TMJD is literally a pain in the neck.

I have to say living with a skeletal/jaw defect isn't fun. Everyday is a winding road as Sheryl Crow would say. No really. Each morning I wake up with the fun surprise of sore teeth, neck soreness, headache,  eye pain, dizziness, or feeling as though I took Mayweather on in the boxing ring. I have to say I feel a lot less lucky than Pacquiao. In a way, i've looked forward to this surgery with fear and anticipation. I'm afraid of the actual (yucky) surgery part and i'm happy for the outcome. I read someone's surgery diary that explained the moment the braces came off (post surgery) they took a bite of a sandwich for the first time, and in this moment he knew this was all worth it. I can't imagine what that must feel like. Biting food with normal and symmetrical teeth. I also look forward to this one pivotal moment. I know I still have a long road to hoe. Especially since I have to continue orthodontic treatment for 3-6 months after my surgery.

Neck Pain

 In the past month I got to see a really cool picture of my neck via X-ray. The first thing I noticed was of course how weird it is to see my skull with braces. The next thing I noticed was how straight my neck was. Normally there is a small inward curvature in the neck. This is called lordosis. Since, i've started having neck problems I have lost that curve in my neck. This too can be common ( annoying but, common). I'll post a pic of how this might look compared to a normal cervical spine.

Image borrowed from: http://www.utahhealthquest.com/text-neck

I borrowed this image (first image above) from a website to show the difference between the current state of my c-spine and a normal cervical spine. I have thought about seeing a chiropractor in addition to my PT. If I do elect to visit a chiro i'll definitely share my experiences here. I also added a few pics of my Kinesiology tape form my PT. The physio really doesn't go light on the taping. Kinesiology is the scientific study of human movements. The tape is used to alleviate pain, balance muscle movements, and reduce inflammation (these are just a few of the benefits). The lower picture also helps to show my trapezius imbalance. It's still strange to think that all of these issues began with a skeletal imbalance.

Surgical Fears 

I'll just dive right in. I am quite afraid of how I will look post surgery. Although, the surgeon says the possible side effects are to become better looking (hehe), I know my face will change dramatically.  The surgeon said I will have a much fuller upper lip and basically my nose will be repositioned (rhinoplasty).  He also said to hide all of the mirrors for a few months. I have noticed subtle changes in my face since I began orthodontic treatment. I can see that my jaw has shifted. My face became extremely narrow at some point and now I noticed that my jaw is slowly widening. It's very subtle but, looking at my own face daily I can notice these changes. I suppose what I feel is normal and just like anything else they will be dispelled with education, patience, and time. In the next blog, I will cover some pre-surgical preparatory ideas!

Check out the images below of my orthodontic treatment updates!

As always- thank you for reading!

Fairly recent picture of my teeth. My midline is still off but, that will be treated after my surgery. 

Image of my bite a few months ago. 

Watching my teeth transform. These are pictures taken over the course of one year. My crossbite is very obvious in all of the pictures. 

Why Physical Therapy?

I've had a lot of people ask me about physical therapy. Why do you go there? What do they do? I know sometimes it's hard to understand that something like teeth alignment can cause severe issues throughout your whole body. It's important to understand anatomy and physiology. However, to simply explain, if you have a skeletal imbalance in addition to trauma ( teeth grinding) after a period of time your muscles fatigue and your body begins to accommodate. My body is off balance and that leads to a lot of other issues. My doctor has informed me that I have some vascular problems due to the inflammation in my neck and upper back. So, with this I get really dizzy. I am now now allowed to perform any heavy duty sports, running, or repetitive activities.  This condition has severely compromised my day-to-day life.  I have many limitations on things I can do. For example, I can't carry heavy bags or backpacks (anything that puts my body off balance), I can't go running ( the one thing I fell in love with), I can't lift heavy weights or use heavy gym equipment, absolutely no contact sports, and so on. I have a pretty terrible ROM (range of motion) with my neck.  It's also pretty terrible that I'm in my early 30's and can't walk more than 5 miles in a day or I feel extremely dizzy or severe neck pain. Sometimes, it's hard for me to even be comfortable siting down.  An easy way to think about this is to imagine that your own head weighs double and that you have to constantly support the extra weight. Due to this, I have a lot of headaches (tension/migraine), nerve problems, and jaw pain. Although, medically this isn't considered a chronic illness, I believe it ranks very close to this. The pain I deal with is not excruciating but, annoying and limiting in my normal daily life. Although, the doctor did explain that this is a chronic inflammatory situation. Not only does this cause physical pain and suffering, also emotional pain. It can be very depressing to have such physical limitations at an early age. I know mostly all of this is reversible, and i've been promised a basic "clean slate" after surgery and PT. It's still hard imaging going back to normal day to day life. However, I am optimistic.

