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.

A few months after moving to Cardiff, I arranged an appointment with a dentist so I could be referred to a TMJ specialist. The dentist was familiarised with TMJ problems, and she focused her attention on my bruxism. She suggested a splint therapy for a few months. If no improvement was shown regarding the pain, she would send me to a specialist. I agreed on giving it a try. She produced a mould of my lower teeth, where the splint would be attached during nighttime to prevent the grinding. A week later I had a brand new splint made of a soft material (image below).

 My first soft splint (right) and its mould (left) 

The morning after sleeping with the splint for the first time was more painful than usual. So was the second, and the third, and all other mornings after. The pain would remain throughout the day. Sleeping with the splint was not helping me; it actually made things worse. After the first week I wanted to quit wearing it. But perhaps it would be normal to have increased pain during the first weeks of the therapy, I thought. So I did my best to continue sleeping with it, although I usually would remove it in the middle of the night because of the pain and discomfort.

A month later I had an appointment with my dentist to discuss the first results of the splint therapy. We agreed on giving it a bit more time to see if I would have any improvements. Three months later I would come back with the same complains - sleeping with the splint was giving me more pain and discomfort. For sure it was making me brux much more intensively, as it was like having a chewing gum in my mouth during the night. I felt much better without it. It was time to refer me to a oral-maxillofacial surgery consultation.

With no health insurance, my hopes were on the welsh public health system. I had to wait around six months for the local dental hospital to schedule me an oral-maxillofacial surgery appointment. The consultation would be two months later. Eight months passed between the referral and the consultation. And since my first dentist appointment, a whole year.

I was appointed as a patient of Mr. C., the leading surgeon of the oral-maxillofacial surgery at Cardiff's dental hospital. However, on my first consultation I was seen by a member of his team. I made my complains: the pain around the right TMJ, the discomfort, the joint noises, the jaw getting locked. I explained him everything that happened since my first TMJ disorder symptoms: the door accident, my first MRI scan results, the diagnose given by my surgeon in 2005 (emphasising the rupture of the ligaments of the disc), my bruxism and the splint therapy.

I have the feeling he only made note of the last two things - my bruxism and the splint therapy. Everything else seemed to be ignored. For him, the cause of all my TMJ issues was the bruxism. According to what he said, the pain was consequence of my overactive muscles being always under tension. That obviously made sense, but there were other factors that should've been taken into account. My bruxism is only a part of my TMJ disorder, not the only cause for it as he was implying!

The treatment he prescribed was based on muscle relaxation and bruxism prevention. He showed me a few exercises that I should do everyday to relax my masticatory muscles, involving opening my mouth as wide as I could. But the main part of the treatment was splint therapy... Was he really listening when I said it didn't work for me the first time?...

So, I was sent home with a brand new soft splint to wear for the next three months. Take a good look at the image below. No, it's not another photo of the splint I was given the first time by my dentist (pictured above).

 My second soft splint (right) and its mould (left) 

This is the second splint, and was in fact much more uncomfortable than the first. I tried it only for a few days and then I quit it. From time to time I would sleep with my first splint, just to keep my conscience clear that at least I was trying. But every time I wore it, the pain would increase the following day. The exercises were no good for me either. I felt that opening my mouth as wide as I could would increase the risk of getting my jaw locked open more often.

Three months later, I had my second consultation at the dental hospital with a junior member of Mr. C.'s team. I told him the splint therapy was not working for me; the splint was making things worse. He checked both TMJs during mouth opening and closing several times. He noticed the considerable unbalance of my lower jaw as it drops to open the mouth. The lower jaw was significantly deviated to the right side. He decided it was best to be seen by the leading surgeon, Mr. C..

Mr. C. was very nice. Just like my surgeon in Portugal years before, he explained me how the TMJ works and the basics of TMJ disorders. He requested a MRI scan, so he could confirm or rule out the diagnose of anterior disc displacement with reduction. He also added that the waiting list for the MRI scan could be long. And so I waited.

Meanwhile, I decided it was time for me to leave the company I was working for. I wished to progress in my career as a geologist, and to have a normal routine in my life - something I didn't have for the past three years of working offshore. I applied for a scholarship, and in October 2010 I started my PhD research at Cardiff University. It was the best decision I ever took! What a bliss it is to be working on something we actually enjoy doing it! I fell in love with my PhD project and dedicated myself almost entirely to it. I was fully enjoying my life with my favourite guy, Davide. There was only one "little" thing bothering me - my TMJ disorder.

I waited four months to get the MRI scan, in November 2010. I was told that once the report was complete, another consultation with Mr. C. would be scheduled. And so I waited four months more for that appointment. Eight months after the MRI scan was requested, I was finally going to know the results. I was received by the first member of Mr. C.'s team that saw me and prescribed the splint therapy. As he read the MRI scan report to himself, I could see his eyes getting wider and wider, and his expression heavier and heavier. "Wait a moment, please. I think it is best for Mr. C. to see this", he said.

I was scared. Really scared. During those waiting moments I felt sick, my heart racing madly inside my chest. I could hear the blood being pumped into my head, and feel the muscles around the TMJ contracting for a spasm.

Mr. C. came and read the report to himself. He raised his eyebrows, and his expression got heavier and heavier. He checked my file and seing that no X-rays were done before, he requested one urgently. To be done straight away. And he didn't say more.

I left the consultation room feeling I was about to throw up. Davide was waiting for me outside and together we went to do the X-ray. Around thirty minutes later I was back in the consultation room with Mr. C. looking at my panoramic X-ray. And then he spoke. The MRI scan confirmed that the disc was anteriorly displaced with reduction. But the condyle seemed to be in bad shape. Instead of a smooth rounded condylar head, the bone was flattened as a result of significant wear and damage. This was a big change since my first MRI scan back in 2005. "So what can be done?" I asked, afraid of the answer.

Sooner or later I would need a surgery to correct bone structure. However, "to buy some more time before a bigger surgery" Mr. C. suggested a right TMJ arthrocentesis, a minor surgical procedure intended to alleviate my symptoms by flushing, washing and lubricating the joint with fluid injected through needles inserted in the joint capsule. I agreed straight away without thinking much about it. "If this can alleviate my symptoms and get me more time before a more complex surgery, lets do it."

Mr. C. added me to his waiting list, assuring that I would have to wait only a few months for this procedure. On the last week of July 2011, I received a phone call from the oral-maxillofacial surgery to have the arthrocentesis done the following week. I was thrilled - finally something was being done to help me!

The arthrocentesis would be done under general anaesthesia, so I had some medical exams to do during that week. Everything went well with these, except a "minor" incident during blood collection - the nurse  slit my vein with the needle. At the time, she "didn't notice" and neither did I, despite finding it odd that it had been so painful. Only when I was arriving home, almost unable to move my arm with the pain, we noticed the plaster was completely soaked in blood. We removed the plaster and saw a deep cut. Although it wasn't very long, it was a slit vein so it was bleeding considerably. Several soaked plasters later, we had to go back to the hospital to get it properly checked and closed.

On August 4th 2011 at around 08:30am, I was already at the hospital. I would be the first on Mr. C.'s list of surgeries that day. I had a short interview with a nurse, signed a few papers, kissed Davide in a hurry, and enjoyed the ride to the general anaesthesia room.

I was happily put to sleep, wishing this procedure would change my life.

And it did. But little did I know that it wasn't for better...