Wires and waterpiks

I went to Dr. F on Monday and he readjusted my wire, he's not sure why it moved, but it's back in place. He also added some stoppers to keep the wire from moving again. My teeth did not turn sideways over the weekend, but one of my teeth was definitely moving towards my middle teeth and trying to move them. Since the wire was replaced that tooth is no longer pushing the other tooth and is back in place.

An update on the waterpik, I love it. My tooth with the gum problem is still a little irritated at times, but it's 90% now and I my waterpik is the reason. It was worth every dollar. Though it does freak me out when I use it and I see all the stuff that was in my teeth - gross! No wonder they hurt!

Wire you moving?

My wire seems to have moved. There is a little updent in the wire that should be in the middle of my mouth between my two front teeth. The wire moved a bit to my right. One of my teeth felt a little funny the other day (other then the normal funny my teeth tend to feel from having braces) but when I looked the wire was in place. I noticed Friday that it's actually a little off. I tried calling Dr. F's office today but they were closed.

I'm now getting paranoid that all my teeth are moving wrong, teeth are still feeling a little funny, just in different places. How bad could 4 days of my wire being out of place be? I hope I find out Monday before my teeth regress and start turning sideways (hey, I said I was getting paranoid.)

I got a new wire

On Friday I went for another adjustment, Dr. F replaced my wire. Now my teeth hurt all over again, braces suck. I don't have to go back for another 6 weeks, but Dr. F said I would need to get spacers to prep the teeth for the palate expander. A new year will bring new dental pain!

I was actually back there today, the wires weren't cut quite short enough and I was getting jabbed on one side.

I still have inflammation of my gums on the lower left from the ring that doesn't quite sit all the way down on my tooth. Things are better then they had been, but I'm still in pain. I decided to get a waterpik and am keeping my fingers crossed. From what I read online I think I should notice a difference in a week or two if it is helping.

Adjustment 2

On Saturday I went for my 2nd adjustment. I conveied LF's concern over the ring on my lower right back tooth, which is causing a gap under the tooth and making my gum in that area inflamed. I'm out of luck. Apparently, the way the rings are made and the way my tooth were made just isn't going to be a perfect match. LF has suggested that I do a good job with cleaning out that area after eating. This should be interesting since I have 2 years ahead of me...

Dr. F didn't adjust anything, he said the wires are still working and that I should come back in 4 weeks.

Pandoras Box

My bite adjustment was Pandora's Box...

Well my tooth slowly started to bother me more and more, I was convinced I needed a root canal.

I finally got to LF on Tuesday with my fingers crossed and a couple people praying for me.

LF said my gums were inflamed, she irrigated it and gave me a prescription mouth wash, who knew they made that. The change in the contour of the tooth has made a gap under the bracket on the neighboring tooth which is allowing stuff in and then inflaming the tooth. I will need to get the bracket fixed, lucky me!

My tooth is feeling better sometimes, and is still irritated at other times, but it sounds like this is my solution, it can't be worse then a root canal.

A filling and a bite adjustment

On Tuesday I went for my bite adjustment. LF didn't adjust too much of my bite, but it's a little better now. She did also redo a filling on my lower right, that tooth is still bothering me. See, this is why I hate getting work done, I always feel like I opened pandoras box. She did mention that the Endodontist had sent a letter to her and Dr. F regarding the tooth that had just had the root canal - the braces are moving the tooth closer to the cleft, part of why the tooth is taking so long to heal.

On a slightly different topic...
I am part of a large medical study and as part of it I get a physical every year, today was my physical. The PA who was conducting the physical went through all of my medical problems and tried to find a solution for all of them, some might have been good but she wasn't really listening to my symptoms first so she ended up just being annoying. For example, she was recommending to me this nasal rinse. I asked her if she knew if I would have any trouble with it because of my cleft lip and palate. I don't think she actually knew what a cleft lip and palate was because she said that it doesn't go in the throat, huh? I just dropped it. Then she was doing an examination of my nose and discovered that my left nostril was small, it blew her mind! She asked if I could get that fixed. I then had to explain that if I do all of this dental stuff, then I can go for an consultation to see if it can be repaired, but pointed out that I had lived for 30 or so years like this. Am I supposed to take this woman seriously?

I bite, but it hurts

This past week I realized that both of the teeth that had formerly been capped, but then separated for my braces, hit the teeth below them and not in a good way. Their position before never allowed them to hit the teeth below them, but the braces have moved them into a position where they are not hitting and combined with the braces are in pain. The pain has subsided a bit in the last day, but I will be going to see LF on Tuesday to get the bit adjusted.