How To Cope With The Pain: 

To help with physical discomfort  I do the following: attend physical therapy weekly, avoid heavy physical activity, attempt to remain on a soft food diet, pay attention to my posture, purchased a special temper cervical support pillow, self massage,  home PT exercises, wear a soft cervical collar,  hot and cold compresses, pain killers (minimally). *If you're reading this and have additional suggestions please feel free to comment in the section below**


My physical therapist has specialized in TMJD. She usually concentrates on helping to strengthen my muscles and ROM. She helps release muscle tension and provides me with exercises and advice to help deal with the pain until I have have surgery. It's quite strange to have another person massaging in inside of your mouth. It's actually very helpful though. She has offered acupuncture to many on various occasions. I have a deep hatred of needles, so at this point I haven't agreed to anything. I will continue to see her after my surgery and fingers crossed my situation will improve dramatically.

My PT tried Kinesiology with me! I highly recommend it! 

Image borrowed from (http://www.necksolutions.com/tmj-pain.html)

The best purchase I have made has been the temper cervical support pillow. It has taken some time to adjust (few weeks) but, I am actually sleeping a lot better than before. Bruxism can also be considered a parasomnia. A parasomnia is generally abnormal movements, perceptions or behaviors that occur between sleep stages. Basically, I never get into REM sleep.

I chose the Millenium model.

Bruxism interrupts my normal sleep patterns and I wake up feeling like I never slept most mornings. At one point I was abruptly woken up with flashing lights in my eyes or strange shoulder movement.  My doctor said it was due to my neck and upper back muscles being constantly flexed through the night. I usually wake up between 4-6 times per night. Sometimes from just being a light sleeper and others from the sound of grinding my teeth (or the movement).  Fortunately, this is improving with the use of my support pillow.  If anyone else experiences these problems I highly recommend getting a support pillow.

There is so little research done about TMJD and other Orofacial pain syndromes that it is difficult to even get doctors on board with the diagnosis. Sometimes  patient needs to be seen by specialized dentist, maxillofacial surgeons, and even neurologist. A diagnosis can be very complicated because so many different parts of the body are involved and grave medical misunderstandings.

In my free time, I spend a lot of time researching these conditions. I hope I can reach others with the same issues and help spread awareness. This is one of those times where you really don't know what others are going through. Just because someone doesn't look sick, doesn't mean they aren't dealing with all sorts of ailments.

Thanks for taking the time to read my story! 

Temporomandibular Joint Disorder (TMJ, TMD, TMJD)

I'm sure at some point in your life you have consciously or unconsciously began to grind your teeth. Some people do it for years and don't notice. Others aren't so lucky. In the past two years i've experienced a lot of negative side effects of bruxism. At some level, I think I have always been a night grinder. For years I woke up with headaches and jaw stiffness. I never really thought anything of it. After I got braces, I began to notice a huge change. My head hurt terribly every single morning, my teeth were sore and hurt, I began to have blurry vision, and random shooting pains in my scalp. I was so alarmed I had no idea what was happening. At first, I convinced myself that I was dying ( like any normal person with these experiences). Panic ensued. This in turn resulted in a lot of stress, which led to more teeth grinding. For months I didn't understand what was happening. The new braces I had put on were causing so much trouble and discomfort. Within one month I had lost 10 pounds (5 kilos) because I was unable to chew my food properly. I noticed that I got very dizzy suddenly, and my neck had started to hurt horribly. I brushed this off to issues from my lower back. Just a few months prior I had been diagnosed with a herniated lumbar disc. I began running a year prior and apparently this was the result. Today, my lower back is basically healed. As my cervical/thoracic spinal symptoms increase, I wonder more and more about how my uneven skull could have played a role in this situation.

