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Volume 1, Issue 1
Spring 2005:

Tales from the Clinic

Shannon Brownlee

Cell 2 Soul. 2005 Spring; 1(1):a2

Okay, you asked for my little saga. Here it is. Print it if you dare.

Two years ago, I complained to my dentist about jaw pain. I was grinding the daylights out of my teeth by night, and hearing popping sounds in one ear by day. She also noted gum loss, but no gum disease. The reason for all my problems, she told me, went back to malocclusion. My bite is wrong in every way possible, despite six years of orthodontics as a kid. Tooth grinding was the body's way of trying to make the teeth fit together correctly. Unfortunately, it was wiggling my teeth around in my head all night, causing gum recession, wearing out my temporal mandibular joint, and if I didn't do something about it I could kiss my teeth goodbye in 20 years as they would fall out of my head.

She sent me to an orthodontist who said my bite was so bad there was no way to make my teeth actually meet properly to keep them from grinding, and I should consider jaw surgery. So, off I trot, like a good little patient, to the oral surgeon, who takes vast numbers of x-rays, sends me to get an MRI of my jaw, and asks me about pain in my jaw. His diagnosis: TMJ. The disk in my jaws were slipping out, due to malocclusion, and I would be grinding bone on bone soon without surgery.

Now, here is the critical part: He said I would need lower jaw surgery, in his opinion. This procedure actually breaks the lower jaw into three pieces and slides the part with the teeth on it forward. Surgery time would be about two to three hours at most. And his fee? After demurring that he didn't know what his fee was, he put it in the ballpark of $8-9,000.

I got a second opinion from another oral surgeon who said the same thing.

But getting the surgery entails orthodontics first, to get the teeth all lined up properly. I go back to the orthodontist every few weeks, suffer more pain than I remember undergoing the FIRST time I had braces, but finally, my teeth are ready for the surgery.

We have our big consultation two weeks ago, me, "ortho", and surgeon. But now, according to the surgeon, I don't need lower jaw surgery, I need both upper and lower surgery, which entails breaking both upper palate and lower jaw into three pieces and rearranging the entire lower half of my face. This procedure, I am now told, will take on the order of six hours (6!), two nights in the hospital, two weeks of severe pain and swelling, and another four weeks for bone repair, and will cost, hold on to your hat, $22,000 for the surgeon's fee alone. Never mind the anesthesiologist and the hospital bill.

Even taking out the assistant surgeon's fee, which is $5,000, and assuming that my surgeon will lavish say, an entire day's worth of attention on me post op, he is making approximate $1,500 an hour for his services. Let's take out the cost of malpractice, which for him amounts to $75 an hour, and even take out his office expenses — the man is making an ungodly sum on a procedure that he cannot tell me will actually fix my problem. When I asked him early on if there was any evidence that surgery helped TMJ and would prevent gum loss, he replied, "You mean, like, clinical trials?"

"Yes, like clinical trials," I answered.


"How long have people been performing this procedure?" I asked.

The answer is oral surgeons have been doing this for 20 years and they have no idea if it actually helps patients. No wonder insurers refuse to pay for it.

I'm outraged. I feel this was a bait and switch. I undergo extensive orthodontics, which by the way has left me with MORE pain, not less, and unable to chew because now my teeth meet in only three places — and cost an arm and a leg.

Even if I thought that the surgery works, which I now highly doubt, please tell me how it is that a surgeon who himself has 20 years of experience was unable to look at multiple X-rays and figure out that my bone structure is so screwy, lower jaw surgery was not going to solve the problem and give me a perfect bite? I could have told him that, because my front teeth have never met. And now they never will, because I am not undergoing six hours of surgery that will cost me six weeks of work and more than my son's private school tuition for two years.

If I could sue, I would, but malpractice relies on standard of care, and this is standard. So instead, I am going to a new orthodontist in the hope that he can move my teeth into a position that will make chewing a functional process, get a bite guard for night time grinding, and stop paying the current orthodontist the several thousand dollars I still owe her.


The second orthodontist said it would be a bad idea to move my teeth back to their old positions, a process called "re-compensation." He also delivered news I did not want to hear: There was no alternative to surgery at this point. A consultation with a second surgeon delivered even worse news. Now that my teeth have been moved, and my maloclussion is about as bad as it can get, the only recourse is both upper and lower jaw surgery. I only hope insurance will pay for it, and that all this pain, time, and money will actually do what was promised, and prevent my teeth from falling, one by one, out of my mouth.

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