Apparently I was raised in a barn

Friday I was back at Dr. F's office. One of the doors on my brackets kept opening. I noticed it one night while brushing my teeth. I did a little investigation and realized I had done it myself with one of those little brushes you use on braces. I closed the bracket and went to bed. The next morning I woke up and the bracket was open, obviously the door was opening itself. So back to Dr. F's. He tied the wire to the bracket using a thin wire. Hopefully the tooth will start moving now.

Root Canal

I've had 4 root canals and yesterdays was the most painful. The Endodontist was very good at doing the injections so I didn't feel the need to bite him. But I ended up waiting a bit before he started to do the work on the tooth. I think that allowed the novicain to wear off a bit during the process. But also because the root is on the edge of the cleft the soft tissue in the cleft was inflamed apparently making things more painful. The good news is that the root canal was done in one shot and I'm done with it. I took lots of Advil last night since the tooth already hurt when I left the Endodontis, but is feeling pretty good this morning. Hopefully it stays that way.

A lack of adjustment

I went for my first adjustment with Dr. F, and it was quite uneventful. He took a look at my braces, commented that a couple teeth still need to move and sent me on my way. Yup, that was it. And I was concerned that I would leave in pain. I guess since my teeth seem to be moving on their own anyway though that it makes sense that he doesn't do much, but I really did expect more. But I'm happy with how that worked out.

Why me?

Ok, I'm being a little dramatic, but I am tired of dental problems.

My tooth does need a root canal, my tooth does have resorption. My Endontist didn't seem terribly worried about that though, he said it was incidental. The bigger problem for me is that the tooth is on the cleft, meaning the roots lead to the cleft. There is a small chance of getting an infection in the site of the cleft, which would be bad. The Endodontis gave me an antibiotic to take before starting the root canal to prevent an infection, I go back on Thursday to start the root canal. Seriously, Why me??? But at least I know that when it's done I should be able to eat again with that tooth.

I should enlighten you all on how the exam went... He took an x-ray, then he pushed on my gum above the tooth, which hurt. Then you pushed on another spot which did not hurt. Then another the spot that did hurt, which I felt free about expressing the pain he was causing with a small yell. Then he tested the tooth again and asked if that hurt more at which time I yelled louder - he got the message. About 5 minutes later the pain subsided. It's a good thing I like this guy.

Clean teeth and more problems

Quick update on the braces - my lower right teeth are feeling better, now the lowing left are bothering me a bit, though at this point they are feeling mostly better. And to think I have to get them adjusted on Friday!

I went to the dentist for my cleaning today, I need to improve my brushing. Also going to have an old filling refilled since that tooth has been bothering me for some time. My upper left front tooth, which has been bothering me, needs to go to the Endodontist for evaluation. As much as I fear what could be wrong with this tooth, I'm glad to know that I'm not just imagining the pain. LF thinks it might be resorption. Since I had no idea what that was before, I thought I would offer a link so you readers could learn more about it. I'm seeing the Endodontist on Thursday morning, I'll come back with a full report.

Health Insurance

Next month it will be time for me to start really looking at the health insurance plans offered at work. Today I had a few minutes to take a look at a website that rates health insurance plans - http://reportcard.ncqa.org/plan/external/
The website didn't have a ton of information, but my current plan is well rated as is one of the other plans I was looking at. The other plan I was looking at wans't rated quite as well. Since it's also expensive it's looking less likely that I'll go with that plan.

My teeth still hurt

Late last week my teeth started to bother me again, on the lower right. I'm guessing that some tooth must have moved in such a way that it allowed other teeth to move and now they're moving. My teeth are feeling a bit better now, though are still sensitive. Does the pain ever stop???

To top it all off the upper left front tooth is bothering me and has been pretty much the whole time I've had braces. Something has to happen with this tooth, at this point I don't really even care what happens to it as long as it makes it feel better.

I saw LF last week when my cap fell off, the same cap the fell off the day I got braces. This time I ate the cap with my dinner. She used permanent cement this time, keep your fingers crossed. LF also trimmed the wire on my upper left side that was irritating the inside of my mouth. I've been eating less wax since then.

