DR's Story

I am 51 years old.  When I was 11, I was told that I had an overbite.  Additionally, the orthodontist said that my teeth were "too big" and that they would crowd my mouth and become more crooked as I got older.  He said that the correction would bring back my upper jaw to better match with my lower jaw as I grew.  It was his opinion that without correction I would develop a "weak" chin.  A top student at the time, I questioned his logic because it didn't make sense to me, but he brushed off my questions and said that they do this correction all the time.  There was NO mention of side effects at all, especially nothing that would hurt my breathing then or in the future.

I was not prescribed with headgear, but I did have full retractive braces for 2 years, with metal bands. Prior to the installation of the braces, he ordered extraction of all 4 first bicuspids.  Four perfectly healthy teeth, the loss of which I still mourn.  The extraction was traumatic, and the braces tightened each month caused excruciating pain for several days at a time.

Mid-way through high school (about 3 years post-braces), I began falling asleep in class.  It was extremely embarrassing, as I loved school and took it very seriously.  I was very self-conscious about it.  I was gently teased by teacher and students that maybe I should get more sleep.  I was at a loss, as my sleep hygiene was impeccable at the time and I didn't know what else I could do better.

In college, I found that I often could not remain awake for more than 15-20 minutes after class started. Some days were so bad that I would sit down, fall asleep until the bell rang, get up and walk to the next class only to fall asleep again, all day long.  I had to go back to my room and read the material for every lecture in order to catch up on what was said.  I would get so tired that I'd lay my head on the book, promise myself to wake up in 10 minutes and then press on.  Which I was able to do, with remarkable success considering.

In college I also became aware of clenching and grinding at night, especially the night before a test. My teeth and jaws were very sore and tired upon awakening.

As an engineer straight out of school, my difficulties staying awake while seated continued. Meetings were especially difficult and I fought so hard to stay awake, without success. Management looked quite unfavorably on my behavior, assuming that I was bored or didn't care enough to stay awake.  Coworker response varied from polite ignoring, to sympathy to teasing to worse.  In meetings I tried fidgeting movements in a vain attempt to keep blood flowing to my brain and stay awake.  I finally went in for a sleep study in 1991 or 1992  The test measured 41 waking events per hour, all night long.  In other words, 8 hours = 240+ waking episodes every night.  My average sleep latency the following day was 7 minutes.  I was diagnosed with idiopathic central nervous system hyper-somnolence.  The doctor prescribed Cylert. I never liked being dependent upon a drug, but I had no choice.  Years later, Cylert was pulled from the market due to evidence of causing liver damage.  I was prescribed Provigil as a replacement, but even half a pill made me hyperactive until 3am and it made me feel spacey and odd.  After that, I opted to suffer the consequences of no medication.  In the late '90s I went in for another sleep test.  The results were consistent with the first test, but this doctor prescribed a CPAP machine.  I was not thrilled, but tried my best to accommodate it into my sleep routine.  I eventually had to accept that it would not work for me.  Part of me was relieved to give it up because of articles I'd read regarding the higher incidence of cavities in CPAP users due to the forced air drying out saliva and leaving teeth more vulnerable to decay.

During those years at work, which was often stressful, I continued to brux.  One dentist told me that I had ground off a millimeter or more of length from my incisors alone. He wanted to give me veneers on the top 6 and bottom 6 front teeth, and then fit me with a bite guard.  I agreed, and after twice having a veneer break off in the middle of lunch at the cafeteria, I went to a new dentist.  The new dentist didn't like the veneers I was given, and said he wanted to do a complete bite redesign on me.  He considers himself to be a bite and TMJ expert, and noted the extreme hypertrophy and tension in my masseter and pterygoid muscles.  He also felt that my chronic bruxism was the result of the orthodontia I'd received at 11, and that in my sleep I was trying to grind my way back to my ideal bite.  I asked him if perhaps I should get braces again, to return my teeth closer to where they should have been and perhaps replace the teeth that had been extracted.  He said that it wasn't practical, and there were other options.  For years he would tell me that he could help me stop grinding if I would allow him to redesign my bite, and finally after seeking a second opinion on the procedure (and cost estimate) I agreed. This job included 8 upper and 8 lower teeth (leaving only the molars untouched) and we negotiated a total cost of $14k out of pocket as insurance would not cover it.  Each tooth was ground down to the very minimum, the super-strong core beneath the enamel and dentin.  He said this was necessary in order to make the crowns large enough and strong enough that they would not break like the last ones were prone to do.  He made several concessions to accommodate my overbite and the "over-closure" that I had developed, including creating an unnaturally thick profile for my lower incisors for greater strength and to allow for a significant slope backward to fit within the confines of the upper teeth.

