(Editors note: I’m very pleased to welcome a new contributor to the site today. Probably much to the relief of our other writers, Michelle Cardinal is the only Bizzy Life contributor I have sexually harassed or purchased lingerie for (it’s OK, we’re married). I do look forward to Michelle’s unique perspective on living bizzy, based on an uber-successful career and life-long appreciation for travel, design, and finding the best things in life. However, today she details how an innocent trip to the dentist led to five years of pain and massive medical bills. TMJ is an affliction that is quite common, and widely misunderstood – even by medical professionals.)
About five years ago following some dental work, I became afflicted with TMJ (Temporomandibular joint disorder). It all started with the replacement of a 25 year-old-filling. My dentist convinced me I should switch to a more eye-pleasing white porcelain filling. Unbeknownst to me, porcelain is less forgiving than metal if not properly shaped, and can result in misplaced bite. That in turn, can throw off alignment of your jaw and surrounding muscle tissue causing TMJ. Weeks after my dental appointment, I discovered I was clenching (Bruxism) and damaging my teeth. But worst of all, my jaw, teeth and gums were in excruciating pain.
My dentist refered me to a “TMJ” specialist and warned me that there are many questionable forms of treatment. “Whatever you do, don’t let them operate on you!” Were his last words, as I scurried out of his office. Online I found horrific stories of people who had their jaw joints and muscles operated on, only to become disfigured with no pain relief. And then there was the story of my sister’s childhood friend who in her 20’s had all her teeth removed and replaced with false teeth, only to remain in pain! Proceed with caution, indeed.
I first meet with Dr. Summer, a very nice man, who appears to have just walked off the set of a 70’s TV show, complete with brown corduroy jacket with patches on the sleeves. Dr. Summer is located in a sparse downtown Portland office. No receptionist. “Ok, that’s fine,” I think. He seems to really know what he is doing, his walls are covered with charts and posters about TMJ and he also gives me several very informative pamphlets on the subject (he also mentioned he was involved in a published study). He recommends making a mouth guard that I will wear at night when I sleep, but best if worn 24/7 (cost for guard is $750).
Simply said, the process of making a mouth guard is extremely unpleasant. Imagine a big wade of blue clay stuffed in your mouth for 15 minutes, while you’re being instructed; “bite down as hard as you can!” The clay then hardens in your mouth, and then your jaw needs to be pried apart with both hands, by the doctor, to remove it. All this, while also suffering from a life-long gag reflex, is borderline torture! All I could think, “Great, I’m going to suffocate to death with blue clay in my mouth, how undignified!”
After two weeks of using the mouth guard, the pain is hasn’t subsided. I go back and plead, “is there anything else you can do?” Dr. Summer appears this day with a black eye and a bruise on his forehead. “A car accident,” I wonder? He then recommends making me some smaller mouth guards made of a rubber substance that I can wear during the day. I try that, but the rubber is annoying, and I find myself clenching even more. I return again, he recommends drilling some areas of my bottom teeth, to readjust my bite. I’m desperate, I reluctantly agree. It did offer some relief, but I’m still obsessed with the look of my bottom teeth, which look imperfect to me now (luckily nobody else seems to notice).
I need a second opinion. I’m referred to Dr. Higdon by my hairdresser. Higdon is also considered a TMJ expert. This doctor has a receptionist, but he’s not very nice and demands I sign a “patients agreement” that among other things instructs I may not use my cell phone in the waiting room. “Does texting apply?” I wonder. Dr. Higdon is also a nice guy, who wants my advice marketing his services (he’s very impressed I run an ad agency). He recommends making a new mouth guard (cost $900). I learned marketing consultation is a very difficult conversation with blue clay in your mouth, good news; my gag reflex is improving.
This mouth guard is different and doesn’t fit as well as my old one. It actually hurts when I wear it. This design uses metal braces on the sides that cut into my gums. I return for 3 more fittings. This includes putting some strange smelling chemical in my mouth, along with a green paint-like-dye that marks the guard so he can adjust it using drills. He pulls and pushes, stretching my jaw (which is a “no no” when you have TMJ), the fittings are painful and I discover green paint in-between my teeth days later. I suspect that Dr. Higdon doesn’t want to recast the ill fitting guard, because it would require being resent to the lab and that costs him extra money (based on his old office furniture, it’s clear he is thrifty).
Dr. Higdon also recommends I wear the mouth guard 24/7 (only removing to eat). “Really,” I reply? “It seems awfully big, and I’m speaking with a lisp and drooling, this won’t be good for my business.” “No,” he said, “your mouth will get used to it, give it a try.” Later that day, mouth guard ensconced, I try to have a serious discussion with a co-worker. It’s completely impossible, I look and sound ridiculous. I ditch wearing the guard during the day. I also eventually ditched the guard at night, because it doesn’t fit correctly, and I couldn’t bear the thought of more smelly chemicals and green dye in my mouth. I go back to Dr. Summer’s original guard at night.