Wax, it's what's for dinner

Well I'm finally adjusting to my braces. It took from Friday to Monday for the braces to start hurting. Then until this past weekend for me to really be able to eat. Some teeth are still a bit tender at times, but they feel relatively normal. The brackets are still annoying me a lot. They make eating a little annoying, food catches on them and my teeth just don't feel right. I have a couple spots that are irratating the inside of my mouth, it seems the more my teeth move the more they irratate my mouth. I'm making good use of my wax which sometimes gets knocked off when I'm eating or brushing my teeth. I've been assured it's not dangerous to eat, which is good because sometimes it serves as an addition to my dinner. If anyone has any tips on how to keep the wax on, I'll be happy to hear it.

My rubber band went down the drain

Less then 24 hours after getting braces I was innocently brushing my teeth and brushed off my rubber band and then watched it get washed down the drain. opps. I called Dr. F and he was actually in today, so in between my 2 other appts this morning I was back at Dr. F's office. He as able to open the door on my brace and get the wire on so that I don't need the rubber band.

I did get the distinct impression from one of the girls in the office that it's very strange to have all your brackets to have the little doors on them, as these are the ones that don't seem to need rubber bands. See, I'm special

My first meal last night went ok, had an omelet which was fine. Bread however was a little more difficult to chew. Today I've stuck with eggs and soup as my teeth hurt a lot.

Here are some pictures of my mouth:

You have glue in your hair.

I started out my morning with a trip to the dentist to get my cap put back on, it took about 15 minutes with no drama.

In the afternoon I went to Dr. F for my braces. I started with a bit of good news... My bill was readjusted, the price didn't change but my payment options did and I didn't have to leave as much of a down payment. I could have paid the whole thing off and saved 5%, but then I wouldn't have much savings and that was a risk I wasn't willing to take.

Dr. F came and looked at my teeth and played with some brackets. Then a sweet girl came and prepped my teeth. They clamped my mouth open with some strange contraption, it made me wonder? Is this how Hannibal Lecter feels? Then she did the prep work, all I really know is that she sandblasted my teeth. Then Dr. F placed all the little brackets. The brackets didn't feel so comfortable, not that I thought they would. Once Dr. F was done the girl who was prepping my teeth picked the glue out of my hair. After having my mouth clamped open I must admit I had already lost some of my dignity, what's a little glue in the hair? I rinsed out and had the wire put in and things started feeling less comfortable. I wasn't in pain but there was definitely pressure on my teeth. I ended up only having one rubber band. My nephew had wondered what color rubber bands I would get, but Dr. F took away that concern. He used the "clear" braces in the front and the one rubber band was metal colored to match the brace it was on. Based on what the girl said, I either didn't get rubber bands because I spent a lot of money and am getting 5 star treatment (knowing the price tag that might be right), or it's because I'll actually brush my teeth and floss and generally take care of my teeth.

One dental observation. One of the teeth on my bottom right (I think a molar) had grown in sideways, it was never a problem, but I think, based on the placement of the brace, that Dr. F is going to rotate the tooth.

In the next few days I'll post some pictures of my teeth, as requested by my friend Kelley. I just don't have time tonight.

I almost swallowed my tooth

This morning I was eating my breakfast, a mini doughnut, when I felt something hard. For a second I was going to swallow it as just a hard crusty spot in the doughnut. I thought better of that plan thinking one of my spacers had fallen out. It was the temporary cap on the tooth with the root canal. I've called the dentist on call, who did not answer the phone and am waiting for him to call back. In the meantime the spacer between that tooth and the next one is probably loose and I'll probably swallow it and then my teeth will close in together over night and I wont be able to get my braces tomorrow. Sorry, my imagination got the best of me. Owell, guess I'll be late for work!

Spacers are annoying

Well, I think the subject says it all. I've had the spacers just over a week and I don't like them. First, they hurt making it hard to eat and just making me uncomfortable. The pain has subsided but the spacers are still annoying. It seems that now that the teeth are spaced out the spacers have just enough room to wiggle around when I eat, leaving me paranoid that they're going to get dislodged and screw up my teeth. Friday I get my braces so hopefully that will resolve the spacer problem while bringing new problems.

I'm spacing out

Yesterday I got the spacer for my braces, they kinda suck. I'm already on a pain killer right now so they don't hurt too much, but they are uncomfortable and it feels funny to eat. Dr. F asked if I had started to process through insurance yet for Dr. S, which I have not done since I have to change insurance. He accepted that as an answer. But conversations like that make me a bit nervous, what happens in 6 months if I have trouble with insurance?

