Adult Class III, Flared Front Teeth, Crowding, Crossbite to Be Treated with Damon, IPR, Acceledent, Possibly TADS - Bloomington

I am a 32 year old woman who has never had braces...

I am a 32 year old woman who has never had braces and in the past few years have developed jaw pain (and clicking at times), gum recession, and the beginnings of tooth destruction from grinding/clenching and a bad bite. Besides a bad bite my teeth are also very crooked and the bottom are crowded. I've wanted braces for years but it hasn't been an option financially until now.

I recently had an orthodontic consultation and am a little uncertain how I should proceed. We seem to be in agreement that if my teeth were straightened then I would actually have an underbite. I would be using elastics, of course, to help correct this, but I'm worried that my jaw joints won't be able to handle the pressure from the elastics. I might just be overly neurotic and it could be fine, but I don't think my concerns are unfounded. He gave a few other options in that case-- IPR (which he might do anyway, and I'm not sure I would want that); removing a bottom front tooth and pulling in my bottom teeth (wouldn't have a good midline then, not that i do now); or TADS.

I am VERY concerned that my profile is going to be even worse than it is now. If my lower teeth are pushed back then my mouth will look completely sunken and I will be very unhappy. Right now my upper jaw is sunken/small and ideally, I think, I would have my upper jaw surgically pulled forward, since I'm happy with my lower jaw pretty much, but I don't think surgery is an option for me financially. I wanted Damon braces because of the purported arch expansion, however I don't know if my upper jaw could even physically accommodate having my top front teeth pushed forward anymore. I haven't had xrays yet to determine the state of my skeletal structure (for braces, I've had them at the dentist of course), so the orthodontist doesn't know, either.

I have scheduled my records appointment for next week (where they would take the scans and xrays) and then the braces would be put on the middle of August.

I'm not sure what to do. I am in school and want my braces put on before school starts so I have some time to adjust, however I'm worried that non-surgical treatment won't give me the results I want. What I want is 1) a good bite; 2) a good midline (at least on the top, I might be able to live without it on the bottom); 3) no more shrinking of my profile, and ideally pushing the upper jaw forward a bit.

Should I have a consultation with a surgeon, even though I'm pretty sure that isn't an option for me? I'm happy with the ortho, they have great reviews and my consult went really well (in terms of time spent, their willingness to answer questions, etc), so I'm not inclined to go to another ortho for their opinion.

What do you think? Might I be happy with non-surgical treatment?
Hi :).  You are looking at a gauntlet, from your title!  Congratulations on finally being able to get this done for yourself.

None of our community members are doctors, so we can't give you medical advice.  But I think you've started on an excellent path.  Getting those x-rays or whatever other scans the orthodontist will use is a very important step.  Without that, the doctor can't really give you any realistic recommendations.  Once you have those x-rays, you might ask for a copy for your own records, then upload them to the Doctor's Q&A section here on RealSelf, along with your mouth shots (front open, front closed, profiles,) and ask for their opinions.  If you can get a free consultation from an oral surgeon, I'd do that as well.  If you have to pay, you have to weigh that yourself.  Do you have any insurance at all?  Some insurances cover oral surgery for class IIIs if it's severe enough.

I am very eager to hear more about your next meeting with the doctor.  Please do keep us informed!  My husband had Damon for arch expansion instead of doing surgery, and he is happy with his result.  But he was not a class III.  His jaws were just too narrow and he had severe crowding.  His arches are still relatively narrow, and v-shaped, but they are better, and no teeth had to be pulled.  He's extremely pleased.  But that's just one anecdote :).  Your doctor is the best next step at this point!
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Thanks twoplusone! :) I do have insurance in general but it doesn't cover orthodontics and I have yet to call to ask if it covers surgery (but it's unlikely). Since my ortho explicitly said (and wrote in my record) the surgery would be cosmetic I think that would ruin any chance with my insurance. However, since he hasn't seen my X-rays I guess that could change. I'm going to try to be patient until Thursday, but it's hard! I think the X-rays are integral, I'm hoping I have mostly a dental problem and not skeletal. I will definitely update when I have more info!
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I think you're right--if he said it was cosmetic.  But yeah, we'll keep open minds till Thursday which, I agree, seems like a long ways away, and I'm not even the one waiting, LOL!  Good luck on Thursday and I look forward to your update :).
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Braces scheduled!

