Today was my two week follow up after having a TMJ lavage/ athrocentesis. While I probably should have been describing my progress as it happened, I was constantly upset by the information I gleened from the experience of others with this procedure/ disease and didn’t have the energy or strength to bother with much of anything- let alone my blog. However, I wan’t to share my own experience thusfar with my temporomandibular joint disorder and put another perspective out there for people to read. All of this down-and-out business was NOT helping my recovery. Personally, I believe wellness includes your own mental perspective of your condition as well.
Please note that I am a graduate student who has been seeing the doctors at the ajoining dental school, so the experience and education of these doctors may be different from others. Actually, I was encouraged by this difference since I know that these doctors are still being educated.
Pre-surgery: Pain level was approximately 6-8 out of 10 depending on the day, stabbing pain in my left TMJ and radiating pain in my teeth and face. Opening was 1 “finger” without pain, 2 “fingers” with stabbing pain. Couldn’t even chew eggs, very painful. Even without talking/ moving I was in pain.
Day of operation:
On the day I had my athrocentesis I was very nervous! My biggest concern, in all honesty, is that it wouldn’t help me. I asked the doctor as they prepped me what the success rate was for this procedure. The doctor told me that, in her experience, 80-85% of the patience she had seen saw improvement in their condition, while the rest saw no improvement. In her experience, she had not seen anyone get worse. This made me feel a bit better and soon the “light anesthetic” knocked me out cold.
I was perscribed hydrocodone+acetomenaphine and ibuprofin for the pain and inflammation. Since naproxen had given me a painful case of acid reflux I was told to take ibuprofin only as I could handle it (which was 200mg every 4hrs, come to find out.). I iced the area non-stop for the first 8hrs after the procedure, as instructed. The pain was manageable under medication, but I had to remain very straight, I couldn’t lay down without a lot of discomfort. Needless to say, I didn’t get sleep that night. (By the way, I have completely recovered from the acid reflux caused by naproxen. It took a few weeks, but I can again eat high acid food! YAY!)
On the day of operation on, even now and for months more, I have been conducting “jaw exercises” that include opening as far as I can and wiggling my jaw side to side. This should prevent scarring of the TMJ that could worsen my condition.
Could only eat broth
On the first four days I experienced a squishy-feeling, squeeky/crunchy-sounding sensation in my left TMJ (where the surgery occurred). This was worse than the pain, since I am sensative to sounds and it was driving me crazy. This was due to residual fluid after the flushing and is considered normal. Each day the sound/sensation abated more and more and by day 4 it was pretty much gone, with some exception to occasional occurences (which stopped me in my tracks- like nails on a chalk board! but didnt hurt). The pain was still there, but managable with ibuprofin only after two days. I feel as though the right side of my face hurt more than my left, but this could be because I was babying the left side and putting all the pressure on the right. NO clicking or popping at this point.
The biggest problem at this point was that I couldn’t close my mouth completely- meeting my molars together. I felt as though a jelly bean was in my TMJ, preventing full closer and producing that obnoxious noise when I tried. The pain was a dull ache. I was sleeping normally and fitfully, althought it took some adjusting to find a place that my jaw didnt align poorly.
My opening was a tight “2 fingers”, my range of motion for jutting my jaw past my upper teeth was minimal (couldn’t pass my upper teeth, a feeling a stretching) and pushing my jaw to the right was also limited (same sensation).
Could only eat broth and yogurt, but I had no noticeable swelling at the procedure sight and very very slight bruising.
Finally, on day five my mouth could fully close, although I felt some pressure. Also at this point I noticed I developed a very obvious lisp. At this point the pain was minimal, but I was still bound to ibuprofin , but now only one or two pills a day. My opening was still a tight 2 fingers and my range of motion was limited as described before. Now I could chew angel hair pasta, still very limited to soft foods. Kept up my exercises, still sleeping well
At this point I was getting pretty upset. I had thought that this procedure, being minimally invasive, would heal quickly. No, no it doesn’t heal quickly. The follow up is scheduled for two weeks for a reason.
Everything was pretty much the same, but the pain kept becoming less and less. Same range of motion, occasional use of acetomenophin and ibuprofin as needed. I had a spasm in the right side of my face on day 10, but I took muscle relaxors that night and everything was ok. Now I was carefully chewing well cooked vegetables like cauliflower. If it took more than two “chews” it was a no go. Lisp slightly improved. Moving jaw to the left sometimes creates a popping in my right TMJ, but opening is fine. Occasionally I would feel a “stop” when chewing or talking, but I think I was trying to move my jaw past its range of motion without realizing. This became less frequent throughout the days 8-10
On these days I stopped taking medicine all together, I had no need. I was able to chew soft foods such as bulgur, hot dogs, meat products, regular noodles, etc, and even the occasional hand-ful of peanuts. Basically, if I could get it in my mouth I could chew it, but I would get tired. Not pain, mind you, just a feeling of tiredness in my jaw. Lisping only on certain words. Range of motion was still limited but now I can align my bottom and top teeth, barely passing the top with some pulling sensation. Pulling my jaw to the right a little bit more, but still feeling a pulling sensation. Could open my mouth “2 fingers” comfortably, but this is not my pre-TMJ opening still. Still occasional right TMJ popping.
Today (2 week check up):
Today it was made official that my opening is the same as before my athrocentesis, but it is PAIN FREE and I think that’s a win. Lisp is still improving and expected to further improve as my range of motion improves. While I cannot jump into chewing gummy bears I have been advised that, if it doesnt hurt, chew it. So I plan on trying some bread soon (soft bread is fine, but chewy crusts have been avoided up to now). When I bit down on the tongue depressor to check for pain I had none, but this started my right TMJ popping when I opened my mouth. I rubbed it, rested it for ten minutes, and the popping stopped. I was advised to get a dental splint, but I don’t have $400. The doctor told me, conspiratorially, that if I’m not having pain that it isn’t necessary, that I can try over-the-counter guards and if they don’t hurt me then it should be ok. The problem is that, if the guards cause a misalignment, it can make my condition worse. Since my occlusion and bite are perfect due to previous orthodontic work, the purpose of a splint would be to prevent grinding and relieve pressure from grinding that I may be doing (which I know I do on occasion).
In a disheartened state I shared with my doctor the horror stories I heard about TMD sufferers and how many people said they spent years with pain and problems. I asked sincerely if I would be doomed to a life of limitations. The doctor smiled and told me that, for many people, TMJ can resolve itself as long as you aren’t aggravating it, and hopefully I will continue to see improvements until I am back to 100%. I have another follow up in 3 months to check my progress and be sure I am not worsening the issue.
So, to all those considering an athrocentesis:
1. It helped me. While my range of motion isn’t back up to where it used to be (approx. 3 fingers I’m thinking) I can eat WITHOUT PAIN and for me that is the most important thing.
2. Don’t be disheartened, with patience you can improve. Honestly, after the first week I was in a very dark and upsetting place about my condition, and I think that hindered my progress more than my actual physical ailments. You will find more people complaining about a problem than praising their recovery, so don’t be overwhelmed by all the negative reviews you may find.
3. It WILL take the full 2 weeks to feel better. The first few days will suck, you will definitely need to confine yourself to your home. Talking will be hard for the first full week, but after day 3-4 you can get back to work if it is not a very physically exhaustive job (office work-yes, construction- no)
I’ll keep ya’ll posted as I continue to progress! Inshallah I will be back to normal!