"extreme cases"

Here's the lowdown on extreme cases. I don't qualify, by the way.

"Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury. (1)

Note: This policy does not address surgical treatment of temporomandibular joint dysfunction or the surgical management of sleep apnea; discussion of these conditions may be found in Medical Policies, Surgery Nos. 49, 122 and 142.

Policy/Criteria
Orthognathic surgery for the treatment of obstructive sleep apnea may be considered medically necessary when the criteria in Surgery, Policy No. 49 are met.

Orthognathic surgery may be considered medically necessary to correct jaw and craniofacial deformities in the absence of obstructive sleep apnea when all of the following criteria (1-3) are met: Significant functional impairment is documented as a result of illness, injury, congenital anomaly, or developmental anomaly.

Significant functional impairment must be directly attributable to jaw and craniofacial deformities and must include one or more of the following:

• Chewing-induced trauma secondary to malocclusion
• Significantly impaired swallowing and/or choking due to inadequate mastication secondary to malocclusion
• Significant speech abnormalities (e.g., sibilant distortions or velopharyngeal distortion) which have not responded to speech therapy and are secondary to malocclusion
• Loss of masticatory or incisive function due to malocclusion or skeletal abnormality
• Airway restriction

Significant over- or underjet as documented by one of the following:

• In mandibular excess or maxillary deficiency, a reverse overjet of 3mm or greater
• In mandibular deficiency, an overjet of 5mm or greater
• Open bite of 4mm or greater
• Deep bite of 7mm or greater
• Less than six posterior teeth in functional opposition to other teeth secondary to a developmental or congenital growth abnormality (as opposed to a consequence of the loss of teeth)
• The functional impairment and over- or underjet are not correctable with non-surgical treatment modalities.

Orthognathic surgery in the absence of significant physical functional impairment is considered cosmetic, including but not limited to when used for altering or improving bite or for improvement of appearance.

The following documentation is required to determine medical necessity for orthognathic surgery:

• Current study models with the appropriate bite registration and/or the back of the models trimmed such that they represent the patient's current pre-surgical centric occlusion and/or centric relation bite
• Intra-oral and extra-oral photographs
• Cephalometric x-rays
• Diagnostic report
• Panorex x-ray

okay, freak out now.

None of the available insurance plans cover orthognathic surgery except for in extreme cases. I can go through a lengthy appeal process with my school district, but even then I'm not sure what my chances are about getting it approved.

So.... a lot of random crying going on. I think I'll just have to have my orthodontist put me back together again, fix my bite as much as possible, and remove the braces - I can't afford this surgery without insurance, and I can't afford to have my bite get any worse. I have shooting pains in my jaws all the time now, and I'm getting migraines every other day or so.

And it's considered "cosmetic." What a bunch of shit.

do. not. freak. out. (yet).

While I was initally pleased (understatement of the year, right there) about my new teaching job, now I am freaking out. I just got back from my new hire orientation, where I learned that my new school district has a really messed up version of insurance. And instead of getting a plan for free in my old school district that would pay for 95% of my jaw surgery, I don't know if it can get covered at all. Two of the five plans cost me 237.00 a month, one costs 25.00 a month, and one costs 45.00 a month (the final is group health, which isn't an option). Now, don't get me wrong, it'd be pretty darned good insurance... if I didn't already have a surgeon that I love and that is working with my orthodontist.

I don't know what to do with myself. I called the patient coordinator to HELP, but they were already out of the office. I'll call again tomorrow. And since my husband is doing the whole army thing come January, his current insurance can't help me even if it did cover more than my own does.

If that weren't bad enough, my new dental insurance doesn't have any coverage for braces. So I owe an additional 400 dollars at the end of my contract now. I asked the benefits coordinator why, and he explained that through their other dental plan (Willamette), braces only cost 400 dollars. Yeah, but they only offer traditional braces, and they have terrible service.

So, I'm panicked. In the next week I have to set up my classroom, get prepared for the first week of classes, pack up my entire apartment, move to a new apartment (possibly unpack?), get my insurance stuff worked out, and.... breathe.

(just breathe).

adjustment today

As I said in my post yesterday, I had a lot of questions going into this appointment. But my orthodontist is so great - he read my mind before I could even ask them!