Taking the first step

I went to the dentist today to have the root canal tooth finished. Unfortunately I have recently noticed a very slight pain in the tooth, not enough to run and get the tooth looked at (I'm really sick of dealing with this tooth), but enough to make it a consideration when choosing what to do with the tooth. LF decided to do a provisional crown on the tooth and see how it goes, she felt it might even be a better option for the tooth since I'm getting brace next month.

The other thing was that since this tooth would take much less time she decided to do the two tooth cap/bridge today instead of tomorrow. With that LF took a drill to my tooth. My first thought was - there goes a couple grand in dental work. Then I had a moment of almost having an anxiety attack, that panic about taking that first step on a long road... It lasted about a minute and then I just sat there as the bridge was drilled away. I got some good news - the two teeth are in good shape, which was very much a concern. LF said that the mobility in the bridge wasn't from the teeth. She did find that one tooth had a touch of mobility in it, but she thought that would go away now that the teeth are separated.

So how does it look and feel? The tooth next to the middle teeth looks almost exactly the same, though is irritating my gum a bit tonight. The other tooth you can now tell is set back in the mouth a little bit and looks a little smaller, though it doesn't look "bad." That tooth is irritating my tongue and the gum in the front is sensitive, I suspect that part of the gum there had been protected by the old bridge and is now exposed to my mouth for the first time in years.

A filled in

My tooth with the root canal was filled in this weekend, just in time, I think the temporary filling was starting to deteriorate. LF had wanted to put in a post of some sort in this tooth, but the dentist in the office that I saw (she's on vacation) thought it just needed to be filled and that the tooth was ok otherwise. I'm still need the tooth crowned later this month, which I'm doing with LF. I wonder what she'll think of the not doing the post. Either way the tooth will last until then.

Moving things up.

I spoke to Dr. F on Friday and it was an eye opening phone call. He didn't have too much to offer in the way of health insurance, though seemed to mention HIP a lot. He did say though that we have to get started with things much sooner then I thought. I had been given the impression that the palate expander would be done early during this whole thing. However, Dr. F needs about 6 months to get my teeth in order before doing the palate expander. I was blown away! He said if I want to do the palate expander in mid February then I need to start with the braces in August. August is right around the corner! This is going to require a shift in thinking and a lot of work I hadn't planned on just yet.

Before he can do the braces though I need to have the cap/bridge replaced, a slight problem since LF is going to be away for most of July. I did manage to get an appointment with her for the end of July, which is good. I also need to finish the work on the tooth that just got the root canal, which is scheduled for the end of July too. I have another tooth that I know will eventually need to be crowned. It now has a little chip in it, I need to find out if this tooth is still sturdy enough to hold up for the braces or if it needs to be crowned before.

My other issue that this is screwing up is that I was planning on taking a little trip to Scotland in September, as a pre-braces trip for myself. I had figured once I got the braces I would scale down my travel to long weekends in the US, so this was to be my last big trip for a while. I'm now considering some other stuff, but money will definitely be an issue once I start everything.

Talking to the orthodontist

I made a call to the orthodontist today, I wanted to let him and the office know that I was delaying my treatment. I also wanted to ask about health insurance. Health insurance plans will sometimes cover part of orthodontic treatment for Cleft persons. The girl explained that they will submit to insurance after surgery because then it's more apparent the need for braces and they're more likely to cover them. So then I asked about my two choices: GHI and HIP, she thought I might have better luck with HIP. She's give a note to Dr. F and said he would probably give me a call to discuss.

A Memory

The other day I was thinking about children who are in the hospital for the holidays, and how sad it is to spend those special times in a hospital and how glad I was that I never had to do that as a child. Then I remembered that I actually had a surgery right before Halloween one year, not the same as Christmas, but as a 7 year old girl it wasn't really cool. If my memory serves me I had the surgery 2 or 3 days before Halloween and then was released a day or 2 before Halloween. My mom did buy me a little bunny thing with ears, not really a costume but it was all I go. I remember on Halloween wearing my bunny ears and answering the door for the 4 people who actually stopped at our house and really wanting to go out trick or treating and getting candy. I'm sure my mom gave me whatever candy and treats I wanted, she was always good like that, but it's not the same as getting dressed up and getting candy from strangers.

