SDS Occlusion Blog

As clinicians dealing with chronic pain patients we spend a lot of time diagnosing TMD problems, guiding them through the various phases of treatment and trying to get them to change habits that have developed over a lifetime. It can be difficult to work out just what is happening while stomatognathic structures gradually heal and change, so that we can get a bit bogged down in our own concerns and lose sight of what the patient is also going through in these very challenging cases. We need to be equally aware of what the patient is going through and any psychological support they might require to help them through what can at times be a frustratingly slow process. I thought it would be useful to share a patient report that illustrates these points.

Nature’s Appliance – tongue and cheeks acting to keep the teeth from touching

The moving testimonial below is written by someone who had an internal derangement of the jaw joints, particularly affecting the left TMJ, with very limited opening (around 18 mm) and virtually unable to make lateral movements for chewing. This condition went undiagnosed for 20 years. She had effectively become a recluse because she couldn’t eat in public or converse with people without it causing severe pain, yet members of the medical and dental profession had really written her off with no hope for a cure. This is her story:

Looking at me now, a picture of health and enjoying life to the full, it would be hard for a stranger to believe how much I was suffering a year ago.

Over the years I’ve been to a succession of dentists; been assessed by a maxillofacial consultant; been referred to a dental teaching hospital; always searching for help. I have tried in vain to explain to various experts my belief that my problem was not just my teeth, but involved muscle, sinews, nerves and bone too. Again and again I asked the question ‘Is it too much to ask that I be able to close my mouth over my teeth in a natural manner and be free from pain?’ Mostly the response from the experts has been noncommittal. Lots of questions were asked of me but no one was able to cure my condition. I was left with my pain, in the hope that it would eventually sort itself out. It didn’t. It got worse. Twice in recent years I had to attend A & E because of muscle spasm and my jaw locking open. My face became more and more lopsided.

I can’t adequately describe the severity of the excruciating pain I was experiencing less than a year ago. It was constant, no respite, and the painkillers I could buy at the chemist didn’t even begin to touch it. The pain moved around from tooth to tooth and around my face and jaw. My facial and neck muscles would go into spasm. Only someone who has suffered similarly can fully understand the agony of such pain, and the debilitating effect it has.

It was my good fortune to be referred to Mr ***** at this point in time. A check beforehand on his website was reassuring, told me everything I needed to know about the practice. Also, the links there indicate someone who has kept an open mind to knowledge over the years. Blinkered thinking has been of no help to me in the past. It is such a relief to discuss my symptoms with someone who can follow what I’m
trying to describe. His understanding of my situation is a great relief and of comfort to me. He clearly has a broad base of knowledge and skills. He also has years of practical experience behind him. I’ve not been a guinea pig; he clearly knows what he’s about.

He removed a good two thirds of my pain at that first appointment by restructuring the surface of some crowns. He also fitted me with an NTI-tss appliance, which prevented the surfaces of my teeth meeting and allowed me the first reasonable night’s sleep in a long time.

Mr ***** suggested that improved posture might help my recovery and suggested the Alexander Technique might be beneficial. From the Alexander technique I learnt, among other things, that I couldn’t trust what I feel. Just because a position feels familiar doesn’t mean it’s right – something to keep in mind as changes start to occur.

Mr ***** also suggested I get rid of my fat cushioning pillow and sleep flat on my back with my neck supported on a folded up towel. This was difficult for me as, initially, I found it painful. However, I persevered and went down slowly over time, at first by placing a pillow under my knees. I also use microfibre towel, which is much softer than cotton, and if I get a skin ailment I wrap it in silk. Both pieces of advice have proved invaluable. To enable change to occur the body needs to be stretched out in a balance way. (a bonus result has been that I no longer suffer from the shoulder pain which had prevented me from driving).

The ultimate aim was to slowly realign my jaw over a period of several months. Mr ***** has very slowly released my jaw and brought it into a relaxed and pain free position. He did this slowly and methodically, always with the reassurance that if this particular thing he was doing for me didn’t work there were alternatives. He calls it ‘like peeling away the layers of an onion’. My description would be that I think of my pains in a line, one behind the other. I tell him which one is the biggest and foremost at that moment and he deals with it. He’s a very clever man and I’m lucky to have him as my dentist.

My next appliance was a bite plate, also known as a stabilisation splint. The good thing is that I was allowed to bite into it as much as I wanted. It gave me a secure feeling and ensured a good night’s sleep. It helped to develop my muscles to work in a co- ordinated way. Mr ***** built up the biting surfaces and drilled them down at successive visits to get me into a comfortable position and persuade my jaw into change. It was not without discomfort at times but I resisted the temptation to alter the splint myself in any way. The whole point of any sort of splint is that your body moulds to it rather than the other way round. Far better to take it out of my mouth for a while than alter it – I left that to the expert. If I needed a painkiller I tried to wait until bedtime. That enabled most change to happen when I was asleep. Also after a sound night’s sleep, next day things are much more relaxed and easier. Chewing something after change had occurred helped to make things feel familiar and comfortable again. At times I would get a clicking and crunching sound which is just part of the adjustment taking place. It felt like a slow wearing down of excess material, which my body had filled in behind my misaligned jaw. Not to be forced, just go along with the natural pace of things. It takes time, be patient with yourself.

After a while I only had to wear the bite plate at night. During the day I tried to keep my lips together and teeth apart, jaw steady.

From there I went onto a set of partial dentures where Mr ***** filled in the gaps of missing teeth. They took some getting used to. Again, I resisted the urge to change things. I concentrated on holding my jaw still and steady. Took them out when it became too much. Always slept with them in. I eventually moulded to them. Soon after that I felt something peel away in my jaw, all resistance melted away and my excruciating jaw pain was gone. I found it hard to believe at first, pain had been such a part of my life it had become the norm. But it went and it hasn’t come back. My face looks more balanced and I can place three fingers into my open mouth (as opposed to one at the first visit).

Throughout the treatment I have been treated with courtesy and respect. I have been warmly encouraged to contact Mr ***** at any time with any concerns or problems I might have. I found emails suited me best and cut down on the time it took to explain things at my appointment.

I make the journey from ****** to ******* for every appointment. Some people think it’s crazy to travel such a distance to go to the dentist. My reply to that is that I’ve suffered pain for over twenty years. Mr ***** is the dentist who has finally freed me from it. I’d be insane to open my mouth for any other dentist! As long as he’s willing to treat me I am happy to make the journey.

20 years?! What a privilege it is to be able to use our clinical skills to help such people re-enter society and catch up on the years they have missed.

It’s a wonder to me more dentists aren’t involved in this very rewarding field, but it seems to be very difficult to fill our Stockport Dental Seminars courses these days, which is a great shame. Hopefully stories like this will inspire more to take up the challenge. Please contact us for more information and if there is enough demand we will arrange some more course dates very soon.