Here is the Canadian tooth numbering sytem:
Keep in mind there are different numbers for baby teeth. Gotta keep all those chompers straight! Pun not intended.
Also interesting to learn is the terms used to describe the sections of each tooth (although I won't be using these on this blog, I'm all for more information. Nerd Alert!
Mesial: the front of the tooth
Distal: the back of the tooth
Occlusal: the top of the tooth ("occlusion" refers to how your teeth fit together....I have "malocclusion" at the moment)
Buccal: the outside surface of the tooth (facing the cheek)
Lingual: the inside surface of the tooth (facing the tongue)
There you go - The More You Know!
Anywho, here's what I'm dealing with in the general sense. As far as my jaw goes, it has now been set and healed in the more-or-less central position since it was wired closed Sept 9. This did resolve the gross movement it had made to the left side of my face. It's still a good 5 mm or so off to the left, which doesn't sound like a whole lot, but it is noticeable and you can imagine that makes for an abnormal occlusion. I understand that since I can physically force it to move to centre, with physiotherapy (stretching, exercises and massage) I will be able to get it back to centre. Braces with elastics will also help.
The condyles of my jaw are also still in play. The left side has always been fractured and displaced. The right side has been fractured, then displaced, then fit back into the joint, and now these recent x-rays and CT scans will determine if that's still the case. What I can tell you is that I can open my mouth pretty well, but not as much as I could before. If I have to live with that, it's ok. But there is still quite a bit of pain and discomfort when using my jaw joints, probably because they're not in the right places. The muscles are all tight and very sore.
The condyles of your jaw go into the sockets in the side of your skull, right around your ears. I have had some ear pain as a result, but in the grand scheme of things, it's pretty minor. What concerns me is the sinking in that's happening to the side of my face. I have divots where my jaw used to be, back near my neck. It's pronounced when I smile, but I see it all the time. Looking back at photos of myself pre-accident and even after, I see that there is a big difference. It's happened over time since the accident, so that might be why some people haven't noticed much. Others see it as very obvious. I'm in the latter camp, obviously.
Here's a photo of me from July (I cropped it, but had to keep the bass in there!), and you can see a defined jaw line:
The aesthetics of it is obviously worrisome, but again...something I can live with if I have to. But the fact that my jaw is no longer where it is supposed to be concerns me functionally. I'd like to be as close to normal as possible. This is where my oral surgeon, Dr. M, has me a bit confused. He said that we will need to "revisit" my jaw at a later time, but mentioned bone grafts to build up the jaw for looks. I'm not sure that I'm interested in that, unless it really bothers me long-term. But is he concerned about the function of my jaw? He just isn't saying. This is where the TMJ specialist, Dr. P., should come through for me on Wednesday.
As far as my teeth go, I've explained a lot of it, but I've had 3 pulpotomies (root canals, teeth 11, 21, 45) and they've relieved a great deal of my tooth pain. The 35 and the 45 are very questionable whether they can be saved, but Dr. T. is trying her hardest. So far the 45 has been crowned with a Cerec crown (awesome procedure...so fast and easy!) and we're hoping it holds up over time. The 35 is due for the same procedure later this week. These 2 teeth were very badly damaged, losing most of the bulk of the structure and leaving the pulp exposed. Thankfully it retreated somewhat during the 3 months they were left alone and the pain level went down.
There are a whole slew of teeth in there that need pulpotomies (all the lower fronts) and many were cracked and lost chunks off the crowns. These will need restorations, I'm not sure exactly that means but I'm guessing a few more Cerecs. The 14 and 33 will be extracted this week, and bone grafts done at the same time to prepare the sites for implants later. The 33 especially needs the bone grafting as that was the site of one of the fractures. The 14 was vertically fractured and is damaging the bone underneath.
My bite is not great..."malocclusion", and I also have an open bite, meaning my front teeth no longer touch each other. This is a result of, obviously, the jaw fracture, and because my jaw still isn't all that great functionally I don't even really know where to put it when I close my mouth. Then there's the fact that all my lower teeth basically collapsed inwards during my healing. This was totally unexpected, and is a major reason for requiring braces. Removing any teeth down there, and at least 1 will be, will just help my teeth to collapse even more. So once the pulpotomies and restorations (crowns) are complete, I will get braces. These will straighten my teeth and help restore my occlusion. They will also help to make room for implants to the teeth that I will lose. Unfortunately, since implants cannot be moved, the orthodontics have to be complete before I can have a full set of chicklets. Until then, its a flipper. I also can only have temporary crowns on for the braces, and when they come off all the crowns will be redone with permanent ones. Of course, there might be another jaw surgery sooner or later to repair what's still wrong.
So I guess the long and short of it is, things are incredibly better pain-wise. I'm getting out of pain slowly and steadily, which is fantastic. Dr T is restoring my teeth and I feel so much better for that too (no more tiny shards of teeth, now they are looking a bit more normal, and my mouth looks more "full"). But I still have a long way to go....and it's a bit daunting to think about.
Music has always been a big part of my life, and I've found it can be an incredibly powerful tool to change your mood. So lately I've been listening to the song "Tough People Do" by Brett Kissel. I'll leave you with some lyrics:
That's the thing about life
The rain's gonna fall on us all
Your heart's gonna break some times
But there's no way around it, life is full of mountains you're gonna have to climb
But there ain't no crime in cryin'
You've just gotta keep on trying'
So remember, no matter what you're going through
Tough times don't last.....tough people do!
Just listening to this song can take my mood from a 2 to an 8 :)
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