Re: so many questions

[Guest guest]

Hello, Reni - Welcome to the group! I think the vast majority do wear

braces prior to the surgery, because they need to have your teeth in

alignment and also they need braces to attach the splint to after the

surgery. I too have a Class III, also known as an underbite. I'm 47

and have noticed a change in speech and mastication; I too have

experienced an increase in headaches and pain in my jaw and neck

spasms. I'm just a few weeks from getting my braces put on. I will be

having both upper and lower surgeries next summer to correct my

underbite with a procedure known as a BSSO (Bilateral Sagittal Split

(Ramus)Osteotomy), and I will also be having a LeFort I Maxillary

Osteotomy to correct my midface deficit (due to Maxillary

Hypoplasia). Read all you can on this site and do a web search on

TMJ, for starters. I did alot of reading here and on the web. Most

Surgeons like to have informed patients who do their own

research/reading on the subjects and by all means bring tons of

questions with you to your OS consult. My OMS was thrilled to see my

list of questions. And, NO question is ever a dumb question! Good

luck - all this is quite an education! ~~ Diane

> I am in the process of being evaluated for the surgery. However, I

was

> told five years ago that I needed it. Now the pain and headaches

have

> gotten bad enough that I am acting on that advice. I have my MRI

next

> week and ENT consult on July 28th, so I don't see the OS until Aug

> 2nd. I have so many questions. Does everyone have to wear braces

prior

> to surgery? I have Tricare Prime Insurance (military insurance)

and I

> am concerned that they won't pay for this (braces especially). I

am

> paying for my son's braces right now, and I hate the thoughts of

making

> that payment x2. I have a Class III malocclusion and TMJ. I have

read

> some articles that say correcting the malocclusion won't help the

TMJ

> and others that disagree. I just don't want to go through all of

this

> and find that it didn't help the painful, tense face or the

headaches

> (these are my worst symptoms). Can someone help me?

[Guest guest]

Reni, I have Tricare Standard as secondary insurance for medical.

For dental I have the Tricare Dental Enhanced through Delta Dental

in Sacramento. If you have the Tricare Dental Enhanced insurance it

will pay $1200 towards the braces. If you don't it's highly

unlikely Tricare medical will pay for the braces, they may pay for

the orthognathic surgery. If I remember right, you must have

referrals for the Tricare Prime, so make sure you get those

referrals.

Good luck on your journey. I hope it helps solves your pain

problems. With TMJ problems I think everyone's experience is

different. I've had problems with TMJ since my teenage years, when

apparently my lower jaw wasn't growing to keep up with the upper

jaw. My left TMJ would frequently lock on me as a teenager. As the

years went by (I'm 62 now), the joint took its share of stress. Not

a lot pain, some headaches. Before surgery it had a lot noise

(crepitus). Surgeon told me it definitely has degenerative changes

as apparently because I had kept thrusting forward that jaw joint to

compensate for the lower/upper jaw relationship.

Though I had braces as teenager, it never corrected the under

developed lower jaw. Also, since I didn't wear my retainer as

teenager some of the teeth shifted. I began braces again two years

ago and just recently (6/23/05) had upper (LeFort 1), lower (BSS0),

genio and turbinectomies to correct the jaw relationships and to

correct sleep apnea. Sleep apnea is a problem, especially with

females that aren't overweight, due to lower jaw retrognathia

(receded-under developed lower jaw).

It has corrected the sleep apnea, but remains to be seen what effect

the surgery will have on the TMJ's. So far it hasn't been too bad,

but I'm still on a no chew diet at this time. We'll see as I begin

to use the jaws more.

You may want to ask your surgeon, what percentage of TMJ cases

similar to yours, are cured or helped by the surgery. They

evaluated my TMJ's as part of my evaluation for surgery.

Hope this helps a little.

Shirley

[Guest guest]

A bunch of questions in one post...

To try to help sort them out:

Sounds as though you're in good hands if your docs are checking out

other possible causes for the pain, using an MRI. And calling in an

ENT.

Most, but not all, people need braces before surgery. The ortho

generally puts your teeth in a different position for surgery than

the one that works without. If you don't have to have braces,

chances are you will need arch bars. If you know what those are, I

need go no further. If you don't know, I'd ask a lot of questions

about them. From what I've heard, I'd pay lots of money to have

regular brackets and wires rather than arch bars, but I've never had

the latter, and I've had braces twice.