Visit number 10

I was back at the dentist this weekend because my tooth was bothering me, again. I waited an hour on a Saturday morning because it was an emergency appt, and the endodontist spent about 5 minutes with me. What seems to have happened is that the bone was soft while it was healing and then hardens again, in the meantime the tooth can float around a bit until it hardens then settles. Apparently it settled in a spot where the bite was off. I got a bite adjustment and am feeling better now. I had to cancel my June 23 appt because of work. It looks like right now I'll end up having another dentist from the dentists office put in a permanent filling and when my dentist returns from Kenya she'll do the crown.

Visit number 9

In visit number 9 the Endodontist cleaned my tooth out again, applied some more medication and refilled the tooth. That was Monday and although it took about 2 days my tooth is feeling normal now and is happy. I'm scheduled to go for my crown on June 23.

Visit number 8...

Well I had to go back to the dentist on Tuesday for my tooth since I woke up Monday with a little bit of pain which got considerably worse during the coarse of the day. The Endodontist said that the bad tooth stuff from the root had gotten into the bone. He drilled out the roots, put medicine in at the bone put in a temp filling and sent me on my way. He did want me to take an antibiotic because this is the perfect situation for an infection to develop, though I showed no signs of one. I'm going back Monday to get the roots refilled. Then on June 23 I'm getting the crown done.

I thought I would throw in that my nephew is getting braces and my sister decided to use the same orthodontist as I will be using, so good luck to him.

Health Insurance

While I'm not trying to turn this blog into a blog about health insurance, the topic has inspired my unhappiness with the health insurance that is offered in this country. As such I thought I would pass along a podcast that I recently listened to about health insurance. It's done by Dan Carlin, he's a talking head, but he's an independent thinker. It's his Common Sense podcast, episode 152 called sick politics. Enjoy...

A tooth with a root canal isn't supposed to hurt

Last week I was on a cruise to Hawaii, which you can read about on my travel blog: http://travelinggiraffe.blogspot.com, when my tooth that had the root canal started to hurt. On Thursday morning when I was having breakfast I started to notice a bit of pain in my tooth that had just had the root canal, but it wasn't enough pain to alert me to trouble. When I had lunch though it was bothering again and worse. I texted my dentist and she wasn't sure what was wrong and offered to call in a prescription for Amoxacilain. In the end I decided against that and instead took pain medication and went to the dentist this morning. He took out the temporary filling looked inside, filled the tooth and said this - either the tooth was just irratated by something and will start feeling better later today, if not then it has a secondary infection. So far it's feeling a little better, but I only ate one meal so far.

Root Canal

Turns out my tooth did in fact need a root canal, which I had done this weekend. The tooth is still quite sore. Thursday I get the root canal finished, should be quick and painless, or so they say. Then I need to get a crown on the tooth since there is a crack in the tooth.

On another front I have decided that I will wait until next year to do the palate expander when I have changed my health insurance.

Of course all of this is screwing up my vacations. I really want to go on a nice vacation in the fall, but the more my teeth cost the more I have to scale down my vacation, damn teeth!

Good news

I met with my primary care physician this week and discussed the possibility of me switching to a health insurance that he does not accept. He encouraged me that if I needed to do this for the year to go ahead with it, and that he would work with me on the costs. He didn't make any promises, but I feel as though I will still be able to be cared for by him and not have to add additional pressure to my existing financial commitments with all this dental work.

Root canal or not????

I went to the Endodontist about my tooth bothering me, he took x-rays and did some tests. He decided that the tooth has a hairline fracture in it and made an adjustment to it. He said to give it a few days, if it feels better then I'm fine until it bothers me again. If it doesn't feel better then I need a root canal and a crown.

I gave it a couple days and my tooth is 95% better so I guess I'm good, thankfully! I'm not in the mood for a root canal and a crown, though I'm sure I will need one at some point, but not right now and that's what counts.

Other dental torture!

When I had my last cleaning it was discovered that I had decay in 4 teeth. I had those 4 cavities drilled out and refilled. All is well with 3 of them. However, the last tooth is quite stubborn. I had the bite adjusted and then LF did some other stuff to it for sensitivity in the area where the pain is coming from. She doesn't think it needs a root canal, and from the tests she did on it I don't think it does either. So now I'm off to an Endodontist to get that area looked at. I suppose this all works out ok with the rest of the problems with my teeth, I certainly wouldn't want to put braces on a tooth that was bothering me.

Sorry if this was boring, but thought since things will be kinda dry here with my delays I would throw out some other dental torture stories.

