How things can go wrong

I was once again nervously awaiting for Mr. C.. He entered the consultation room smiling, and very kindly asked how I was feeling. "Not so good, I'm afraid..."

I explained all the new symptoms I had during the past month, since the right TMJ arthrocentesis. Limited mouth opening (max. 23mm/0.9inch), inability to chew anything solid, more pronounced lower jaw shift to the right side, and the pain. Severe pain. "Please, help me cope with the pain..."

He thought for a few moments before speaking. I took a deep breath and prepared myself for it.

One of two things had happened with the arthrocentesis: either I was taking a little more time than usual to recover from the procedure, or things had gone wrong. In the light of my symptoms, he was inclined to believe it was the second case.

TMJ arthrocentesis results

TMJ arthrocentesis

I opened my eyes. It took some time until I realised where I was and what just happened. A nurse stood on the left side of my bed, checking my blood pressure in intervals of few minutes. "How are you feeling?", she asked. "Thirsty..."

My first word after waking up from the arthrocentesis came out strange. Not the voice, but the mouth movement. It felt odd as if my lower teeth wouldn't fit into the upper, being the whole jaw misaligned. I tried to open and close my mouth slightly a few times to check how was the right TMJ. Spongy. That's the best word to describe it - spongy. There was something spongy inside my right TMJ, some extra volume that somehow felt like a thick cushion preventing the right side of my lower jaw to close completely.

"How is the pain?"

"It hurts..."

"Can you tell me from one to five how bad is the pain?"

"Errr... Don't know... Four?...", I asked myself out loud. I was still confused from the anaesthesia, although I was awake enough to start feeling the pain kicking in. I saw the nurse injecting a fluid through the needle I had in my left hand.

Sometime passed, although I can't precise how long it was.

"How's the pain now from one to five?"

"Still hurts... A four, I think..."

"Can you take codeine? Are you allergic to it?"

"I don't know... Never had it..." I never even heard that name before. What was codeine for?

Well, codeine and I would become "best friends" later.

I was waking up after a TMJ arthrocentesis performed whilst under general anaesthesia. But what kind of procedure is this? What have they done to me exactly?

TMJ in the UK

I graduated in geology in 2006, and soon after I moved away from home to work. For six months I lived in a beautiful village located in the Azores islands, right in the middle of the Atlantic. During this time, Davide and I became good friends. Once our contract was over, we both found jobs in the oil industry, working offshore in rotations of two weeks on/two weeks off. However, a few months later Davide got a scholarship to do a PhD in Cardiff, Wales (UK). From then on, my time-offs where spent there.

In January 2009, I left my family, friends and sunny Portugal to live with the best guy ever, and to fully enjoy the "great" british weather.

During these years I felt my right TMJ slowly deteriorating. I could tolerate the pain, but the discomfort on the joint was becoming more and more intense. Mouth opening was not smooth as I felt like having  sand grains being crushed inside the joint. From time to time, the lower jaw would get locked open. Although I was able to find a technique to put it back in place after the first few times it happened, it was always a really scary and painful experience. The joint noises were a constant torture. They reminded me of chicken leg bones getting broken.

Regarding the pain around the joint, it was usually more intense in the evenings, with all the normal eating, talking and general mouth movement the TMJ had to go through during the day. However, it wasn't uncommon waking up in the morning already feeling pain, or having quite strong headaches. Knowing I used to grind my teeth during the night (bruxism) ever since I was little, I considered the morning headaches quite normal.

It all started when...

... I was leaving the room in a hurry. I can't recall the time or the day; I don't know exactly how I did it. I just remember the pain I felt when the door hit my face.

But I was in a hurry - no time for tears or complains. The pain would ease sooner or later.

But it didn't.

A month went by and the pain on the right side of my face was still there. The right TMJ felt weird, uncomfortable. Even worse was the noise the joint was making every time I opened my mouth. Someone standing next to me could hear it, just like fingers getting cracked.

It was time to get it checked. My mum got me an appointment with a oral-maxillofacial surgery specialist at a private clinic. Going private would be faster, and it wouldn't be so expensive with my health insurance.

The specialist barely looked at me. He gave me the papers for an MRI scan to be done, and prescribed me a medicine. He sent me away telling me to come back with the scan results. I wasn't inside the consultation room for more than 5 minutes. I didn't like the guy at all.

Later that day, my mum and I went to the local pharmacy to get the medicine. The pharmacist found the prescription odd and asked us what was it for. The reply to my mum's explanation was "Your daughter should be given an anti-inflammatory, not diazepam!". DIAZEPAM. We didn't have any clue of what could be the problem, but surely diazepam was not going to fix it! Or so we thought...

We left the pharmacy without the drug, thinking the guy was nuts and promising we would never go back there. At least we had the papers for an MRI scan.

Background info

Temporomandibular joint (TMJ) disorder is one of the few health problems where laughter is definitely not the best medicine...

Smiling hurts. Laughing is even worse - it can be excruciating.

But however painful, the joy of a good laugh is what gets me through the day.

The temporomandibular joints (TMJs) are commonly referred as the jaw joints and are located in front of the ears, where the lower jaw is attached to the skull. They are the most frequently used joints of our body, and their function is responsible for the most elementary needs - eating, chewing, talking, yawning, and general mouth/mandible movement.

 Lateral aspect of the left TMJ 

(source wikipedia.org)

The term temporomandibular disorder (TMD) groups several disarrangements affecting the TMJs, masticatory muscles and associated structures (tendons, ligaments, blood vessels, and other tissues). The symptoms of any of these disorders include pain in the jaw and surrounding muscles (commonly extending to the neck, shoulders and back), limited mouth opening and joint noises.

First things first - the introductions

Hello!

My name is Ana.

I am a petite portuguese girl living in Cardiff (Wales, UK) with my favourite guy, my partner ("compincha") and best friend, Davide. We are geology researchers or - as I prefer - rock scientists!

I am a photography enthusiast, a traveller, food lover and a bit of an artist (at least I like to think so!), enjoying all things crafty and colourful.

I am almost thirty, although I look much younger.

I look healthy, although I live in constant pain.

I look normal*, although I have a temporomanbidular joint (TMJ) disorder.

Most people don't know what it is or have never heard of it. Most people don't understand or can't/won't help.

Welcome to TMJ diaries - the little place on the internet where I share my everyday hopes and struggles.

*very ambiguous term, so lets keep it sensu lato.