My Jaw Story ~ Part 2
This is the timeline of events in my Temporomandibular Joint Story.
I will be sharing personal photos and some medical records at my own discretion. I ask for respect in this personal process. Feel free to share this blog. Please do not use my photos / records without my permission. Nothing here is intended as advice of any kind. This is only intended as a journal to share my experience.
I have always had a crooked smile. We all have imperfections. That’s part of our humanity and what makes us different. No one is perfect.
Each decade has a story to tell. Looking through my photo albums trying to establish a timeline of my dental / maxillofacial history, I see subtle changes in time. Not only changes in my smile, but changes in my learning regarding how my teeth and jaw joints impact my health. As I explore research, listen to other’s experiences, study my own health data, I discover many views and opinions along the way. I have discovered you must do your own due diligence and learn what is the right treament for yourself. Not all providers have the same background, education, training or philosophy.
1970 I came into this world with the use of forceps. My mother suffered from preeclampsia, frequently called toxemia at the time. My birth weight was under 5 lbs. All I know is that it was a difficult to manage delivery and the medical providers used forceps. At approximately 15 months, I stumbled, as toddlers frequently do, and hit the left side of my forehead on a glass coffee table. Leaving a small scar above my left eye. Are either of these events to blame for damage to my condyle(s) during my youth? The potential cause of my crossbite and tooth crowding over the years? Perhaps. At this point in time it is all only speculation. Of course these events are all second hand information injected into my memory from stories told by my mother. Stories I have heard time and time again. The use of forceps has drastically reduced since the 1970s, there are improved methods of delivery to reduce injury and improve outcomes. As far as childhood injuries … Unless we start raising kids in bubble wrap, I see no way of avoiding injuries. At least there aren’t as many death trap type of children’s playground equipment at city parks. Although children will always come up with ways to injure themselves, intentionally and unintentionally. Looking at the photos below it is obvious my jaw did not develop correctly. What caused this facial asymmetry? What variation in development happened? I am no expert and these photos are just clues along this journey.
1980Those infamous years of beloved music, colorful hair and whimsical clothing trends. I don’t recall exact dates of my experiences, only general timelines of orthodontic work and wisdom teeth removal. Of course I don’t have any medical records from this time frame. I recall lengthy appointments and hearing several opinions about braces. I remember my parents having some distressed conversations about my situation. I didn’t have a full set of braces in my teens. I did have some minimal braces to straighten my teeth, at a fairly young age, 13–14. I recall some brackets on the front teeth and a long wire that curved around to the back teeth. I did have to utilize elastics to fix my “cross-bite” malocclusion. My wisdom teeth were removed at age 14. I recall that specifically due to being in bed for an entire week of spring break. Being so young with “impacted” wisdom teeth was not a pleasant experience. I am grateful those were the only molars removed. I did not have any other teeth removed. My Mother does recall that the Orthodontist told us I would need surgery and that was a very difficult and painful process. She was informed it would be best if I made that decision as an adult. I only learned of her memory of that conversation recently. I don’t have any photos of myself in braces / elastics as a teen. I believe it was at about age 13 that I had braces. As you can see in the age 17 photo, my malocclusion has returned.
1990 I am an adult! But am I really? Starting off life after high school and community college, young and married. A few years into marriage my husband and I leave the US for several years overseas in Germany while my husband served in the military. While there, he had his wisdom teeth removed at the age of 23. Since we had access to some dental care while overseas, I requested a consult for braces, or whatever may be needed to correct my persistent crooked teeth and crossbite. My teeth always seem to be moving and that bothered me. Why don’t my teeth ever stay in place? My bite still doesn’t line up. I obtained a consult by a team of US Army doctors in Grafenwoehr, where there was an Army dental center. I recall at least 3 providers in the room evaluating me. Dentists? Doctors? Who exactly, I don’t recall. What I do remember is, they measured my jaw, comparing the different dimensions of my facial structure. Mostly visual inspection and xrays perhaps. One of them literally held a string to each side of my face and compared the differences in the jaw line. I don’t remember any other scans. It was approximately 1994. I remember discussions about possibly needing to cut a wedge of bone out of my mandible in an attempt to fix and match up the difference in the sides of my mandible. At least that is the best recollection I have of that discussion. Again, I have no medical records from that time. In the end, they told me they would need more time to work on my case. My husband only had one year left on his tour of duty in Germany. So we did not proceed with any treatment. Thank Goodness.
