My desire to straighten my teeth uncovered a hidden health problems unknown to me. This journey has taken a sharp turn, left or right, It doesn’t matter; the turn was sharp and fast. The emotional whiplash that is about to unfold is painful, frustrating and eye opening. If you recall from My Jaw Story ~ Part 3 “This will change your life”, I have met my new Orthodontist, Dr. McDonald, and he has recommended I have an MRI done to evaluate my Temporomandibular Joints. He is very concerned about the condition of my joints and how that is impacting my overall health. Looking back over the years, from My Jaw Story ~Part 2, “Smiles over Time”; I have had braces twice before and both of my children have had braces. No one has ever recommended an MRI of the TM Joints. I have also never had a Dental professional talk to me about sleep apnea. Sleep Apnea was discussed at my initial meeting with Dr. McDonald and I complied with his recommendation to have the full in-lab sleep study done, as discussed in My Jaw Story part 4, “Insomnia and Sleep Apnea”.
It is now March 2023, I am now reviewing the MRI and CBTC imaging with Dr. McDonald via a zoom meeting. He does the zoom meeting so the information can be recorded and reviewed as needed. The report he generated is extremely comprehensive and he looks at everything from the occlusion (bite), airway, cervical spine, and the condyles. It took me awhile to digest all of the information. It is overwhelming. The pieces of this puzzle are starting to emerge and I was not sure how to put them together. According to this article, MRI is the best way to evaluate TM Joint status.
“Temporomandibular joint (TMJ) abnormalities cannot be reliably assessed by a clinical examination. Magnetic resonance imaging (MRI) may depict joint abnormalities not seen with any other imaging method and thus is the best method to make a diagnostic assessment of the TMJ status.”
Upon completion of the zoom consult, He recommended that I see a surgeon. He recommended I see Dr. Shah an Oral Maxillofacial Surgeon in Florida, for TM Joint evaluation and Orthognathic surgery, for airway improvement. He clearly stated in the recommendations that he doesn’t recommend Orthognathic Surgery without TM Joint evaluation since that surgery would most likely relapse due to the condition of my condyles. If I choose not to seek any surgical intervention he recommends I wear a splint to prevent any further damage to my condyles for the rest of my life. Of course without surgery there would be no improvement in my sleep apnea, only management with CPAP / BiPap therapy.
Sometimes a story is best told in pictures. Below is the Radiologist impression from my MRI in March 2023. I am grateful that Dr. McDonald included “normal” examples of TM Joints in his 53 page report. That helps anyone without knowledge of the anatomy of the joint understand what is happening within the joint .
The image below shows edema within the Condyle. The arrow pointing to the white area is edema or effusion, also known as necrosis (dead bone). Here is another article recommending MRI for visualization of the TM Joints.
“The main advantages of MRI over all other imaging modalities are the lack of ionizing radiation and the high soft-tissue resolution.[7] T1-weighted images are preferred for outlining morphology because of the greater latitude and better visualization of disk tissue relative to the osseous anatomy of the condyle. T2-weighted images are obtained routinely to document the presence of joint effusion and inflammatory changes in the joint capsule.”
We also discussed my cervical spine, He reported to me that I have a C1 torsion to the left and C2–5 rotations, image below. I received a referral to an Atlas Orthogonal Chiropractor. I really have no idea when these issues with my cervical spine developed. I have been in 2 rear-end accidents and I essentially grew up with a developmental deformity related to my mandible and condyles, as noted in photos from My Jaw Story Part 2 “Smiles over Time”. Essentially, In my simple explanation, all of our muscles, bones, tendons and ligaments are connected and work together within the body. When something grows incorrectly it is likely that something else will be pulled out of place over time. I frequently have stiff neck muscles and tension in my shoulders.
Below is my airway image from my exam and presentation from my initial consult.
Additionally I was instructed to start a vitamin protocol including calcium, vitamin D, vitamin E, vitamin C, vitamin K and Glucosamine. The goal is to increase bone density and help with arthritic pain.
It is at this point I am given 2 options:
A conservative option is a splint to protect my joints which I will have to wear for the remainder of my life, and my joints may still continue to erode, and great care will be needed by any member of my dental team if I ever need crowns, implants, anything that will effect my occlusion. With this conservative option my airway and sleep apnea is only addressed by CPAP / BiPap therapy, for the rest of my life.
The second proactive option is a referral to Dr. Shah, a Maxillofacial Surgeon for evaluation of my Temporomandibular Joints. I am very grateful for finding an Orthodontist that is concerned about my overall health and provided me with a comprehensive work up.
I quickly scheduled an appointment with Dr. Shah. Scheduled in early June 2023. I want to have a full understanding of all the options that will impact and improve my overall health. We only have one life to live and I want to live as long and healthy a life as possible. This whole time my brain is still trying to absorb and understand everything I am learning.
In other words YOLO.
You Only Live Once. Make it a healthy and happy one.
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I’ll leave you with lyrics from Maroon 5, “Harder to Breathe”
There’s no way we’re gonna give up.
Seek Wellness . You are worth it.