Having random shooting pains in your head and eyes can be really scary. I found myself panicked and visiting the local Emergency room many times looking for answers.  I had all kinds of fun diagnoses. A neurologist said I had a migraine disorder (wrong). Another Dr. believed I had anxiety issues (wrong).  Then there was the herniated disc factor followed by the idea that I had rheumatoid arthritis (which was also incorrect). I got brushed off by my local health care center many times. The health care centers in Finland (where I currently reside) are organized very differently than in the United States. Which can be favorable but, if you have an odd, non-text book condition- can be very difficult.  All along the answers were laying in my malocclusion and bruxism. After talking about my symptoms with my orthodontist, doctor, and surgeon- they came to the conclusion that I had TMJD. I was told to eat only soft foods, avoid chewing hard or large meals (which is hard- hey I love cheeseburgers), and no gum. I was also advised not to talk a lot (which if you actually know me, is VERY HARD). My orthodontist sent me to a nutritionist. She was concerned about my sudden weight loss. I also began physical therapy for my jaw and neck. I'll talk about that in a different post. 

My journey with TMJD has been crazy. About 6 months ago I was having terrible ear pain. At first I thought it was just the changing and windy Finnish weather. One day I went to put in my headphones and I noticed that one side wouldn't fit and was super painful. Two days following this I began having the absolute worst pain in my jaw. It felt as though someone has sent a huge volt of lightning through my face. Half of my face was numb ( like a huge slab of meat just sitting there) and the rest of my face was constantly tingling. I went on with this for a few days. I also forgot to mention that a week before this happened I had the surgical molar bands installed onto three teeth. My jaw was quite angry about this new addition and I guess my bruxism got out of hand. 

The following week I elected to visit a private doctor (ENT specialist). He believed I had irritated one of my facial nerves and that the area was inflamed. I was put on medicine (NSAID) for two weeks and this cleared up the issues. This process has been long and arduous, and I still have one more molar band to go on June 1st. 

In the midst of this my orthodontist has tried to control my bruxism in a few ways. She hoped the PT would help. She initially got me a very large mouth guard that didn't work. It was so big and since my bite is not aligned ended up on my pillow at some point during the night. About two months ago, she ordered a new type of guard. Which I'm happy to report is working. The orthodontist ended up fitting it for my teeth ( which is still somewhat ill-fitted because of my every changing teeth and bite) but working. I would otherwise have a fitted guard ( and I will after my surgery). Unfortunately, since my teeth are still moving there is no way to fit a guard to my teeth. 

Two weeks ago I actually ended up breaking a molar tooth because of my bruxism. I took out my night guard for a few minutes and accidentally fell back asleep. This resulted in a fracture. It's crazy to think about how many things can go wrong just based on jaw alignment.

My first unsuccessful night guard 

My latest mouth guard ( you can find it here: http://www.aqualizer.com/html/faq.html) 

Once again, thanks for reading! 

Le Fort 1 Surgery

To correct my jaw misalignment I am undergoing a Le Fort 1 Osteotomy. A Lefort I Osteotomy is a common procedure used to correct mid face deformities. In my case, the maxilla will be down fractured so that it can be mobilized and repositioned. This will result in a more favorable occlusion. My surgeon warned me that this could also result in a more symmetrical face. Which translates into a better looking face. :) On a serious note, the real outcome i'm looking for is the ability to chew my food properly, sleep soundly, and alleviated neck/jaw pain. This surgery is pretty big and scary. I'll be in the hospital from 1-3 days. This is scary because i'm in a foreign country and everything isn't nicely in English. Secondly, i'll be recovering for quite sometime. It can take between 6-9 weeks to initially recover and up to 9 months to fully recover. I'll be eating from a syringe for several months. I definitely don't look forward to this. Later, I will post some possible meal ideas and solutions to maintain proper nutrition. Below I have posted a video of a Le Fort 1 Osteotomy from YouTube. The nature of this video is graphic and some viewers may be disturbed.

Since I have gotten braces I have been diagnosed with Temporomandibular Joint Disorder. Web MD defines TMJD as an Injury to your jaw, the joint, or the muscles of your head and neck -- like from a heavy blow or whiplash-- can lead to TMD.

