How do I make a rational decision regarding my treatment?
It’s hard for most patients, and parents, to be objective about the need for surgery, or not… especially as it regards a face. By far the easiest decision is not to have the conversation… or hear the words… or see the condition.
Most patients find us. We do not look for them. We don’t knock on their doors. We do not offer business cards in supermarkets. The people who are reading this blog about us are looking for answers to questions that they have, made on their own observations.
We wrote this blog, because we know people like you are seeking answers to the questions that you have independently formed. If you have spoken to other people who agree with us… then you should thank them.
If however you have experienced the frustration of a conversation which ends up going nowhere… where your logic is overwhelmed by the insistence that the man-in-the-white-coat always knows more than you… well, we support you in your decision to seek more information.
Firstly, there is nothing wrong with seeking information. You are not being vain. You are not being irrational. You exist in your own body, and it is you that is best placed to understand whether there is something wrong, or not.
What are my treatment options?
When we go to a travel agent, very few people ask to buy a ticket to board a 747 & simply fly. In contrast, when we have crooked teeth, or a big toothy smile, we seek out someone for cosmetic or orthodontic treatment such as “braces” or "veneers".
We assume that we have a common condition that everyone else has, and that the same process treats everyone perfectly… We expect that the event of our treatment journey will achieve exactly all our unstated expectations.
A nicer way to organise your travel… in fact it is a normal way… is to ask your travel agent to take you to a specific place… from a specific starting point. For instance I might ask “I want to go to New York, and stay in a up market hotel, and I live in Sydney, and I want to leave in May. Can you organise the journey for me?”
I always let my travel agent decide on how best to get to New York… They are usually best at finding the most efficient, cost effective, reliable, predictable way to get there. I might also ask for a specific hotel, or airline, a specific travel class, or date.
And the travel agent in return will give me options, or choices… and from that I can rationalise my travel. I can make choices. And I can also rationally decide on what best suits my travel needs.
This way of thinking also applies to choosing medical or dental care. Like airlines, and airports and hotels, there are many options available to us. But in the first instance we have to generate a list of ideals, wishes, wants and expectations.
Making a choice between surgical and orthodontic options is always going to be hard. But if you are truly going to make a rational choice, everyone needs to make a list of what they want at journey’s end.
The job of the initial doctor is to define your origin (your problem), and the trains, planes and automobiles that are required to get to where you want to go. The predictive success of his or her care will then become dependent upon how many boxes against your wish list that they can cross.
I am a surgeon. I can be criticised for only offering treatments that are surgical. That same argument can be applied against orthodontists too, who may be offering only an orthodontic solution to your care.
What I am talking about in this blog, is helping you rationalise how you approach any treatment paradigm, by any professional, in whatever discipline they may be. Not all orthodontists are the same. Not all orthognathic surgeons are the same. And not all procedures are the same in delivering the same outcomes of care.
Maybe it is not possible for your dental or medical or surgical practitioner to link an “A” condition to a “Z” condition… many dental practitioners insist for instance that 28, or even 24 teeth is all that is needed for a full functioning bite.
Some do not see the relevance of facial proportion to their care, or even of a final stable occlusion. Fewer still may see a link between dental overbite, to dewlap, to glossoptosis, and to obstructive sleep apnoea (OSA). Maybe even you yourself do not care about certain this or thats.
But everyone can develop a wish list, or basic question list, for their combined facial and orthodontic treatment. It is up to you to ask the questions, and it is up to you to decide whether the treatment you want to choose (the journey), will match your condition (the origin), and your desired treatment outcomes (New York).
My Jaw Surgery question checklist
These are the questions you should ask when deciding whether Jaw Surgery or Orthodontics is right for you…
1. Will I achieve a wide smile, without buccal gutters, and full upper lip projection, or will my bite be narrow and set back or long?
2. Will there be aesthetic improvement to my overall frontal facial balance, symmetry and proportion?
3. Will I achieve idealised facial profile balance?
4. Will I achieve symmetrification of my face or jaw, or chin point, or dental midline?
5. Will treatment eliminate my dewlap?
6. Will I gain vertical facial height proportionality?
7. Will I achieve normal lip competence?
8. Is there a chance that treatment will cause a dorsal hump in my nose, or will treatment imiprove my dorsal hump or sense of nasal size or projection?
9. How will treatment affect my nasal tip projection?
10. Will treatment improve my nasal alar base widening?
11. Will treatment achieve jaw widening?
12. Will treatment achieve cheek bone widening?
13. Will there be correction of lip projection and fullness, with back-lip dental support in passive (non-smile) state?
14. Will I have normal aesthetic chin point projection by my treatment?
15. Will my eventual jaw line be feminine or masculine, and can I accentuate the effects of either?
Airway & Breathing
1. Will I gain an open airway, titrated against exercise tolerance?
2. Will I gain an open airway titrated against full night sleep free of snoring?
3. Will treatment improve my nasal airflow?
4. Will treatment eliminate the dark cricles beneath my eyes?
5. Will treatment improve my sense of tiredeness or alertness or energy or sense of attention during the day?
6. Will this treatment extend my life span through reduction of risk factors associated with development of OSA"?
7. Will there be general growth normalisation through growth hormone assay normalisation if I am already “small for dates”?
8. Is there any possibility for reduction of lifetime cardiovascular and cerebrovascular risk associated with OSA?
9. Will treatment prevent for tonsillectomy or adenoidectomy or palato-pharyngo-uvuloplasty as treatments for OSA or upper airway resistance syndrome?
Dental & Occlusion
1. Do I want to keep 24, 28, or 32 teeth of my teeth?
2. Will I achieve a fully functional class I occlusion in full dentition, with my jaw joints in a normal anatomical position, free of asymmetry or risk of joint disease?
3. Will my treatment achieve eventual CO-CR synchronicity?
4. How stable is my treatment result, and what is the chance for teeth to move away from their treatment positions?
5. Will treatment eliminate my dental crowding without the need for dental extractions?
6. Is there a chance for improved developmental & functional eruptive potential for my wisdom teeth?
7. Is there any potential that I may achieve natural decrowding of my crowded teeth?
8. Will there be smile levelling and dental midline centralisation?
9. Will I avoid dental extractions or impacted wisdom teeth removal?
10. Is my treatment choice avoiding or eliminating or accentuating a risk of periodontal or root resorptive effects from the treatment itself?
11. Will my treatment produce a gummy or will it produce a normal “smile line”?
General treatment questions
1. Will I improve or worsen socialisation?
2. Will I improve my self esteem?
3. Can I expect normalisation of cervical postural control or at least improvement?
4. Is speech lisp improvement a possibility (sibilant control)?
5. How is this treatment or that treatment compared in terms of overall treatment time?
6. Will my treatment aggravate or cause TMJ disease, or TMJ dysfunction, or tension headaches, or will I be trained to adopt a “Sunday smile”?
7. Does my surgical treatment have surgical side effects like persisting numbness to skin or lips or tongue?
8. What are the costs of my treatment?
9. Which treatments offer a minimum or maximum of treatment time?
10. Are there risks of not having a certain treatment vs risks of having a certain treatment?