Ten weeks

14 Jun

My accident was ten weeks ago today. With the teeth having been repaired and arch bars off, there are no obvious visual signs of serious injury remaining. I do still have scars from the road rash on my elbows and hands. My facial wounds healed long ago, but I’m finding that the bump on my chin where I had stitches is very prone to getting cut when I shave.

I sometimes get a tingly numbness on the left side of my face, but this seems to have grown more slight over the past few days. Occasionally, I feel a little discomfort (which I would not describe as pain) on the left side of my jaw. I do get a little bit of pain on the right side of my jaw when I open my mouth very wide, but I think it’s just a pulled muscle. Sometimes I also get a soft sound coming from the left side of my jaw when I open or close my mouth. The best word I can think of to describe it is a creaking sound, but I don’t think that captures it perfectly.

The benefits of a metal-free mouth

13 Jun

I’ve quickly come to believe that the best thing about not having arch bars on my teeth is that it’s much easier to keep my teeth clean. Food was always getting stuck in the arch bars and the wires that secured them to my teeth, and it would often take fifteen minutes or so to clean them with the toothbrush and the WaterPik and then dental floss. Without the wires, it’s much easier: I just brush and then floss.

Another great thing about having the arch bars out is that my gums don’t hurt all the time. I can’t remember whether I mentioned this in a previous post, but when I had the arch bars on my gums would always hurt a little bit where the wires touched them. Sometimes the arch bars and wires would move slightly, and then my gums would hurt a bit more. It wasn’t that bad, because I eventually got used to it and stop noticing it, but now that the pain is gone, I notice that my gums feel much better.

Good enough

12 Jun

I went in to the oral surgeon’s office today expecting to learn some new jaw exercises. In view of my recent reading, I was somewhat skeptical of the idea that my opening was actually going to get better, so I showed up prepared to ask whether it was reasonable to

When the oral surgeon came into the examination room, he asked me how my opening was. I started to answer before he clarified that he wanted to see it. I opened my mouth, and to my surprise, he told me that it was better than he expected. He added that most people can put three fingers in their mouth, and then demonstrated by trying to put three of his fingers in his mouth. The third one didn’t really fit, though. He had me try to do the same, and I was able to put two fingers in easily, but my opening wasn’t wide enough for a third finger.  The oral surgeon said it was close enough,  demonstrated with his fingers that it was only a millimeter or two from normal, and then watched as I opened and closed my mouth a couple of times to make sure that it was opening straight. He said that I “totally qualify” to have my braces taken off and asked if I wanted them removed right then. I wanted little more, so I answered in the affirmative.

The oral surgeon told me that the wires around my teeth would poke my gums as he pulled them out, so he gave me three options for counteracting the pain: nitrous oxide and a numbing gel; nitrous oxide, the numbing gel, and  novacaine; or general anesthesia. I chose the first of these options, and the oral surgeon told me that most people can handle it, adding that it was “like having a really mean hygienist.”

The oral surgeon moved me to another room, where an assistant put gauze in my mouth, spread the numbing gel on my gums, and hooked me up with nitrous oxide through my nose. The oral surgeon came into the room and started to say, “The adventure that began in April…”. He said it in this overly dramatic tone that sounded like it might have come from one of Barack Obama’s speeches (video; see 9:44), but the second half of the oral surgeon’s sentence, “…comes to a close,” was decidedly less dramatic. He then took the gauze out of my mouth, told me to open my mouth, and cut each of the wires on the top of my mouth before pulling them out. It hurt a little bit, but the pain went away when the wire was out, so it wasn’t bad. At this point, I realized that I had actually started breathing through my mouth again, and I wasn’t feeling the nitrous oxide as much. The oral surgeon then removed the bottom wires. Somewhere in the middle of removing the bottom wires, I noticed that I was sweating a lot, but I don’t know if this was nervousness, an effect of the numbing agents, or a result of the room actually being hot.