I've scheduled to have my braces put on August 14! They took my x-rays and did a digital scan of my teeth (instead of taking impressions, which was an interesting and long process!). Apparently my x-rays didn't show anything bad/surprising since no one said anything (about my skeletal development, bone density, etc).

The bottom braces will be metal Damon, top will be half metal half clear (front 6 are clear). I debated on whether to get all metal, but decided that the potential risks of the clear (breakage, staining, harder to remove at end of treatment, etc) were worth the possibility of having less noticeable braces.

I'm REALLY nervous to have them put on and to be committed to them for up to 2+ years! I hope the Acceledent really makes a difference in reducing my time in braces. I'm worried about it hurting when they put the brackets on (my teeth are sensitive, especially to blowing air) but that is such a small part of the treatment I shouldn't worry about it. I feel I can handle "regular" pain (abrasions, etc) much better than "nerve" pain, though (like from air, cold, fillings etc).
This Thursday is the day! It feels like I've been waiting forever to get the braces on. I'm trying to eat everything now that I won't be able to (or shouldn't) with braces.
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Congratulations!!!  You may want to ask the doctor whether there is anything you can do ahead of time to lessen the risk of nerve pain.  Like sensitive toothpaste or over over-the-counter medication or something.  

I am also very excited to see how AcceleDent helps.  It seems it really would, especially with Damon, since the teeth are free to move at their own pace.
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So far so good!

I got my braces on Aug. 14th and so far so good! I was so worried about it hurting (sensitive teeth) and making me want to gag when they put them on but it was totally fine! The tech was so careful and used warm air and warm water, and lots of suction so it was fine.

Once the wire was placed I felt it immediately. At first it was a "good" pain (like a healthy pain) but then it got more insistent. It wasn't too bad when I wasn't eating but I had pretty bad pain when I chewed on the right side, so I chewed on the left. I never had to limit myself to liquids or mush, though. The pain spread to the left side, too, after a few days but then quickly started to fade so that now I don't have real pain at all just some general discomfort when chewing. It's a weird feeling, it's like I can feel every tooth when I chew and they all feel pointy! Weird.

I've been using the Acceledent daily and I'm not sure if it's doing anything but maybe that's what made the pain go away (or I'm just getting used to the braces).

My mouth is very dry and nothing seems to help it. I'm hoping I just have to get used to the braces and that I'll go back to normal soon. Having dry mouth makes the wires stick to my cheeks, makes it more difficult to talk and even eat. The only good thing about it is that it makes the Acceledent easier to use since I have no spit! The first few days I used the Acceledent it was really gross there was so much spit.

I'm finding that keeping my teeth clean is pretty easy, flossing isn't bad at all it just takes time and patience. I haven't gotten any sores but if my mouth continues to be dry I probably will :( . I used wax at night the first few days in hopes of avoiding sores but I haven't used any lately.

Very few people notice I have braces! It's pretty cool and I'm not very self conscious about them. I haven't really eaten in public yet since a lot of food does get stuck and it's annoying.

I keep looking to see if my teeth have moved but I know it's too early. My 1st adjustment is the middle of September, I hope there's some movement by then!
Congratulations!!!  Everything I've seen here on RealSelf makes me believe that the AcceleDent will definitely work for you.  Everyone goes through their treatment twice as quickly.  :)

When you say the flossing isn't that bad, just takes patience?  How long does it take you to floss?
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The first night it took about half an hour, but it's gotten steadily faster. I think it's maybe 10min now? I know that's a crazy long time to floss normally but it doesn't feel that long since it's all spent actively trying to thread to floss through my teeth. For a lot of my teeth there's enough space that I can just put the floss in right at the gum line without having to thread through the braces first (can't do that on bottom where they're really crowded). I started off using threaders but am now using up my sample pack of superfloss and really like it. I wish it didn't have that spongy part on it, though, it seems pretty useless to me. I like the threaders, too, but my floss always comes untied at least once. It's funny because brushing is the annoying part for me! It takes sooo much longer to brush and get all the plaque off. I never really liked brushing my teeth to begin with and now I'm having this weird gagging thing all the time and I have to brush twice as long. I'm going to buy some plaque revealing tablets at some point to see if I'm actually getting my teeth as clean as I think I am. I haven't bought a waterpik yet and might not since I don't seem to need it. I am always swishing my mouth with water while I eat because I hate the food getting stuck in there so when I go to clean my teeth after I eat there's almost nothing stuck. However if I get the plaque revealing tablets and they show I have plaque I'll probably end up getting a waterpik and seeing if that helps.
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Great idea!  My mom used those on me when I was little to help me learn to brush my teeth.  I need to get me some of those!  Thank you for the detail, though, about your hygiene.  I always wonder about that.  My husband used to take 30 minutes every time he flossed, throughout his Damon treatment!  Nice to know that not everyone takes that long :D.
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First Wire Change!