Universal Health Care is looking good right now

After discussing with Dr. S's office about insurance it was suggested that GHI insurance is what a lot of people come in with as insurance. The other insurance that is an option for me is HIP POS. There is Aetna too, but it would probably be cheaper for me to just pay out of pocket then to switch to them. Before making any decisions about that I decided to call around to my existing doctors to see if they take GHI or HIP. Right about now Universal Health Care looks like a good option! My primary care physician takes HIP and my Gastrointestinal takes HIP. My Neurologist and Dermatologist take GHI. It's like a bad joke! Then I called the office to see which one was going to be better then the other, in terms of difficulties getting approval and paying out - the girl was no help. Nothing like getting support from your doctors office! If everything works out all the surgery done with Dr. S would be done in one year so I would only have to deal with this issue for the year. I could probably just deal with some doctors via the phone, or if I needed to go I could pay out of pocket for the 20% the insurance wouldn't cover.

Begging for money

I currently have health insurance through Blue Cross, but through my union at work I have dental insurance. The dental insurance sucks, like most do, or worse then most do. But it's better then nothing. Unfortunately, it covers orthodontics for children of members, but not for members themselves. Really frustrating since I don't even have kids! On my sisters advice, in January I wrote a letter to my union about my dental issues, basically begging them for money. I put a brief history of my medical/dental issues and told them what I had planned and asked them to consider giving me additional benefits. After a month and a half I got a response from them:

"This is to inform you that your case was brought up to our dental insurance and their consultant and it was advised that you should first see what is covered by your
Medical plan and for you to keep in mind that the we don’t cover implants. Keep us inform on your status."

Well at least they didn't tell me no.

Back to the oral surgeon

I went back to the oral surgeon to discuss how to progress, the plan, and insurance.

First we went over the dental plan. First a surgically assisted palate expander would be placed in my mouth by Dr. F. Then I would go to Dr. S and he would cut into my gums to break some bones in my mouth. I didn't ask too many questions about this since the thought of it grosses me out, this is why they have anesthesia. But this is a necessary step since my bones are fused and wont move the way the palate expander would make them. The recovery time for this is about a week and I will be swollen. Dr. S didn't tell me if I would have any pain, but I read a bit about this on the internet and there isn't any real pain. Then I would have to crank the palate expander twice a day for around 2 weeks - how long will depend on how much Dr. F wants to expand. Once I'm expanded I will have gaps in my teeth, Dr. F told me he would put on some temporary fake teeth so things look good in the meantime.

Approximately 4 months later I will be ready for the bone graft. The bone graft would likely be taken from my shin just below the knee. Some fancy synthetic bone growing stuff thing would also be used to help the bone grow in. Dr. S estimated that the recovery time for this would be closer to 2 weeks because of the grafting from the leg, I would probably have a limp for a good week. The palate expander could be taken off at this time since the bone will fill in the gap created. After another 4 months they'll do some x-rays to see how the bone graft set, if it has set then I will be ready to start with the implants.

At this point no one knows how many implants I will need, there are currently 3 teeth that are candidates and the gap would create a spot for my missing lateral incisor, which would be a 4th. My left canine, which is part of the two tooth cap/bridge with the bicuspid, may not (and it sounds like wont) be salvaged because of the lack of bone in the area of the tooth's root. That will be decided at the time of the bone graft. The bicuspid, which is set back in my mouth, is also an unknown. As I recall the tooth was in good condition before it was capped, but may have broken down since then, that tooth is an unknown until the cap is removed. My front tooth is another tooth that may have to be removed. About a year and a half ago I had the tooth capped, ever since then the tooth has been a little loose and it occasionally hurts, particularly if I bite into harder foods. It could be from the tooth having to deal with a cap, or from lack of bone, though Dr. S thinks there is good bone (though not perfect) to hold the tooth. A decision will be made about that tooth prior to the bone graft.

Then we talked about prices and insurance. As I previously stated Dr. S does not take my health insurance and my insurance does not provide out of network coverage. I have 2 options: pay out of pocket or change my insurance. Dr. S said that if I opted to pay out of pocket he would discount me and he would charge $3000, I would also have to pay around $1500 for an anesthesiologist. This would be done in the office, but this would only cover the palate expander. The insurance girl did say that I would still have out of pocket expenses of around $3000 with insurance, that sounded high but she also didn't know what exactly was being planned and what surgeries would be done so I'm not going to get stuck on that amount. But with insurance I wouldn't be paying for the anesthesiologist. I'm sure I'll be in contact with her again.