I will be surgery ready in.... are you ready???? APRIL! However, I can't take time off of school, so surgery will have to wait until June. But what a relief! He also explained what will happen in my next few appointments - the next appointment is a long one, repositioning brackets and getting my first set of stainless steel wires. After that, the focus will be on closing my lower gaps and achieving as much width in my lower arches as possible. He says that while they are working on my upper jaw, it's not as big a priority because it's going to be widened in surgery.

School gets out on June 16th with the 17th-20th being possible snow makeup days. I will probably shoot for the last week in June to give me time to prepare. My mom has a ton of vacaction time, luckily, so she'll be able to come up and take care of me the first week or two (my husband leaves for National Guard training in January, and will be gone for a year to two years in California... with no way to take time off). Thank goodness she'll be able to help - otherwise, things would be scary.

He also gave me a few splints, hoping to curb some of the severe migraines I've been getting lately from my jaw. They're pretty neat - I'll post pictures when I get a chance, and let you know how they work out.

Oh, and the gums? Looking fine. Whatever.

the almost waterpik and why I hate my husband....

Big things are happening in life - in the last week, I got a new job teaching band and orchestra, with a continuing contract to boot so I don't have to interview for jobs next summer with my jaw banded shut and swollen like a cartoon. I think I found us a new apartment (we'll move in next weekend) and we are possibly buying a new car this weekend... Which of course, results in us needing to save our cash flow and not being able to buy a waterpik!!

The gums are still doing terribly... but I have an appointment tomorrow in the early AM so I'm going to talk with them about it. I also need to talk with them about making sure my surgery date is as soon as school gets out, and to talk with them about insurance stuff, since I've got the new job and I don't know how that'll work out.

My husband went into the orthodontist a few weeks ago. We've been noticing that his teeth have been moving quite rapidly, and I noticed his midlines being extremely off - he had braces for a very long time as a teenager, and he wanted to talk with an orthodontist. Just like I suspected, he has a severe cross-bite and needs braces and lower jaw surgery. He doesn't want braces, but the orthodontist is worried about his front teeth shortening because they are hitting together every time he closes his mouth. (P.S. If we ever decide to have kids, poor them. Or poor us, having to shell out all that money for orthodontics).

All things aside, he was able to skip the braces and jaw surgery for now, and got to get these:

I must say I'm jealous. Aren't they pretty? Can't wait to have my own some day.

why I love braces

You know? Seven-ish months into this journey, I love my braces. Here's why.

• They are always a conversation piece.
• They are an excuse to not try a food or a drink I don't want to at a party or social gathering (oh... no thanks, you know, I'd have to go brush afterwards again. thanks anyway!
• They are an excuse to eat frozen yogurt whenever my teeth hurt.
• They are working so quickly and efficiently!
• I have met a whole host of wonderful blogging friends.
• At the end of all of this, I will have a beautiful smile and an even-more beautiful bite!

In other words, while I'm not seeing any changes, I know that they're working in there. My teeth have been hurting quite a bit (randomly) for the past week or two, now. My jaw is very tired all of the time, and it's been giving me vicious headaches. Stupid bite.

Just two weeks ago I had a PERFECT placement to chew food - it was beautiful! I wanted to eat all of the time because so many teeth met together! However, now we're back into a more normal placement - only the outside of my rear-most molars on my right side touch when I bite, and my incisiors on my left side touch at the same time. Well, that's the bite that I chew with, not the bite that has unsurfaced itself. I'm developing quite the overbite! It's really attractive with the large gummy smile and huge braces, let me tell you :) I'm workin it!

Progress picture time! (It's too bad that it's not easier to upload photos. I really have a tough time with it sometimes!)

Look at my overbite! I'll give you two shots of it (one sideways because my photo editor is being a pain in the rear end). It is large. Very, very large. And seeming to keep growing (great). In fact, when I position my jaw where it should be (versus where I'm posturing it to be) I can stick my tounge out at people. Fun times, huh? It doesn't seem like my open bite is getting any worse, though... In fact, it seems to be getting better!!

The arch on my lowers is continuing to widen. It's really a spacious home now for my tounge! My gaps from my extraction are still there - but the one on my right side seems to be closing up quickly lately - hopefully the left one follows suit!

Finally, the uppers. They seem to be doing NOTHING! I was a bit upset at the last wire's lack of teeth moving - especially in the area of my front teeth. I assumed that this wire would kick some butt, though - and it just hasn't. It's changed a little, my arch seems a bit wider, but what I really want to happen is for those front teeth to straighten out. And they're just not. Maybe the next wire will do it - my next appointment is in just a few weeks.

Until next time!