The oral surgeon turned off the nitrous oxide and turned on a supply of oxygen, and told me that I didn’t need to return to his office, but I could call if I had concerns. He added that I’d be ready to chew the hardest foods (which he identified as crisp apples, hard French bread, and very hard vegetables) around July 4. The assistant gave me a toothpaste and toothbrush and had me brush my teeth. I had brushed before going, so there wasn’t anything but blood on them, but I complied anyway. The assistant told me that my gums would bleed easily for the next two or three weeks, but that I shouldn’t let this keep me from flossing.

Finally, I have some pictures. First up is a picture of my mouth, sans arch bars.

open mouth

It isn’t perfectly straight, but the appearance of crookedness is exaggerated by the fact that my front teeth are not the same length. The second picture is of me trying to stuff my fingers in my mouth.

I tried to stick my fingers in my mouth before I got caught by the vegan police.

I tried to stick my fingers in my mouth. I suppose this endeavor was made slightly easier by the fact of my having slender fingers.

Teeth cleaning

12 Jun

I just got back from my routine six-month cleaning at the dentist’s office. I only saw a hygienist; the dentist didn’t look at my mouth. To my relief, she didn’t find any cavities. She told me that one of my back teeth has a deep groove in it that will need to be brushed extra carefully, but she emphasized that this was the anatomy of the tooth rather than a cavity.

When my mouth was wired shut, I was unable to brush most surfaces of my teeth, so I find it quite remarkable that I don’t have any cavities. A large part of this, as the hygienist pointed out, is that I’m lucky to have hard enamel. What I don’t owe to luck, I owe to my WaterPik, which proved to be an absolutely indispensable tool for cleaning my teeth and the wires around them.

I also learned that the dentist’s office has already billed my second insurance for the rest of the charges on my account. I should be receiving a bill for whatever they don’t pay in a few weeks. The statement of benefits from the insurance company, however, will probably go to my parents’ address.

Bills and such

10 Jun

I’ve been out of town for a bit, and I returned home this morning to find some billing-related materials waiting for me.

The only actual bill came from Bay Imaging Consultants Medical Group. as far as I can tell, this has something to do with the x-rays I received in the hospital. This is apparently separate from the radiology item on my statement from the hospital. The bill lists charges for three items: “ORTHOPANTOGRAM”, “SHOULDER COMPLETE”, “FACIAL BONES, COMPL., MINIMUM”. The total charges were $147, but payments from my insurance brought it down to $53.79. The bill doesn’t say, but I’m pretty sure (based on my memory of some paper which I think I have in a big stack somewhere) that those payments come from my UC Berkeley SHIP plan, rather than my parents’ plan (which is supposed to be my primary insurance). I’ll have to give them a call to see if I can get them to bill the other insurer for the remainder.

I also received an explanation of benefits from the university insurance plan for my services from the oral surgeon. The insurance was billed for $3,720, of which $3,200 was for the surgery and $520 was for anesthesia. The insurance company has covered $1,831.82, and they expect me to pay $1,888.18. Of this amount that I’m responsible for, $146.21 is applied to my deductible, $457.95 is my coinsurance responsibility, and $1,284.02 “exceeds the allowed expense and is the member’s responsibility to pay.” For the record, I don’t really understand what all of these words mean, but maybe some day I’ll find out.

I’m hoping that the oral surgeon’s office will bill the remaining balance to my other insurance. I shouldn’t need to remind them about my second insurance, seeing as they called me for information about it while I was still sleeping off the anesthesia from the surgery.

The last related document I received was an explanation of dental benefits from MetLife, which provides my dental benefits for the SHIP plan. This was for the repairs of the chipped teeth. The statement tells me that the fee for my services is ordinarily $372, but the dentist agreed to accept only $286 as part of his participation in Metlife’s Preferred Dentist Program. Metlife reports having paid $208.80, leaving me to pay $77.20. As I understand it, they are applying $25 to my deductible and then paying 80% of what’s left. I’ll have to ask the dentist if they are also billing my parents’ dental insurance. Either that or I will just wait until I have a bill before I do anything.