Changing my insurance is slightly more complicated and will delay things until next year. My insurance change period is in the fall and the change takes effect for January 1. Then they would still have to get approval for surgery which will take another 6-8 weeks. I wouldn't get started with things until late February. If I did wait though I would be able to set up a flex-spending account, where you put pre-tax money into an account to pay for medical expenses and then get reimbursed as you pay out. This could save me a bit of money, especially when looking at $9000 for braces and the out of pocket expenses for the 2 surgeries.

The other issue is that even if I decide to pay for the palate expander I still have to have the bone graft. I'm not independently wealthy, I can't afford another $5000 for that, assuming it would only cost $5000. I suspect it will cost more because it is a more complex procedure. So, I would still need to change my health insurance no matter what.

If I opt to pay out of pocket for the palate expander and change insurance for 2009 to cover the bone graft then I should probably wait until October or November to do the palate expander. That's assuming 4 or 5 months after the palate expander until I could get the bone graft. And I would also need to allow another 2 months to get approval for the bone graft. So paying out of pocket for the palate expander would only save me 3 or 4 months of a delay.

The other factor is that if I pay out of pocket then I would have the palate expander done at the office, if I wait and use health insurance then it would be done in the hospital.

Roadblock

A few days after meeting with Dr. F I made an appointment with Dr. S to get things moving. The following day I got a call from one of the girls from Dr. S's office, apparently Dr. S does not take my health insurance and my health insurance company does not pay out of network benefits. I wasn't happy, actually I was pretty upset. I was going to either have to pay out of pocket or have to change my insurance. And why didn't anyone tell me this when I first met with Dr. S???? I didn't even feel like going to Dr. S again to even discuss my options, what was I going to learn? That I was going to be broker then I thought or I was going to be or change insurance and wait almost a year to get started. Ugh!

Orthodontist #3

In the middle of March I met with Dr. F. He's a bit older then the others, and knew my old orthodontist and plastic surgeon. This felt good. He started with a very basic history and I liked his style. Then he hit me with the $650 consultation fee. I figured I wasn't really in a position to walk out and I liked him so far so I went with it and had the whole history done. Besides the $650 would go towards my total price from my braces - I was trying to think positive because I knew the braces were going to be expensive. During the history he seemed to do things a little differently and in a good way. I left poorer, but felt like I might have met, the one...

Three weeks later Mom and I met with Dr. F. He presented 3 options. I'll go in reverse order... Don't do anything except have LF make a better crown for the two teeth and go on with life and be done. He didn't say it, but I will, it wouldn't last forever. Option 2 had me using braces to round out my mouth and make other adjustments. Get a bone graft to secure the teeth in that area and call it a day. This was pretty much I was expected and was similar to what Dr. G had suggested. But plan 1 was still to come. This plan would start with a palate expander, braces, then bone graft. What this would do is open up my smile more, widen the base of my nostrils and allow for a more extensive bone graft. All of this would allow the opportunity for me to also have surgery to further repair my cleft lip and the partially collapsed nostril. The price tag was just about $9000. for the braces. Dr. F explained that the palate expander and bone graft would be processed through health insurance which would probably have some sort of co-payment/deductible issues. He also explained that NY State has a law that requires health insurance plans to pay for an implant for a congenitally missing too, which I have, or rather don't have.

I walked out feeling more then a little overwhelmed. I didn't walk in thinking that I needed perfect teeth, nor did I ever consider having my nose and my lip re-repaired. But the ability to do so, if I chose to, made me lean toward the most extensive plan. Mom seemed to agree too, though she never said so. I did a little research on this infamous palate expander and found this account of the experience, and it really didn't seem that bad.

Orthodontist #2

At the end of January I met with Dr. K, Orthodontist #2. He immediately seemed very nice, caring and interested in my case. I got the appointment really fast with Dr K the downside was that he hadn't spoken to LF or Dr. S so I had to explain all the different issues, probably not the most effective way to do this. I liked him and his office manager seemed well versed in getting insurance companies to pay for things. Additionally, he was only charging $5000 for the braces. I must admit that I was weary that the price was so low compared to Dr. G, but his office seemed a little more modest so I hoped it just had to do with lower overhead

A few days later I got a call from LF, she had spoken to Dr. S and they decided that Dr. K wasn't up to doing the job. She found another Orthodontist for me to go to, Dr. F. I started to wonder if this was every going to happen.