It's been a little over 1 month and 1 week since I got my braces! I had my first wire change last week. One of my bottom brackets had popped off the Friday before the appt (the appt was on Thursday) but it was no big deal to reattach. She said that since I'm so early in treatment and since it wasn't off that long it didn't matter too much.

They changed both my wires, up to the very next wire. She said they're concerned about flaring my teeth so I may have to go through every single size wire! I don't really mind, though, since it looks like I'll be getting the wires changed every 4 weeks so I can at least feel like I'm making progress. I also don't want my teeth to tip or my roots to have problems, of course.

The wire change was so incredibly easy, she popped open the doors and took out the wire. She let me brush and floss without the wire and it wasn't as nice as I thought it would be! The doors were still open so the brackets were very abrasive, I just wanted her to put the wire back in and close the doors as fast as possible!

One thing that was interesting is she changed the bumpers out and I could see how smooshed and degraded they were! They definitely feel a lot better new, have more cushion. Even if I didn't have an appointment every four weeks I'd still probably want to go in to get the bumpers changed out, it makes a big difference. They also were getting discolored so it was nice to have new ones.

I have almost no pain from the wire change. Maybe that's from the Acceledent or maybe it's because I only went up one size. My teeth have definitely moved, mostly outward increasing the arch. My front teeth have barely started to rotate. I will feel like a new person with straight front teeth, that will be the biggest change for me!

I'm only a bit over a month in and am already getting lax in cleaning :( . Instead of immediately brushing my teeth after eating dinner I wait a few hours sometimes (so I can keep grazing...) bad for my teeth and my weight. I'm getting back on track though.

I'm also finding it difficult to use the Acceledent for 20 min every day. 20 min is a looooong time to sit around when you're in grad school and have a million things to do. I think I've only missed one day, though. My dry mouth is also weird, it comes and goes. Sometimes I can barely stand to use the Acceledent I have so much spit and sometimes I have no spit at all.

I'll post pictures at some point to show the progress. My back molars are still not hooked up to the braces, she didn't say when that would happen. I wonder what that will be like? It's weird to me that my teeth can still move properly even though they're not all hooked up.

The biggest difference so far is in my bottom front teeth. I really have to take some photos so I can compare. I can tell just by looking, though, that the arch is becoming rounded in the front instead of squared off. The teeth are still really crowded, though.

So far so good!
So fast!  The AcceleDent really is amazing!  My seven-year-old daughter just started her Damon treatment today, and I was seriously considering getting the AcceleDent.  They're just so expensive.  And would I be able to get a seven-year-old with some cognitive delays to sit with that thing in her mouth for twenty minutes per day?  She can't even stand the vibrations of the electronic toothbrush I use on her teeth.  Are the vibrations very strong?

And yes, please post pictures! :)

Oh!  And the doctor recommended this kind of floss called Platypus, that you don't have to use a threader for.  We bought a bunch of it but haven't gotten it yet so I can't say how well it works :).  They say on the website you should be able to floss in, like, two minutes!
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I could see it being VERY difficult to get a child to use Acceledent on a daily basis, especially one so young. 20 min is a really long time, especially if you're drooling like crazy. The intensity of the vibrations depend on how many teeth you have contacting the bite piece. It's not at all like an electric toothbrush, though, it's much gentler. I think the vibrations feel good, and it seems that most people feel that way. They definitely seem to reduce the pain. I definitely miss it when it stops at the end of 20min! The ortho tech also suggested that the Acceledent helps heal mouth sores (from braces rubbing/poking) since it increases blood flow to the area. I wouldn't doubt this, since I haven't had any serious mouth sores and the little ones I've had healed quickly and never hurt too badly. Orthodontists charge different prices for Acceledent, some charge ridiculous amounts ($1,000+). My ortho only charges a bit more than $500 something. I would definitely not have paid $1,500. Although if it gets me out of braces in half the time, with almost no pain, it might be worth that much. It's hard to say. If you can get one for about $500 I would say go for it. Worst case your daughter could use it just when she is in pain like after wire changes. Then maybe the relief she feels would encourage her to use it more. I just bought some superfloss so i wouldn't have to bother with the threader, I haven't heard of platypus. The superfloss is not quite stiff enough to get to my back teeth, but is great for the rest. I probably floss in about two minutes at this point. It's so much easier when the teeth spread out!
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Thanks for all that info!  I ended up asking the ortho about it and she said that it wouldn't really be that useful, because part of what we're waiting for with my daughter is for her adult teeth to come in.  So it can't go any faster than they want to go, and she didn't think the AcceleDent would affect the speed of her adult teeth coming in.

