What the dentist really meant…

1/30/2013 06:15:00 pm

Over the past couple of years, in some many senses, I have been travelling pretty well. I have to be honest with myself that things are not too bad: I have a stable, happy relationship; I have my two bunnies, though they hate me and I cannot help but love them; I have a job. Everything is right on paper, and yet some other things have happened that have just been absolute shit. 

I took a hiatus from writing because I got to the point where I no longer felt I had anything interesting to say. And, even though this has always been a mindless vanity project, I felt that no one was listening anyway and what focus I had was gone, lost in the wallowing of the whale of doom that has occasionally threatened to overcome me. 

Now I have a few more things to say and I hope that one day, someone who has been swallowed by the whale of doom because of the same problems, might stumble over here and realise that they aren’t the only overly-medicated, overweight person around the traps with a clicky jaw, PR bleeding (we’ll get to that later) and some bad orange highlights. 

Part One
Some background
My mother started to notice my clicky jaw after I had my braces removed and my wisdom teeth out. She thought I was doing it deliberately, and she found it quite irritating. I might just point out that if she thought it was loud, you can imagine what it sounded like in my head... In fact, by about 2 years ago, it had worsened to the point that I could be heard chewing from across a room, and was making my face hurt. Some foods, in particular steak and gummy bears, were worse triggers, but really, what is a life without gummies?

At some point I’d asked some doctor what was making my jaw click, and he said only, “TMJ”. TMJ. Oh, those three letters.* So two years ago, I decided to go and see a dentist about this clicking.

Some more background- The temporomandibular joint
The TM joint is special because, among other reasons, it is a synovial joint divided into two distinct parts by a hard cartilage articular disc. For the joint to function properly, the disc has to be in the right place so that the condyle of the mandible can rotate freely as you open your mouth. It’s called anterior translation, because unlike a hinge on say, a clam shell, which is just open-close-up-down, the bottom jaw sort of slides forward as the mouth opens. The important thing is that the disc is in the right place

My TMJs are circled in purple, and the condyle is the round bit on the lower part. It sides inside the fossa, just behind the articular eminance. 

Two years ago: What the dentist said.
I went to this dentist because a radiology person that I knew through work told me that he was the TMJ guru. A guru. The guy to go to.

First he performed a thorough examination of my TMJ by getting me to stand with my arms out to the side then pushing down on them with his fingertips. A test of my arms. Or more specifically, my pelvis. Apparently, by pushing down on my arms he could tell, through his dental knowledge, that my pelvis was out of alignment and that’s why my jaw was clicking (I believe that this is called “applied kinesiology”, as opposed to the quackery that is just “plain kinesiology”).  

 Also, I was probably grinding my teeth, which was stressing my lateral pterygoid and masseter muscles, which was making my jaw click. He didn't tell me the names of the muscles, because I probably wouldn't understand anyway, but luckily I can use the internet and have institutional access to Medline. 

I was grinding my teeth because I had sleep disordered breathing, and needed to have a sleep study to make sure I didn’t have sleep apnoea. He was pretty sure that I did have sleep disordered breathing because he noticed that I was breathing through my mouth. So, in a nutshell, it wasn't really about my jaw at all.

What the dentist did.
Told me I needed a special splint to sleep with at night to bring my lower jaw forward and prevent me from grinding and stop me from having sleep disordered breathing.  Also, told me I needed to have a sleep study to confirm that I had sleeo disordered breathing, and see an ENT surgeon so that I could breathe through my nose and stop clenching my jaw.  

What the dentist really meant.
"Nothing I can do here is going to fix things, so I’m going to get you to spend some money on a couple of generic interventions which may or may not be related to your clicky jaw, and send you on your way."

The total cost of this interaction: $875 

I also found out that I have mild sleep apnoea, which can be remedied by an advancement splint, which luckily, the company that does the testing, manufactures. My sleep study report didn’t say that mild sleep apnoea can be resolved, in many cases, by losing a few kg, but luckily I am in denial about that anyway.

* Now, some years down the track, it is clear to me that of course I have TMJ, in fact, I have two, because I have a head, and inside it are two temporomandibular joints, and he probably should have instead said, you have TMD…for disorder. Am I nitpicking?

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