 07:19:16 AM by PloskoPlus »

earl25

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Re: A dentist's opinion on jaw surgery.
« Reply #7 on: December 24, 2013, 03:46:19 PM »
well rom experience many top orthos can fix your bit without surgery. for those who saw my pics my teeth  and bite was horrific. as a kid I went to an ortho who told me mom he can fix my bite by altering the teeth  to compensate and we can avoid surgery. He was right.  The 10  years later I went back to have it all reversed so I can get jaw surgery. I only did it to look better.