I stayed with that dentist until just a few years ago, when repairs were becoming more frequent and he seemed unable to cement my upper bicuspids sufficiently to stay in place more than 6 months at a time.  I only go back to Boise 2 times a year, and it was becoming more inconvenient to return for repairs.  One dentist afterward who saw my dental work shook his head at the level of morbidity of the work that had been done to my teeth at this point.  Unfortunately I don't remember who it was, I just remember his assessment.

In May 2013, I found a new local dentist in Washington.  He told me that I have the worst overbite he has ever seen, and that the orthodontic work I had was very poor.  A bite strain analysis shows significant imbalance across the dental arch.  This dentist recommends braces, as well as muscle relaxation therapy to unclench and lengthen the chronically knotted over-built mastication muscles.  The paperwork he gave me states that any crowns which might weaken or fail in the course of or after orthodontics must be covered additionally at my own expense. 

It was shortly after my consultation with this new dentist that I had the epiphany of the connection between my sleep disorder and the orthodontia I received as a young teen.

I desperately need the dental work, as chewing is becoming increasingly uncomfortable, but I am very concerned about the cost and the possibility that pursuing treatment could set me up for financial ruin.  In 2005 I left engineering during a voluntary severance program implemented to cut back on the workforce, and returned to school to become an acupuncturist.  I am now self-employed, with no health insurance, and am just barely making do.  My only vehicle (which I require to drive to work) is 16 years old and becoming increasingly expensive to maintain.

I also have developed significant neck stiffness and very poor range of motion in lateral flexion. Recent open-mouthed cervical X-rays revealed that my jaw has become very skewed, and the left muscles are much shorter than the right.

It may also be helpful to know that I have had chronic sinus infections since the age of 13.  I have had 2 septoplasties, an ethmoidectomy, and a turbinate reduction to improve my airflow.  I wonder now how much my sinus challenges are also related to the orthodontic and dental work I've received.

 

Today:

My profile between nose and chin is noticeably receded, making my chin look rather pointy especially when I smile.

My tongue feels like it barely fits in my mouth, with no extra room, like toes in shoes that are a half-size too small.

I am back to grinding again, even with a bite guard, and I've lost so much tooth height especially on the molars that my bite feels "flattened" and it is an extra effort to bring my teeth together close enough to chew.  My face and jaw, already square due to my German ancestry, has become hideously squared and shortened when my teeth are in fully occluded position, with considerable asymmetry evident between left and right.  I have become very self-conscious now eating in the presence of others and avoid situations (such as dating) where someone is facing me directly and is able to see me chew.

I am finding it more and more difficult to get through the challenges of daily life.  I feel like I keep slipping further and further behind, with little hope of catching up.

I am chronically fatigued, depressed, and experience suicide ideation several times per week. 

I have significant headaches which are often migraine intensity, up the entire sides of my head and often between one eye or the other.

My sleep is very irregular and disrupted.  I have to sleep longer in order to feel rested.  Those moments of feeling rested are rare and fleeting.

I have chronic neck tension and lack of ROM, as well as low back and hip tightness and pain.

I have no doubt that the impact of my orthodontic treatment and related problems has adversely impacted my life in many ways, both financially and emotionally.

 

DR

©2014

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