I used superfloss on her yesterday and she was not pleased.  I sure hope she gets used to all of this, because having her crying at me while I floss her is not fun!
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Two months!

It's been 2 months and 1 day and I'm definitely seeing some movement! I'm glad I've been taking photos since the movement is much easier to notice in comparison to how my teeth were in the beginning.

I have my second adjustment this week. I'm hoping I'll go up another wire size and that they'll take off the bottom bumpers for good, since my top front teeth no longer seem able to hit the brackets on the bottom. I'm really concerned about tartar on the bottom teeth, and those bumpers don't help. I'm going for an extra cleaning in November. I've always had a lot of tartar on the bottom just naturally, and braces don't help. I am concerned about getting a permanent retainer on the bottom because of this, I might see if I can avoid that. But that is a loooooong ways off...
Huge changes!  Congratulations!!!! :D

You know, I wonder whether they'd let you go to Vivera or other clear-plastic style braces if you committed to, like, six months of full-time wear.  Quite a few Invisaligners opt for the bonded (permanent) retainer to avoid the full-time wear after they've already been doing it for years.  But maybe one can do the opposite and avoid permanent retainers.  Worth asking about.  I would probably ask sooner rather than later, because of the cost differences and the fact that the clear plastic retainers require impressions and time to make.  It may even take some negotiating.
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That's a really good idea, thank you. i'll ask them about that during my appointment tomorrow. It's possible my tartar won't be as bad once my bottom teeth are straight, since they'll be easier to clean, but I think some people are just genetically prone to the problem no matter what. I also saw there's an "s" shaped permanent retainer which allows more easily for flossing, but I wonder if that would just offer even more surface area for plaque to stick. I'll see what they say!
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I am prone to tartar there, even with my teeth perfect, so I know exactly what you're talking about.  I saw those awesome s-shaped ones!  None of the orthos I know are offering it, but that'd be super-exciting if you could get one of those!
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Second Wire Change-- and Elastics!

I had my second wire change a few days ago and also started on elastics! They're the fox elastics, and I wear them in the Class III configuration from top back to bottom front. They attach far enough back so that they're not visible during normal conversation, thankfully. The teeth they attach to were sore for a day or two (especially the top ones), but they aren't sore anymore and it was never so bad that I couldn't chew. I only take the elastics out for eating so I wear them probably 20 hours a day or so? I actually look forward to putting them in because they symbolize progress for me!

For the wires, I started with .014 in August and then went on to .016 in September (they were being very cautious because of my crowding, etc). I'm now at .018. I LOVE having my wire changed every month! I know that probably can't continue (I don't think there are that many wire sizes!) but I love feeling that I'm making extra progress that way (even if it's not necessarily true).

I'm still using the Acceledent every day. I wish there was a way to know whether it is making a difference. All I know is that my teeth have moved substantially in just two months and I have had almost no pain (after the first 10 days or so when eating really hurt).

I really hope I can avoid extraction (of a front bottom tooth) or TADS. Maybe at my next appointment I'll ask them what they think my chances are of doing this only with elastics.

TwoPlusOne, I did ask about having a removable retainer instead of a permanent bonded one and they said that would be no problem! She said it's hard to talk with both retainers in, though, and I'd have to wear them 24 hours a day so I'll have to think about that. I think I'd be fine with a permanent retainer on the top, it's the bottom that's the problem for me, so maybe I could do half and half :)
Oh, they also took my bumpers off my bottom teeth! Woohoo! My top front teeth are no longer in danger of hitting the brackets, instead one of them hits exactly along the top of one of my bottom teeth that is still very crooked. I hope they both keep moving so that I don't chip a tooth...
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Dr. Henderson

We had a great consult, they answered all of my questions and made me feel comfortable that they would fix my bite and straighten my teeth however I have concerns about the final aesthetic result.

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