I then meet with two more dentists, first an orthodontist who recommends complete metal braces for 2 years. “I don’t think so, I actually like my teeth alignment,” I think. And let’s not forget the vanity issue (metal braces at 40 are not very attractive!). The second dentist mentions I may need oral surgery (run!).
I also met with a Chinese acupuncturist, nice experience, but no lasting effect (Cost $150).
Then I met with a nice woman doctor, who I saw written up in Portland Monthly magazine. Dr. Motlagh, also a TMJ specialist and cosmetic dentist. Who recommended I start with physical therapy, before she would continue with my treatment. She refers me to a woman therapist Dr. Reed.
I start attending 2X weekly physical therapy sessions, which included a painful in-mouth massage. Whereby the therapist dones latex gloves and proceeds to painfully manipulate the muscles and tendons inside your mouth and jaw line. Literally sticking her fingers into the fleshy tissue between my gums and my cheeks and lips, OUCH!! The treatment is arduous but rewarding afterward. For the first time, I started to see real progress. As my treatment progresses Dr. Reed teaches me to be aware of my clenching, how I place my head on my pillow at night (avoid leaning on one side of jaw too long) and how my spine and back can affect my jaw alignment. She also showed me how to do self massage, as well as several neck and facial exercises (cost for 6 months $7,450).
I then return to Dr. Motlagh who proceeds with her treatment. She explains she has a very high tech approach to the problem, which involves using a computer and electrical impulses to realigning your facial muscles to their original preferred state. “Once we achieve that,” she said; “We will fashion a new mouth guard based on feedback from the computer.” First, she attaches a bunch of wires (think EKG) to my face. She then explains she is going to send electronic jolts into my jaw and cheeks to relax the muscles and electronically track the movements of my joints. The treatment begins. Several hundred jolts of electricity are shot into my face (think shock treatment)! Each time, my face twitches uncontrollably. The computer then tracks the movements using fancy color line graphs on the computer.
This all sounds very respectable to me; I’m a big believer in science, although this treatment is very expensive (cost $4000). Only shortly after I leave the office, my left eye started twitching (think palsy), on its own. Ok, I’m concerned. “Perhaps it will go away,” I think. I call Dr. Motlagh, who claims this has never happened before. I’m very busy at work, and my husband assures me he can’t really notice the occasional twitching. It continues. I decide to power through it. 3 weeks later I go on vacation to Mexico, after a few margaritas the twitching disappears. I then delay returning to get my new mouth guard, which I’ve already paid for, because I really like Dr. Motlagh and don’t want to have to tell her I’m skeptical about her treatment. I eventually return, and she’s not happy I won’t undergo more electrical jolt treatments and warns me my mouth guard may not fit right because she now has to do “manual” adjustments. Needless to say, the new mouth guard doesn’t fit. I’m back to using Dr. Summer’s original mouth guard.
After all that, I’m now currently seeing they physical therapist Dr. Reed every few months for a painful “in-mouth” massage. And I also inquire with traditional massage therapists, about their knowledge of TMJ. Many know how to do a good jaw massage and are familiar with TMJ. My TMJ has indeed improved, although not totally gone, livable. It tends to flare up when I’m under stress, and when it does I still wear my original mouth guard (while sleeping), made by Dr. Summer.
I estimate the total experimental treatment for my TMJ cost over $15,000 (none covered by insurance). It’s important to note that every specialist I saw was genuinely committed to treating TMJ, but I found, the proven magic bullet, is just not yet available. In my case the TMJ symptoms eventually did diminish. My guess is, if you’re suffering from TMJ, your jaw and facial muscles need to be retrained, from whatever trauma caused it. This is most efficiently done with properly fitting mouth guard and physical therapy. There are less costly over the counter mouth guards, but beware, anything that doesn’t fit properly could do more damage than good. And as in my case, make sure your fillings are fitting properly before you leave the dental office, to avoid this whole mess in the first place!
(Important to note; there are many causes of TMJ, dental work being one, many theorize it is also stress induced. Also symptoms vary from mouth pain, jaw clicking, limited jaw movement and migraines etc…)
Dr. Kelly Reed (Portland, OR) – Cedar Hills Physical Therapy – (503) 292-3583
Dr. Summer (Portland, OR) – (503) 241-7353
Brenda Wilson (Eugene, OR Massage Therapist) – firstname.lastname@example.org
Joachim (Santa Ynez, CA Massage Therapist) – Terra Massage – (805) 688-9111
John (Santa Barbara, CA Massage Therapist) – Float Spa – (805) 845-7777