2000 Y2K. IYKYK. Lived it, suffered through the strange computer outages due to computer programs not understanding how to compute past 1999 as the new millennium approached. My husband and I are back in the US and he has finished his time in the military. He has a brand new career path and I graduated Nursing school in 1999, our class slogan was “Nurses for a new Millennium”. Fresh new nurses graduated out into the world, energized and empowered to do good work. I found myself with new dental insurance and a continued desire to FIX MY TEETH and CROSSBITE! I sought out orthodontic care, for the second time in my life. I was met with a device called a Herbst appliance. As a adult, age 30 at this time, I was self conscious about having braces so I opted for clear ceramic brackets. It was not as common then for adults to have braces. I wanted to try to hide the braces as much as possible, but there was no hiding this Herbst appliance. Once again, I don’t have many photos of this experience. I also don’t have any medical records. The concept of a selfie was non existent yet. Who is going to hold up a polaroid camera to their mouth in an attempt to photograph the orthodontic appliance in their mouth? Well at least I did not. This appliance was intended to work similar to elastics to pull my crossbite into alignment and my jaw forward. Additionally, my treatment included a tooth borne palate expander that I had to turn every night. The rods on the sides of this device would slide apart if I opened my mouth too far. My husband recalls that I got good at putting them back in place just by manipulating them with my tongue. I also had a small key as a turning device for the expander. That key, which was no bigger than an average sized nail would get stuck in the device and my husband had to help me pull it out, after he deciphered my panicked arm gestures and grunts attempting to explain what was wrong. I am grateful this experience did not cause harm to my teeth / gums. A quick internet search today, shows me some Orthodontists are still using this Herbst appliance device. It’s hard to imagine life without the internet. How else did we question procedures, research information, or share ideas ourselves?
A side note regarding the internet…. proceed with caution with your own research and public forums. This has been a difficult process, it is emotional and time consuming. My education helps me understand some medical jargon and information. I also learned along the way to proceed with caution in support groups. I have used support groups as a basis to learn some basics and then I can seek out my own information. Just be careful out there, it is the Wild West. Even though the internet has been helpful in finding information quickly it has also developed cesspools of anon posters that will berate you in a moments notice. But I am grateful for all of the information that is at our fingertips now. Take the time needed to utilize it appropriately and in conjunction with information from your chosen providers.
In 2000, we didn’t have access to the internet as it is today. I did not do any research at that time. Below is a screen shot from an internet search today, this shows the full Herbst appliance I had installed. I was 30 years old, I had this during my first pregnancy and birth of my son. The site I found this picture on for credit is here.
Eating was very difficult initially with this device. I lost 15 pounds within weeks. Without doing any research of my own at the time I didn’t know what any other options were. That Orthodontist used this device with braces and it seemed to pull my bite together. Did I have any expansion during this treatment? I don’t know. I have no records to confirm, measure, or compare. I was very very happy when I finally had this and my braces removed. I was 31, My son was about 3–6 months old. I think I was in this device for approximately 18 months.
2020 50 years of Life! Wow! The time has flown by. My kiddos are graduating high school. The world is in the midst of a pandemic and we are navigating this new challenging world. I have been going to the same dental office for about 12 years. I have always been diligent at having my teeth cleaned every 6 months. My Hygienists have told me over the years that I grind my teeth, an occurrence known as bruxism. They suggested using a night guard to me many times. I denied headaches and didn’t “feel” like I grind my teeth. So I never pursued the night guard they recommended. My Dentist never mentioned the grinding or bruxism to me as a concern. He palpated my jaw every 6 months and we never discussed the popping, crepitus or weird noises that my jaw makes. Remember, I have lived in a state of denial. “I don’t feel unwell” so I don’t ask many questions. When asked to bite down during a dental exam, I have ALWAYS been very diligent about guiding my teeth “into position”. I know I have a cross bite. I have had braces twice. Over time the cross bite ALWAYS comes back. I have to shift my teeth into position so they line up better when I smile. I have always hated taking photos because I never know how my teeth will look, or how crooked my smile will be. My Dentist never discussed my temporomandibular joint or my cross bite with me. Only the Hygienists would tell me I grind my teeth, which I always denied symptoms of. I denied and ignored many symptoms and just carried on with life.
2022 Something changed in 2022. I started having headaches. I kept finding other reasons for the headaches, I tried to blame the covid vaccine, stress, whatever else it could possibly be. This facial pain would occupy exactly half of my face, sometimes the left, sometimes the right. The popping and crepitus in my temporomandibular joints worsened. I also started to acknowledge a sensation in my upper chest and neck, I described it as heartburn or just a lump in my throat or upper chest. I started inquiring with my PCP about some of these vague random symptoms. I had my thyroid checked with ultrasound, and a barium swallow to rule out a GI issue. Those tests didn’t reveal any problems, so I carried on with life as we all do. By this point in time, my bite is totally off again. I can no longer slide my teeth in place when I need to smile for a photo. I started thinking more about what the dental Hygienists were telling my about grinding my teeth. It has always been frustrating to me that my teeth and bite are always a problem. I started asking more questions at the Dentist. My Hygienist highly recommended an Orthodontist who is actively involved in dental education. I called to get an appointment and there was a year long waitlist. I had them add me to his waitlist. In the meantime, I am ready to learn more about this chronic problem (cross bite and crooked teeth) I have attempted to fix in the past.