New name and address

9 Jun

As of today, this blog has a new name (Shock and Jaw) and address (http://shockandjaw.com). The reason for this change is mainly personal preference. I have a weakness for bad plays on words, but I didn’t think of this name until some time in late May. A secondary reason is that it gives the blog an identity which I can take away from WordPress.com (a platform which I dislike more and more by the day). For now, the old URLs will work, though.

My natural teeth

7 Jun

For the first few weeks after my accident, and then again in the first several days after my chipped teeth were repaired, I’d often wonder what my teeth had looked like before the accident and lament that I’d never know. On this point, however, I was wrong.

When I got my braces off just short of eight years ago, my orthodontist made models of my teeth. These were to be used to shape the clear plastic retainers that I would have to wear regularly from then on. For most of the past eight years, the models have sat collecting dust in my old room in my parents’ house.

My old teeth

For me, the most striking thing about the models (which unfortunately my photograph doesn’t adequately show) is that they show that my right front tooth was actually slightly bigger than the left front tooth before the former was chipped in the accident. In the repaired version, the edge of my right front tooth (number 8 for the dental notation enthusiasts out there) slants so that the tooth approximately matches both of its neighbors in length where it meets them. In particular, the right front tooth is considerably smaller than its neighbor to the left, and it also looks weird.

The models also confirm that my bottom front teeth have moved a little bit. The two in the center now stick out slightly further than the ones to the left and right. This is something that I’ve suspected since my jaw was wired shut, when I detected a change in the way things felt to my tongue. I’m hoping that the movement is due to pressure applied by the wires in my mouth and that the movement is slight enough that my retainers will be able to nudge them back into place after I get the arch bars out.

Some pessimism

6 Jun

Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

Twenty-three with braces

2 Jun

These days, the only major sign of my accident is the arch bars on my teeth. The oral surgeon told me that they’d stay on until my mouth is opening normally enough that he is sure they won’t be needed again. As the days progress, I find myself increasingly impatient for this to happen. I don’t particularly mind the look, and the arch bars aren’t even that visible. It’s just that I feel like I’m about ten years too old to have braces on my teeth.

Over the last week or so, I’ve been stretching my jaw muscles more and more. The oral surgeon only told me I should work on opening wider, but sometimes I work on the side-to-side motions a bit, hoping that it might help to correct the problem of the right side of my mouth opening further than the left.

The truth is that I don’t even really know how far my mouth should be able to open, or even what straight is. The latter question seems like it should be easily settled, but it’s not so easy because my front teeth aren’t perfectly straight. Some of them have shifted slightly since the accident (owing to my inability to wear a retainer while my jaw was wired), and two were chipped and then repaired artificially. The oral surgeon wants me to focus on keeping my chin straight, but even that’s not so easy because my chin has a small bump on the right side where it was stitched up. As for the width of the opening, I haven’t been able to find out what is normal, but I’m pretty sure that it’s wider than my opening of about four centimeters.

If there’s one thing that keeps me from sitting around and exercising my jaw all day long, it’s the understanding that my trying too hard to fit in may well have caused the accident in the first place. I’m not quite sure what could go wrong here. I doubt that my muscles are strong enough to break the bone again, but I’d rather not find out.

The jaw today

29 May

By now, my jaw feels more or less normal. On the left side, the tingly numbness around the site of the fracture has diminished considerably. The area is still tender to the touch, however. I’m chewing most foods normally. In fact, I find that I’m more cautious about not breaking my newly repaired teeth (which are on the right side) than my jaw, so I’ll usually bite with my left teeth rather than the right ones. Oddly enough, I experience pain more often on the right side of my jaw than on the left side.

Other than that, all I have to share is a picture. I made an attempt to record a movie displaying the range of motion of my jaw, but I found that to be too difficult. Even taking a closeup picture was challenging and required several attempts.

IMG_0802

It seems to me that the size of the opening is progressing pretty well, but I don’t really have any good reference points. What is clear, though, is that my mouth still isn’t opening straight. This is perhaps most obvious from the misalignment between the lines between the pairs of teeth at the center of the top and bottom.

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