Some folks in the military have had the whole thing done by military

docs, at a much decreased price -- or at least that's my impression.

But the military can be sort of daft about this -- yes, I love the

guys and gals who are laying their lives on the lines, and don't

mean to slam them in the least. But I knew one young woman in the

Coast Guard who had surgery at a military facility, paid for by the

military, but couldn't go for pilot training while she was in

braces. Go figure.

As for insurance, the general non-military rule is that the dental

insurance pays a lifetime cap (somewhere between $1,000 and $1,500)

for ortho, and the major medical policy covers the surgery, on the

grounds of medical necessity to repair a congenital structural

anomaly. Read your policy. Some exclude orthognathic surgery. Dunno

whether you can then get a military doc to do it, under your

coverage.

If you have not done so already, I would suggest that you consult a

headache specialist, and a specialist who treats a lot of cases of

TMJ troubles. The surgery did help the mild jaw aches I was getting,

but it's not always predictable.

As my surgeon put it: " I hate to hear that anybody's predicting the

future. " Sometimes TMJ troubles get better post op. Sometimes they

get worse. Sometimes they stay the same. We know that the relative

position of the jaws changes the stress on the joints, but we don't

always know what effect it will have. I have seen more posts from

folks whose headaches were resolved by the surgery than from those

whose weren't, but there are a few folks who have more troubles

after surgery than before.

In short, it's a risky business, and you need to inform yourself

about the potential risks and benefits and make your own decision

about what to do.

Sorry not to be able to give you a more straightforward answer. It

worked well for me -- but I only needed surgery on the lower jaw.

Cammie

> I am in the process of being evaluated for the surgery. However,

I was

> told five years ago that I needed it. Now the pain and headaches

have

> gotten bad enough that I am acting on that advice. I have my MRI

next

> week and ENT consult on July 28th, so I don't see the OS until Aug

> 2nd. I have so many questions. Does everyone have to wear braces

prior

> to surgery? I have Tricare Prime Insurance (military insurance)

and I

> am concerned that they won't pay for this (braces especially). I

am

> paying for my son's braces right now, and I hate the thoughts of

making

> that payment x2. I have a Class III malocclusion and TMJ. I have

read

> some articles that say correcting the malocclusion won't help the

TMJ

> and others that disagree. I just don't want to go through all of

this

> and find that it didn't help the painful, tense face or the

headaches

> (these are my worst symptoms). Can someone help me?

[Guest guest]

Thanks so much for the info. I can't have the military docs do the

surgery because I am a dependent wife, and they only do the procedure

for the active duty. This will have to be done by civilians. Our

dental only covers braces for dependent children, but I'm not sure of

the special rules for medical necessity. I guess I will find out.

The ENT is due to some hearing loss on one side. We don't know if

there is any relation. Guess we will find out. The doctor says

probably not, but he wants to make sure what we are dealing with. I

appreciate that he is cautious.

Although, I have known about this for many years, it has gotten worse

lately. My jaw is no longer symetrical and the tension is so much

worse. I was able to somewhat control the headaches w/ Motrin for a

long time, but then I developed an ulcer due to the med and can no

longer take it. It does help sometimes to tilt my head back and

allow my jaw to rest in an open position. Is this odd?

Anyway, I thank you for the info. I am just nervious and have a ton

of questions. My doctor will be tired of talking to me when I go

back on 8/11.

> > I am in the process of being evaluated for the surgery. However,

> I was

> > told five years ago that I needed it. Now the pain and headaches

> have

> > gotten bad enough that I am acting on that advice. I have my MRI

> next

> > week and ENT consult on July 28th, so I don't see the OS until

Aug

> > 2nd. I have so many questions. Does everyone have to wear braces

> prior

> > to surgery? I have Tricare Prime Insurance (military insurance)

> and I

> > am concerned that they won't pay for this (braces especially). I

> am

> > paying for my son's braces right now, and I hate the thoughts of

> making

> > that payment x2. I have a Class III malocclusion and TMJ. I

have

> read

> > some articles that say correcting the malocclusion won't help the

> TMJ

> > and others that disagree. I just don't want to go through all of

> this

> > and find that it didn't help the painful, tense face or the

> headaches

> > (these are my worst symptoms). Can someone help me?