Dentist mission part 1

I was sitting in a waiting room, waiting for an appointment to get a new night guard for my teeth. The type of mouth guard I needed was similar to the ones that boxers or rugby players wear to protect their teeth. This type of dental guard however is custom made, in order to fit individual mouths comfortably. I had been aware of grinding and clenching my teeth whilst sleeping, for at least 15 years, and had recently been waking up in the middle of the night with my teeth clenched tightly together. It was as though my subconscious was intervening and was now warning me when my teeth were engaged in this habit.

I already owned a mouth guard which I wore on my bottom teeth, and which had been made over 10 years ago, when I lived in England. I had worn this guard on and off for many years. In the past, when I went to the dentist, the only question I was ever asked about the guard was whether or not I had one. Nobody ever asked me how old it was. It had been expensive to have made, and I never thought about getting another one. It was only recently after my consultation with the Maxillofacial doctor; who seemed confounded that I had been using the same guard for over 10 years without having it adjusted, checked or replaced, that I realized perhaps I should get a new one. Of course, our faces change with age, as do or jaws and teeth.

The relationship between teeth grinding and clenching, and problems with the temporomandibular jaw joint (TMJ) causing problems with the ear are well documented. Curious that this connection was never mentioned by any of the many ear specialists I had consulted with. Typical symptoms of a TMJ disorder include ‘hearing loss, an earache, tinnitus, a sense of ear fullness, and vertigo’. Hmm I had experienced all of these, and continued to do so with all except the vertigo. I had even read stories of people who had suffered a hearing loss, and then after wearing a night guard for some months, their hearing had gradually returned. I was not hoping for this kind of miracle, but I did have some optimism that a new night guard could help reduce some of the pressure I was feeling in my ears and my head; this being the most difficult of my symptoms to tolerate.

The dentist surgery was in an old style apartment block. The waiting room felt as though it was probably once someone’s living room, many years ago. The room was square and dark padded sofa chairs lined three of the walls. There were no windows, and the walls were a plain dismal-cream colour. Around the bottom of the walls was dark brown skirting. There was a dark coffee table, situated in the space made between the chairs, with Spanish magazines arranged on top, in three piles. It was simply decorated, with two large framed pictures, one on each chair-lined wall. In the far corner, situated up high, near the entrance was a small box TV playing a Spanish soap opera with subtitles and low volume. As well as the low rumble from the TV, jingly-sounding elevator style music attempted to liven up the atmosphere. The surgery had looked so clean and white on the photos on the website. This definitely did not resemble the sterile and shiny images that had been advertised.

The receptionist called me to her office to speak with her. She had a confident, sociable and easy going attitude. I stumbled my way through the general health questions and she corrected my Spanish a few times, each time smiling with friendliness. She was the kind of person who made me feel like she immediately liked me. Perhaps it was the child-like Spanish I was speaking to her. For this appointment I hadn’t prepared any Spanish phrases or helpful vocabulary. I had become accustomed to meeting new specialists, doctors and receptionists, and the taking of basic details didn’t feel too scary anymore. I then went to sit back in the waiting room.

Shortly I was greeted by the guy with whom I had spoken on the phone, who had given me an appointment within 45 minutes of me phoning. He was younger than me, and spoke to me in a mixture of Spanish and American-sounding English, as he lead me to the dentists room. When I entered, I was met by a small old man, who was wearing a medical face mask, dentist overalls, glasses with magnifying mirrors attached, and whose bald head was covered in age spots. He muffled a greeting through his mask, and I wondered what he looked like under the medical disguise. He resembled a little mole, as he shuffled calmly around the room. He asked me why I was there and whether I had had a ‘ferula’ before. Ferula is the Spanish word for mouth guard – this was my new medical Spanish word of the day. He asked me to perform some jaw movements as he felt around my head and under my jawline. He also examined my teeth. He mumbled constantly into his face mask, directing his speech towards his companion. I could only hear and understand a little of what he was saying. The younger dental technician spoke to me in his broken American English and explained that they would need to do an X-ray to make sure the night guard would fit properly, and then they would be able to do the molds of my teeth. After that, the dentist left the room, and that was the last time I saw him during this appointment. The dental technician took me to a room to have the X-ray. Later he filled my mouth with pink putty to form the molds, chatting happily at me whilst my mouth was unable to move. I would return the following week…

Underground scanning

Back to my story…

Two weeks after my consultation with the Maxillofacial doctor, I went for a bone scintigraphy scan. The scan was to be performed in the basement of the hospital. I walked down some red painted steps into a concealed underground hospital corridor. It was a world of large metal pipes and echoes. Since the scan involved radiation, I guess it was to be performed in an isolated area to protect other patients. The first step of the scanning procedure was an injection of radioactive dye. I was then asked to wait in a room with around twenty other people. The room was square, and painted a tired off-white colour. At the entrance to the room were two toilets. There were no posters on the walls. The perimeters of the walls were lined with plastic chairs. In one corner was a table covered with a plastic table cloth and large bottles of water and plastic cups. I was told to drink at least 5 cups of water, and to use the toilet as much as I needed to. I had to wait for the dye to travel in my blood stream around my body. I watched as people’s names were called. They were asked to go to the toilet, and then they would go out of the door of the waiting room for their scans. As time went on I watched as people started to become agitated with the long wait. One old man started to pace back and forth, leaning heavily on his walking stick. Another man positioned himself near the door, making himself very visible; seemingly hopeful to be the next person called. I waited for 5 hours.