I have heard the term “TMJ” used in the past. The acronym “TMJ” has always been a vague term I have heard thrown around. What exactly does that mean? Other than the acronym for the Jaw Joint, Temporomandibular Joint. Do I have this “TMJ” condition? Is that what is causing some problems? Why do I have a persistent cross bite and teeth crowding. How does the bruxism, or teeth grinding fit into this picture? I have occasional popping and crunching sounds in my jaw joints. But this is not new. I have had it on and off my whole life and it has not caused significant pain. I am starting to lose my patience waiting for an opening at the recommended Orthodontist. I continued talking to the Dentist about my tooth crowding and cross bite. He started to engage with me about using invisalign and shaving my front lower teeth to fix the crowding. In my mind I wondered, what about the crossbite? If my Dentist can do this with invisalign and I had a torture device in my mouth years ago? Nothing about this makes sense. He never made much attempt to really discuss this with me other than to have me sit down with his financial person to discuss cost. I did not pursue this option at all. I thought, No, there has to be other thoughts and ideas out there.
I sought out another opinion from a different Orthodontist. During his exam and evaluation, he palpated my joints and immediately told me he could not help me. He would not take on my case because my jaw joints were too damaged. This was the beginning of my realization that I have a more significant problem. I felt a bit of despair that a provider had turned me away.
At this point I am still on the waitlist for the Orthodontist my Hygeniest recommended. I have made multiple calls and still unable to get an appointment. I decided to reach out to a “TMJ” clinic in town. At least perhaps they can make me a night guard for the bruxism and I can learn more about “TMJ”.
I spent about 8 months with this local “TMJ” office getting my guard made. This office also wanted me to do a sleep study. They questioned me about snoring. I didn’t know if I snore, more accurately, I didn’t want to admit that I snore. This is actually an embarrassing topic. Snoring is such a loud and embarrassing sound. They encouraged me to use an app to listen to my snoring at night. I admit, I didn’t want to use an app to listen to my snoring. They also encouraged me to pursue a sleep study. This is where my denial kicked in. Sleep study? That’s for sleep apnea.
My mind screamed ~ I don’t have sleep apnea.
I didn’t think I had any of the symptoms of sleep apnea and I am not over weight. Isn’t that an obesity problem? Despite my education as a Nurse, I didn’t know much about sleep apnea. Remember , I am HUMAN and DENIAL is strong. I work out 4 times a week and I consider myself fit. I am not a super athlete, but I am able to keep up with strenuous workouts at the gym. I procrastinated with the sleep study. Finally I did ask my PCP, she asked me if I snore, I admitted, YES, my husband says I snore. So she gave me a referral. I made the call and was scheduled with a home sleep study. I thought to myself, Ok, I can do an at home sleep study.
In the meantime, I did have a CT scan done by this “TMJ” clinic. They reviewed it with me and emphasized a few health insights that were not necessarily relevant to my joints or teeth. We did NOT talk at all about the condition of my jaw joints. Although there was mention on the CT scan report of jaw arthritis. Arthritis? Who doesn’t start developing arthritis in their 50s? We all have some joint arthritis . I pushed that info down the same DENIAL hole. They provided me with a device that would possibly help with snoring and act as a night guard to help with bruxism. The process of obtaining this device was lengthy. I had to go in several times to have it adjusted to the providers liking, about 4 weeks apart. Once it was adjusted too much and they had to remake it. This was not a device made in office. I had to wait for it to return from a lab. Additionally many of my appointments were changed, cancelled and the process was long. I later learned that this practice was sold and a new provider was taking over. I finally met the new provider and she continued to make adjustments to my device to her liking. Then she wanted me to start wearing it most of the day to give my joints a “break”. I did this for a little while but I didn’t notice any difference. She never recommended an MRI for my joints. She mostly gauged my treatment on how I felt. Remember I have never felt horrible and I have a history of pushing through life’s challenges.
I finally did the home sleep study, October 2022. It was pretty easy, a chest band with small device on my chest, a finger probe and a cannula similar to an oxygen cannula. Pretty simple. There I did it, Is everyone happy now?Afterwards, No one from the sleep study office called me to tell me about the results or to schedule a follow up. So I read the report on my own and my uneducated mind shrugged off the results and continued to DENY this aspect of my health problems. I wore the guard at night, and sometimes during the day. The guard did provide me with some reassurance at night. I felt like I slept better. Well at least maybe I wasn’t grinding my teeth? I did chew on that thing… It was kinda comforting. Weird I know.
Stay tuned for a separate story on sleep apnea.
It is very relevant.
In the meantime, I have been calling the recommended Orthodontist office for a consultation. This guard is ok, but I want my crowded teeth fixed once and for all. Finally I was able to obtain an appointment with the recommended Orthodontist in January of 2023. A new year and he is accepting new patients again. To be continued.
The thought of finding wellness keeps me strong.
Keep Peace Love and Wellness in your heart.
