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Decisions, Decisions

The decision to begin a plan towards optimal dental health and esthetics can be a difficult one. Depending on your specific situation and diagnosis, it may be a plan requiring a significant investment of time, energy, effort and finances. Our goal is to help you understand all aspects and implications of your treatment plan so you feel you can make a decision that you feel good about and that you feel is in your best interest. We are here to help you through the process, to walk with you “arm-in-arm”, however long it takes.

Read this patient’s story recounting the various emotions she experienced and decisions she had to make before she could move forward with her treatment.


by Deborah E. Bush, Pankey-gram Editor

I am an orthodontic Class II patient. That means I have a retruded lower jaw with associated bite problems. A year ago, Dr. Gregory J. Tarantola and I talked frankly about the condition of my teeth. At that point, I had worked as the Institute’s Manager of Marketing and Communications for two years, and I was familiar with some of the treatment options available. I desired the best dentistry. But, even though I was motivated and had a master Pankey dentist by my side, I did not receive well the news that orthognathic surgery was in my best interest. To be frank, I was scared. Just how much trauma would occur and how fast would I recover? Was it really necessary? I felt as if someone was suggesting I jump over a cliff.

Over the next five months, Dr. Tarantola worked with articulated models of my mouth more than once. He was convinced that my teeth could not be brought into proper alignment, equilibrated and restored without the assistance of jaw surgery. During this time, I underwent bite splint therapy to stabilize my jaws and relax my muscles and visited orthodontist, Dr. Lindsey D. Pankey, Jr.; corrective jaw surgeon, Dr. Steven M. Holmes; and endodontist, Dr. Stephen E. Morrow. I appreciated the forthright report from each of these specialists, and they concurred with Dr. Tarantola’s recommendations for two-jaw surgery. They also were in. total agreement on the predictable nature and most certain success of the whole process. But, it was another two months before I committed to comprehensive treatment and five months before my husband was 100% behind it. I had to work through the emotions of (a) changing the face I have lived with for 48 years, (b) committing to a liquid diet for two months post surgery (although I would not be wired shut), (c) the probability of some discomfort (post surgical swelling, nosebleeds, perhaps pain and nausea) and (d) a very small but possible risk of nerve damage. I could manage the financial investment, so at least that wasn’t a hurdle. The thought of two weeks away from work wasn’t a big concern as I would have time to prepare. Certainly, it did not help, though, when family members and friends gasped and said, “I’ve never heard of such a thing. Are they nutty?”

I had to check out my own mind and heart on the matter. Like a good Midwesterner, I asked myself if I was considering this for the right reasons, i.e., right for me. Was I overly enamored with the improved facial profile and smile? Or was I truly concerned about the long term wear and tear on my teeth–and, if so, was that sufficient to warrant so much work? Did I want to comply with the dental experts because they wanted me to comply or because I wanted to have the work done? And, if I did enjoy the esthetic benefits of optimal treatment, was there anything really wrong with that? Once, I determined that it was the adult “me, myself and I” who was committing to optimal dentistry (not the compliant inner child) and that the long term wear and tear on my teeth would warrant the recommended work, I could relax and enjoy the prospect of an improved facial appearance. I had figured out my value system was clear on what makes for a beautiful person–the inner self. To me, the work was warranted for functional, health and comfort reasons…and improved appearance would be a nice by-product. One interested Visiting Faculty member suggested I look at it this way. Sometimes our bodies don’t develop according to God’s plan, and the science of medicine has made it possible for us to make corrections. That thought comforted me.

The interesting thing is the process wasn’t over when I came to that set of conclusions. I found myself wondering if I wasn?t fooling myself with my Midwestern mentality. Maybe I should embrace the “cosmetic” aspects of the process, “go whole hog” so to speak. Why stop with the jaw and teeth? There are other parts of my anatomy which certainly could be improved upon. So, I analyzed myself some more. Eventually, I settled on a position that I have been comfortable with since November. I really do want my jaw line, chin and teeth to be optimally healthy for the long term and more attractive, but I don’t mind having a “gummy” smile as it’s “who I am.” It’s the friendly trademark of my family line. As for the rest of my anatomy, I’ve started exercising more, and some days of the week I diet.

Please think about this a moment. I probably never would have considered jaw surgery if it had been suggested for only esthetic reasons. My appearance has not handicapped me, and I think its imperfections helped build character. But now that esthetic improvement is an option that fits into my value system for health, I am looking forward to the improvement.

Dr. Holmes was an extraordinary communicator when it came time to assure my husband of the value of the process, the competence of the surgical team, and what we could expect to happen. Dr. Tarantola was patient with me through the process. But, the decision did take time, didn’t it? Patients need time to work through feelings and judge the validity and value ‘their dental team’s recommendations. Patience is a virtue. It may take months of keeping the conversation going before the patient makes the appropriate decision for herself. I believe the key is for the restorative dentist to work with specialists who have the same high understanding of comprehensive dentistry and competently talk the same talk and walk the same walk. Like the team Dr. Tarantola works with. One of the more difficult parts of the job for the dentist may be “standing by” and supporting the patient as she comes to terms with herself and makes the necessary value judgments. I had to do that part of the work…not the dentist, not the orthodontist, not the surgeon, not my family.

I now face the restoration process with anticipation, not fear: I have chosen to be fascinated by the process and marvel in the changes as they take place. I had anticipated third molar removal by of Holmes in December. (I was committed to optimal treatment at that point.) I began orthodontics with Dr. Pankey’s partner Dr. Juan-Carlos Quintero 10 February. (My husband was at peace ~ then.) Last week I got a warm smile from Dr. Morrow in Master’s Hall when I “flashed” my braces. The next morning, I got a hug from Dr. Stephen Chase, another Guest Presenter, who will be following my perio. 1t feels really great to have the best of the best caring about me and taking care of me. I hope all of the specialists that have been part of my story so far know how important and valued they are. As I said to them in our group consult, my case wouldn’t be going forward without them and if I didn’t trust their skill, care and judgment.

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