The scan took about 20 minutes. The machine was white, and resembled an MRI scanner. At one end of the machine, there was a ring doughnut-shaped compartment. Positioned at the entrance to the centre of the doughnut hole, was a long examination table that had a groove that ran through the middle of it. I was asked to lie down on the table. My body slotted into the groove. My head was supported with a pillow, and another pillow was placed under my knees. I was then wrapped up in a blanket, with my arms hugging my body, and a belt was fastened around me. I imagined that my blanket-swaddled body resembled a snug fitting battery in a remote control battery compartment. The technologist positioned another part of the machine around my head, and then she went into a small room behind a glass screen and turned on the machine. The robotic arms of the machine rotated slowly around my head, making loud clicking sounds. Next the battery compartment started to move like a conveyor belt towards the entrance to the doughnut. I was transported inside the doughnut. I looked up and saw the top of the machine was only a few inches from my head. I focused my stare on a small area of the machine above my head, so as not to move, and to prevent my thoughts from drifting to contemplation of my confinement. More loud clicks followed, and more images were taken.

About a week after I had the scan, I met again with the new ENT (Ears Nose and Throat) specialist. He said he was happy to see me looking well, and asked if I was back at work yet. In my previous consultation he had been concerned about my well-being. I told him I hadn’t yet returned to work. He said I would have to try soon, but he was worried about me being in an environment with lots of noise, as he knew I’d find it difficult.

Then he changed the subject of discussion. He asked about my breathing; in particular whether I had any difficulties due to my deviated septum. He asked whether I breathe through my nose or my mouth. I was asked to sit in a big black chair opposite his desk. He then performed a Fiberoptic Nasopharyngoscopy. This is an imaging technique, using  a long thin black flexible wire with a light on the end, that is inserted into the nose. It can allow visualization of the nasal cavity, septum, and other structures. The specialist slowly fed the viewing tube down my good (right) nostril, until I could feel it brushing past my throat. My eyes started to water involuntarily. I remained in rigid stillness. This was a procedure that one of the other specialists had done before, so I knew the level and type of discomfort I would experience. Then he removed the tube and started to insert it into my deviated (left) nostril. This I had never had done before. He got as far as the top of my nostril; the furthest area you can touch with your finger. Then he stopped. He said the nostril was completely blocked due to deviation of my septum. But then, to my bewilderment, he continued to feed the tube into my nose; forcing it further down towards my throat. I was in extreme discomfort. My eyes continued to produce uncontrollable tears that streamed down my face. He carefully removed the tube. My body was shaking. The specialist told me that my left nostril was completely blocked. He said that I couldn’t breathe through this nostril – this I was obviously something I was aware of.

I then sat down again at his desk, more relaxed now, and he asked if I wanted to have an operation to correct my septum; that would help me breathe better. He said I would probably need the operation in the future anyway. I said I’d like to wait for the results of the jaw scan first, and then if everyone was OK with that, then I’d prefer to have the operation sooner rather than later. I thought it would be better to have an operation in the present, rather than in old age. Also, I’d like to be able to breathe better, especially when I’m trying to sleep. He said he thought this was a good plan. He said that correcting my breathing should help to make me feel more comfortable, and could possibly help with some of the stuffiness I was feeling in the left side of my head, since my hearing loss. I would meet him again in a month.

Two weeks after the bone scintigraphy I was back at the hospital for a consultation with a maxillofacial (jaw) specialist to get my results of the scan. I was going to find out whether I had Mandibular Condylar Hyperplasia (a rare bone disease that causes asymmetry of the face amongst other things). My boyfriend accompanied me for this appointment, as I was feeling nervous. The specialist explained that the results of the scan showed that I didn’t have the rare bone disease…Breathe…She said that it did however show deviation of my jaw. I was then led to the adjacent room where I sat in a dentist-style chair and she examined my jaw; asking me to open and close my mouth. She told me there was a problem with my jaw muscle. My boyfriend asked whether my problems with my ear could be related to my jaw issues. She answered discernibly carefully, saying that ‘the ear pressure could be associated with the jaw’. She wrote down recommendations of treatment for my jaw problems on a piece of paper for me:

  1. Go to a dentist and have a new night guard made. This would protect my teeth and jaw muscles from night-time clenching.
  2. Try taking Robaxisal (a muscle relaxant) for 5-10 day cycles. The specialist felt my jaw was probably in spasm. This medicine could help release some of the tension.
  3. Seek treatment from a specialist in craniofacial rehabilitation  – this is a type of physiotherapy for the jaw.

…Next stop the dentist…