Orthodontist #1

In December I met with Dr. G, the first orthodontist I would meet with. On the first visit he took x-rays, photos and molds. He seemed to be a nice guy with a nice office, and he explained to me about a new braces system, Damon, that had come out since I had braces years ago. I don't remember the specifics of it, but they are supposed to be better, faster, and less painful.

In the beginning of January I went for the consultation with my mom. I called a few days before the appointment to make sure that he was ready. At the appointment he seemed confident he could do the job and seemed to know orthodontics. He however had not consulted with LF, who I knew wanted to speak to him, I have been and continue to be in close contact with LF. Dr. G did not know where my teeth were. Granted, the two teeth covered by the cap can be a bit deceiving, but there are two teeth side by side, he thought that one was in front of the other. He also started talking about a periodontist, which had never been mentioned and said I could need jaw surgery, also never mentioned. He just didn't seem to be working with this team that was being created, he seemed like he was operating on his own. When I left he said he would get in touch with LF, which he should have done BEFORE I came. I wasn't impressed and neither was my mother. I should mention that his cost would be $7,500., which I thought was a lot for a guy who I wasn't impressed with.

I consulted with LF, told her that I didn't feel comfortable using Dr. G. She decided to talk with him about the case, if for no other reason then to get a gauge on what his thought process was. She didn't seem overly impressed with him either. She did some asking around and it was recommended that I see Dr. K.

The Oral Surgeon

On the recommendation of LF I made an appointment with Dr. S, an Oral Surgeon, for November of 2008. At this appointment Dr. S took pictures and molds of my mouth, he was able to scan the x-rays that I had from my appointment with LF. I really liked Dr. S he was nice and knowledgeable about Clefts.

The first week of December I went back to meet with Dr. S, this time I took my mom with me since I knew that at this visit Dr. S would be explaining options to me. First he spoke to my mom and I about the state of my teeth. I am missing a tooth on the top where the cleft palate is (my left side) it's the one that should be next to my middle teeth - the lateral incisor. The bridge/crown was adjusted to make the the left canine look like that missing tooth. He showed how my dental line has more of a V shape instead of a rounded shape and spoke about the mobility of the bridge/crown. We also discussed my goals: not to necessarily have a prefect mouth, but to have a more permanent solution to my bridge/crown.

He then went to discuss what I could do with my teeth. He explained to me that he did not think that I needed a palate expander and that the same goal could be reached by getting braces. He said at some point a bone graft would be needed as the bone graft that was done when I was younger was no longer there. Apparently, with a bone graft the bone that isn't used basically dissolves, you can now, on an x-ray, see a gap in my bone where my cleft palate is. Depending on the plan that was developed I might need at least 1 implant. I was a little taken back by all this work, when I walked in to see LF in July I never thought about the idea of getting braces, a palate expander or a bone graft. But ever the trooper since I was born, I went with it and started to really think about doing these things.

My next step was to meet with an orthodontist, Dr. G was recommended.

Introduction to my mouth

I'll use my first post to introduce what this blog is about. I'm a 30something woman who was born with a cleft lip and palate and am trying to trying to "fix" my mouth. This blog is to tell the story of my journey while I try to do this. This journey started about a year ago so I have some catching up to do, which I will do in the first couple posts, and then you can follow me as I take the journey. I'm not going to use the names of any of the doctors, but if anyone would like that information you can contact me by email at giraffe1 (at) optonline (dot) net

As a child I did have a good amount of dental work done including having braces for 4 years, 8 months and 1 day - not that I was counting. My teeth are in pretty good shape right now, they work, and they look ok. There are however some underlying issues. A good 5 years ago or so I had a bridge/cap put on two of my teeth - the left canine and left bicuspid. It certainly looks better and it has been holding up well, but it's never fit quite like my original teeth did and there was a bit of chipping at the top of the crown.

About a year ago my mother met a new dentist, LF, and told her about my teeth and past dental issues, she was interested in my case and I went to meet with her. Last July I met with LF and she did a work up on me, she explained that the crown is lose and eventually will have to be replaced and will eventually need to anchor onto more teeth and then be replaced again. It became obvious that this crown/bridge was not a permanent solution, and I was interested in what would be a permanent solution. LF presented my case at Grand Rounds at the North Shore Dental Clinic. It was recommended that I see an oral surgeon about the possibility of a palate expander and a bone graft. This is when I first started to realize that this would be complicated.