Orthopaedic orthodontics - part I

As chiropractics proved to be unsuccessful to reduce my TMJ pain, I followed my second chiropractor's advice, and phoned the dental practice of Mr. P. B. to book a consultation. The receptionist was very kind, and promptly arranged an appointment for the following week. She explained all the procedures done on the first consultation, and just before hanging up the phone she added "By the way, the first consultation will be £240; is that ok?"

Ana - I'm sorry, can you please repeat that?

Receptionist - The first consultation will be two hundred and forty pounds.

Ana - WHAT?

Receptionist, now on a really dry tone - Two hundred and forty.

*awkward silence*

Ana, swallowing the shock - Oh-kay... That was a bit unexpected... Alright then. Err... See you next week.

During February and the first weeks of March, Davide and I had spent almost five hundred pounds (£500) in all my chiropractic treatments and appointments. Taking into account that since Davide submitted his PhD thesis (December 2011) our only monthly income was my scholarship, it was through great effort that that money was spent. Now, for a single appointment I was being asked the whopping sum of two hundred and forty pounds. "Oh boy... You better fix me!"

Mr. P. B.'s dental practice is an hour away from Cardiff by train. I was really nervous and anxious, tormented by my thoughts, my pain, my questions, my frustrations, my doubts. "Will he help me, when everything else has failed? Is there a way for him to help me? Will I regain control of my life? Will I get my life back?"

We were kindly greeted by the receptionist and were asked to wait a few moments. Mr. P. B.'s assistant came and led us upstairs to the consultation room. Mr. P. B. was at his desk, analysing the documentation I filled previously, reporting all my symptoms and complaints. I was surprised by his aged looks - his website photos are really outdated, showing a much younger Mr. P. B.. I took this as a sign of his experience, as a sign of hope. I sat in front of him and summarised everything the best I could, with Davide interrupting me from time to time to add something (he does it all the time, which annoys me a bit...). Together we tried to explain my next surgery, to be performed by Mr. C.. We couldn't remember the name of the procedure, but we mentioned it would involve some kind of small bone removal in order to create more space inside the right TMJ, so that the disc would return to its original place. His answer was simple: "I don't think this type of surgery is the most appropriate for your case".

My whole world trembled. I felt my head spinning around, and I hold myself fiercely to the chair not to faint and fall. Nervously shivering I asked "what do you mean, it is not the most appropriate?". I can't recall his answer properly, as I was completely overwhelmed. However, Davide and I are sure he didn't say what would be the appropriate surgery for my case, or mentioned any other appropriate solution.

I was asked to lay on the dental chair to be examined. After this, Mr. P. B. said he would try to do a mould of my upper teeth for a splint made of a hard material. "Oh no... Not another one!", I thought. But then he explained: soft splints are the worse things to be given to someone with bruxism since they promote teeth grinding. It is like having a chewing gum inside the mouth for the whole night. Finally I understood why the soft splint therapy I had done previously only made me feel worse! And I was given two soft splints by different practitioners...

Because of my limited mouth opening, it was impossible to get a proper mould of my teeth. So Mr. P. B. decided to mould the splint directly to my upper teeth with a paste that solidifies under special light. The following thirty minutes were excruciating, between mouth opening and closing, forcing the paste and tools inside my mouth, pressuring my lower jaw against my upper teeth... even with my right cheek muscles numbed by a cold anaesthetic spray. When I couldn't hold the tears any longer, Mr. P. B. decided it was best to stop. The hard splint looked terrible and only covered the front two thirds of my upper teeth, but it was the best he could do with my limited mouth opening (it was impossible to get the paste deeper inside my mouth).

Back to his desk, Mr. P. B. said he would give me some drugs to take along with my normal medication. "More drugs?!" The hard splint should be worn every night, but he advised to wear it also during the day, whenever I could. I would do this treatment for a week and then come back for another appointment, hopefully reporting some improvements. We payed the £240, arranged the following week's appointment, got the new medication and splint, and left the dental practice.

We spent the rest of the day wondering around in deep thought, wishing all this was just a bad dream. The whole situation was too surreal to be true. More then ever, I was terrified. "Is the next surgery really inappropriate for my case? Should we trust Mr. C., the one who performed the surgery that ruined my life?" One thing was sure - instead of answers, we got more doubts after this consultation.

We only checked the new medication on the train journey on our way home. It was all based on drugs that act as muscle relaxants, something I wanted to try for some time as it proved to be helpful for some people affected by TMJ pain. I was given three different drugs, to take one hour before going to bed: 2mg diazepam (central nervous system depressant), 10mg amitriptyline (tricyclic antidepressant), and 8mg chlorphenamine maleate (antihistaminic). Contrary to what happened on my first ever TMJ-related appointment in 2005, I was not surprised by the diazepam. Actually, with all the research Davide and I have done regarding TMJ disorders, I soon realised that I was wrong regarding my first surgeon - by prescribing the diazepam, he was really trying to help me.

And so I did as I was told by Mr. P. B.: I took the new drugs one hour before going to bed and I wore the hard splint while sleeping and whenever I could. However, after the first few nights I felt something was wrong with the medication. I couldn't sleep at all, and if I did manage to fall asleep, it would be a very troubled sleep. The worse was getting into that stage just before falling completely asleep, when one still has some perception of what is happening around us - I would hear noises, steps around the house, someone knocking at the door, and even voices, although I could never understand what were they saying. I knew these couldn't be real, but I swear I could hear them. I would get terrified and try to wake up Davide to be sure those noises were only in my head.

The turning point was when I first understood what the "voices" were saying. I heard a clear whisper commanding "self-destruction". That was it - I had enough! I felt I was going crazy. This had to be related with my new medication! And most probably with the amitriptyline, according to the side effects stated on the leaflet. It says clearly "thoughts of suicide and worsening of your depression or anxiety disorder", "thoughts of harming or killing yourself may be increased when first starting antidepressants", "delusions, seeing things that are not there". There was no other explanation. I was having some pretty bad "trips" under this drug. So no more amitriptyline. And I never heard strange noises ever again...

The diazepam however appeared to be helping me, as I felt the muscles surrounding the right TMJ a bit more relaxed. As for the hard splint, I didn't notice any change: I can't say if it improved anything regarding my bruxism (as I am asleep when I grind my teeth), and the pain remained the same.

The whole week was a nightmare, between horrendous medication side effects, my constant severe pain, new doubts regarding my next surgery, and the overall anxiety. Could it get any worse? Yes, it could...