1978 The Basket Case

During 1978,

I quickly became a “Basket Case”

within the dental community.

Craniofacial pain was triggered
in a routine dental appointment:
my dentist ground an upper canine tooth (equilibration).

This procedure unintentionally precipitated
a ‘lightning bolt’ of sharp pain 
instantaneously flashing through my face.

Etude in F minor

Stephen Heller

Nardil Round One

This unexpected dental insult in 1978 produced a referral to an ‘equilibration specialist’ whereupon I was prescribed a strong  pain killer while my teeth were ground and the bite (occlusion) adjusted over a six-week period.  The pain outlasted the dentist and his occlusal artistry. Little did I know that these occlusal adjustments affecting jaw posture would create a chain reaction – ‘backlash’ –  down my spine – a domino effect ricocheting from head to toe.

My son’s orthodontist referred me to a dentist specializing in TMD (temporomandibular disorders) . I soon discovered that I was his first TMD patient, having  completed  his first course in TMJ treatment only recently. The ‘treatment of choice’ in this era of  TMD understanding was to ‘recapture the disc in the jaw joint’.  This was achieved by pulling the lower jaw forward in a splint to create a Class III malocclusion. Currently, this appliance is known as a “Mandibular Advancement Device”. To prevent the jaw from relaxing and moving backwards while lying down, the dentists created a prong sticking up from the splint on my lower teeth.  My low back screamed at this insult. 

Based on my orthopedic history of degenerative disc disease, the temporomandibular disc appeared to be the next disc to degenerate. This dental treatment landed me in physical therapy every day for three months with no improvement. 
I also began seeing a therapist during this time and vividly remember him asking me what I feared the most. My immediate response: ” I’m afraid I won’t be able to cope with the pressure that’s building in my head.” It was not long before this fear materialized.

A chiropractor referral had been a blessing after my spinal fusion had failed to resolve back pain.  He was horrified at what this appliance was doing to my neck and cervical spine.  A high-velocity thrust with my jaw pulled forward by a dental splint proved to be counterproductive. The left side of my head was traumatized with this maneuver. I was immediately assaulted with deep pressure and tingling on the left side of my head. I was very scared and visits to this trusted doctor immediately stopped. 

I fell apart, along with my life.  Teaching piano was impossible. My daily routine of getting kids to school, cooking and cleaning was almost too much to handle. My mother was not well during this time and added to the family stress.  My husband assumed the posture of an ostrich – head buried in the sand.

My name became notorious in TMD dental circles. I was invited to participate
in a city-wide dental symposium as the  ‘difficult patient’.  A group decision was made at this meeting and my case was transferred to a different dentist.

Along with the new dentist, I received a new splint, designed for the upper (maxillary) teeth.  The mandible was no longer pulled forward.  This sudden change in jaw posture, however, created a new scenario: I was unable to lay down without blinding pain shooting through my face and palate. Daily injections of novocaine in the palate became the norm while the dentist adjusted the splint, attempting to alleviate the pain. o

In a very short time, I became acutely aware that I was not coping with this new dentist and his maxillary splint. I called my mother’s psychiatrist.  He immediately saw me and prescribed high doses of Valium while I gradually reached treatment dosage on Nardil,  the psychoactive drug that he was using in a research project. Currently treating a baseball pitcher with a bad elbow for pitching anxiety, I became his test case for dental anxiety which was now through the roof.  At the time, this drug was banned in Europe because of serious side effects:  seizures and death.  The doctor assured me that if I strictly followed the diet regimen that was mandated by this class of drugs, I would be fine.  I was very careful to avoid foods that contained tyramine…no aged cheese, processed meat, citrus, fermented vegetables, beer and red wine. I didn’t ask questions – actually, I couldn’t ask questions. I could barely get in the car to drive to the appointments.

Initially, the main side effect of Nardil was the forceful, involuntary snapping shut of my jaw as I drifted into sleep.  I was told not to worry, even when I expressed concern that this seemed counterproductive to a jaw joint pain problem.  But, I was a compliant patient and reached treatment dosage with a snapping jaw and an occasional bleeding tongue while going to sleep.

The dental splint remained on my upper teeth. The pain became tolerable and I was gradually able to reduce the dosage and eventually taper off of this psychoactive drug; Valium continued to be my constant companion. The dentist referred me to a physical therapist with specialization in craniomandibular problems. She was baffled by my body’s response to her treatment as well but worked with me as I gradually adjusted to the splint. 

Nardil Round Two

Just as my life started to have a routine again, an unexpected challenge arrived.  Our springer spaniel became very sick and my husband was in Tennessee visiting his parents.  When I picked up all fifty pounds of Banjo to put him in the car, my jaw snapped shut, clamping down on the splint and my mouth refusing to open. I talked through clinched teeth as I relayed the Banjo story to the vet, who thankfully kept the dog at his office.  I drove to the dentist, unable to open my mouth.

The dentist threw his hands up in exasperation, telling me that I needed a psychiatrist not a dentist.

“This was picking up a dog; I already have a psychiatrist!”
I retorted without hesitation.

The removal of the appliance was difficult and painful.  The punch line of this visit: 

“Do not come back to my office. 
Find another dentist.” 

I left in shock, having no referral and nowhere to turn.

The next office I visited was the psychiatrist, who wrote a new prescription for Nardil and increased the dosage of Valium. Banjo came home from the vet in time to greet my husband returning from Tennessee.  A box of Smokey Mountain taffy was a gift?  It’s the thought that counts, I told myself  – and I did love Gatlinburg taffy… however, I had not been able to eat chewy foods like taffy for a long time.

Thus, thanks to Banjo,
I started down the path of Nardil Round Two
 to control anxiety and pain as I searched for a new dentist.

Little did I know what radical change
I was about to encounter on this precarious road

It became a very rocky and treacherous path.

1981 was just beginning