Other causes include:

• Grinding or clenching your teeth, which puts a lot of pressure on the joint
• Movement of the soft cushion or disc between the ball and socket of the joint
• Arthritis in the joint
• Stress, which can cause you to tighten facial and jaw muscles or clench the teeth 

Common symptoms of TMJD include:

• Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide 
• Problems when you try to open your mouth wide 
• Jaws that get "stuck" or "lock" in the open- or closed-mouth position 
• Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful. 
• A tired feeling in your face 
• Trouble chewing or a sudden uncomfortable bite -- as if the upper and lower teeth are not fitting together properly

The surgeon said that I might need to undergo both top and jaw surgery. However, I won't find out if that's the case until July 27, 2015. At this point, i'm just hoping for the upper jaw surgery. The Beginning of this process has been really painful and really negatively impacted my life. I'm still hoping for the best though! TMJD has been very difficult. I can't eat foods I once used to enjoy. I am basically embarrassed to go to dinner with friends or eat in public. At this point, my teeth only meet in one position, which doesn't allow me to chew my food properly. I always say, it's not really dinner unless I choke 1-2 times. I try to make light of the situation but, it's really difficult. I hope you'll continue to follow my journey!

Once again, thanks for reading. 




Check out the images of a Lefort fracture below! 

Image of Le Fort 1 Fracture from(https://www2.aofoundation.org/wps/portal/surgerypopup?contentUrl=/srg/95b/05-RedFix/P360-MaxOstLeFortI/06_Fixation.jsp&soloState=precomp&title=&Language=en)

Images of Le Fort Fractures (http://aragec.com/le+fort+3.html)

What is this surgery I keep talking about? (Orthognathic Surgery)

Image (http://jawbreakover.com/category/le-fort-i/)

So, i've been thinking about writing a blog for a very long time. It's been mildly frustrating to explain what orthognathic surgery is to so many people. I also have a unique situation. I am currently living abroad and due to the nature of my skeletal situation, i've encountered a lot of symptoms and complications from the misalignment of my jaw. I'm hopeful that this blog will help others who are struggling with questions about their surgery or complications with their own situations. Also, this will allow my friends and family to understand what I am going through. So, what is orthognathic surgery? I'm going to make this relatively easy and just provide the medical description listed here:

http://myoms.org/procedures/corrective-jaw-surgery

Corrective jaw, or orthognathic, surgery is performed by an oral and maxillofacial surgeon (OMS) to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.


The following are some of the conditions that may indicate the need for corrective jaw surgery:


Difficulty chewing, or biting food
Difficulty swallowing
Chronic jaw or jaw joint (TMJ) pain and headache
Excessive wear of the teeth
Open bite (space between the upper and lower teeth when the mouth is closed)
Unbalanced facial appearance from the front, or side
Facial injury
Birth defects
Receding lower jaw and chin
Protruding jaw
Inability to make the lips meet without straining
Chronic mouth breathing
Sleep apnea (breathing problems when sleeping, including snoring.



I've taken the liberty of highlighting (yellow) some of the issues i've experienced with my own situation (basically all of them). My diagnosis is Class III Malocclusion and severe crossbite. I originally went to a private orthodontist in Finland (where I live now as an Expat from the USA) to get assessed for orthodontic braces. The orthodontist explained to me that I was not a candidate for orthodontic treatment alone and I would need to see a surgeon and specialist to treat my current condition. He went on to explain that my upper jaw (maxilla) failed to grow with my lower jaw (mandible). For many years this condition didn't cause me too many issues. At least I didn't understand until now the impact it had on my life and health. Since my occlusion has been so poor for so long, chewing alone has irritated my temporomandibular joint. With an increase in stress, I also began noticeably grinding my teeth at night. This is known as bruxism. I will write about this condition separately. I have had many complications from bruxism which include: sleeping issues, cervical spine issues, imbalance of the trapezius muscles, and other spinal difficulties. It's strange to thing that all of my symptoms could lead back to my teeth and jaw.

Surgery Date 

After waiting for nearly two years, at my last orthodontist appointment I was told that my surgery would be in late September or early October of this year (2015). Hopefully, I can write a few entries about my preparation for the surgery and keep up-to-date about my treatment and life after the surgery. I will discuss my exact surgery in the next entry.


Thanks for reading.


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