Have your wisdom teeth out in the chair

Here's wishing you a blessed Christmas and happy and healthy 2014. And the last newsletter from Chiropractic Help for this year.

It's strange how in the practice, conditions often crop up several times in one week. One week it's shoulder pain, the next upper leg pain and, this last month, it's three women who have had severe migraine headache and facial pain after surgery in the mouth.

All three under general anaesthetic. Two after wisdom tooth extraction, and one after a tonsilectomy.

One of them was so severe, the headaches so bad, associated with a stiff neck that she was hospitalised with suspected meningitis, had a lumbar puncture, but in the end it was the TMJ anatomy that should have been more thoroughly examined.

Why women, you may reasonably ask? Simply because women have smaller mouths and surgeons, mostly men, have large fingers! Over-opening of the mouth under general anaesthetic, when you are unable to rebuke the doctor that he's hurting you, and bingo, you stand the possibility of severe jaw joint pain, with the resulting facial pain and migraine headaches; and occasionally life-long pain.

My advice: do your damnedest to convince your dentist to extract your wisdom teeth in the chair under a local anaesthetic.

Wisdom teeth

With our jaw bones gradually getting smaller, there is usually not room for the wisdom teeth and they have a propensity to crowd the other teeth causing them to mal-align, both with immediate neighbours and the molars from the jaw above or below, affecting chewing and the rhythm of the temporo mandibular joints.

In addition, they often impact or erupt in a partial manner causing a host of problems which you can read about on Wiki.

Simply because of their location so far back in the mouth, and the fact that food debris tends to accumulate behind the tooth, brushing and flossing of wisdom teeth is usually less effective. The net result is infection; redness, swelling and pain affecting the local area, but also spreading out into the jawbone, jaw joint, and even the upper neck where the sensory nucleus of the nerve is located.

And hence the usual practice is wisdom tooth removal before infection. It's wise, and I have no issue with the practice. Prevention is better than a cure, especially as wisdom teeth usually have smaller roots and are mostly easily extracted in the chair by your dentist.

Exactly when depends on where you live. In some countries wisdom tooth removal is recommended much earlier, even extracting perfectly healthy teeth, before they become infected, causing ear pain, jaw pain, neck pain, facial pain; and before the bone becomes more dense, making extraction more difficult and a greater likelihood of injuring the nerves and even the floor of the sinuses as the tooth is extracted.

And before the infected wisdom tooth, arrowed, begins to infect adjacent teeth as you can see is happening in the pic above.

The long and the short of it is that you are probably going to be getting your wisdom teeth pulled, if they haven't already been.

Surgical removal of wisdom teeth

There certainly is a place for infected and impacted wisdom teeth removal under general anaesthetic, especially as two nerves in the neighborhood may be injured.

But I strongly recommend you plead with your dentist to extract them in the chair under a local anaesthetic. At a fraction of the cost, without the risk of nosocomial, hospital-acquired infection, no danger from a general anaesthetic, and without the risk of injuring the disc in the TMJ.

In most instances it's no big deal in the chair. Grunt - loudly - if your dentist is over-opening your jaw. If it has to happen under a GA, then discuss it with the surgeon. Threaten him with a law suit, if necessary, if he injures your TMJ!

Case history: Wisdom tooth extraction and headache

A 30-year old woman consulted me with R TMJ pain, facial pain and severe headache, and upper cervical pain. Three months previously she had her wisdom teeth extracted under general anaesthetic.

On examination, there was extreme tenderness of the right TMJ with associated active trigger points in the right masseter, temporalis and external pterygoid muscles.

Fortunately there were no popping or clicking sounds from the TMJs, but there was delayed opening of the left TMJ.

Rotation of the neck, in both directions was painful, with a marked fixation of C2.

There were other details that I won't bore you with. It took six treatments of her upper cervical spine, jaw joint mobilisation and deep, painful soft tissue work of the muscles, to relieve her severe facial pain and headaches.

I'm hoping her condition will now stabilise; she's had to stop chewing gum. The next step is TMJ exercises. But there is no guarantee that this will not continue, and become chronic migraine and facial pain. It often does, but fortunately she didn't wait years before consulting me. If you're having trouble, don't delay. See your chiropractor.

Popping, clicking jaw joints

If the jaws are forced even wider, then the meniscus in the joint is injured, and the joint begins to develop a painful click when you yawn, bite into an apple, even kiss, often associated with facial and jaw joint pain and headaches.

Prevention is the key. If at all possible, have them out in the chair.

Take a proper holiday in 2014

There are few more vital parts of sparkling good health than a regular, minimum two consecutive weeks' holiday, three if you have a very stressful job.

It doesn't have to be expensive. Just a tent, hiking in the mountains? Camping, caravanning, a small cottage, all are an important escape from the daily grind. Do it, otherwise you get stressed up, angry, frustrated and depressed. Take time to smell the roses, to live in the present.

At the beginning of this newsletter, I wished you a happy and healthy 2014. Good health, by and large comes to those who make the right choices. And one of those is to make sure you get enough down-time.

It is important.

"Painters understand nature and love her and teach us to see her.
   It is looking at things for a long time that ripens you and give you deeper understanding."
         Vincent Van Gogh

This month I would encourage you to look, for a long time, at those around you who have reached a healthy, happy eighty; ponder their health; may it ripen you too, and give you a deeper understanding of how to reach eighty with all your marbles intact. And inculcate in you the desire to emulate them.

And so to 2014... it cannot and will not be a good year for us all. Old age, it reaches us all, consequences of bad decisions and habits, accidents and the unexpected will inevitably come to many. I wish you fortitude and God-speed in your pain if it turns out to be a difficult year.

Don't slip on the ice this winter; it can do nasty things to your pelvis.

Books

My apologies, nothing much on health books this month. If you're an American, you might like the classic, The Professor's House, by Willa Cather. I've just enjoyed it on my Kindle, dirt cheap.

Between writing books, I try to read a book a week. This week it's a Jane Austen, Mansfield Park. She is reputed to have edited her books 130 times, all with no computer. Remarkable, but that's why two hundred years later, we still love her books. This one's free on your Kindle. The Kindle paperlight is the best e-reader if you're thinking of buying one.

Google

Google has made some far-reaching changes in their policy and, I suppose in the long run it'll improve your web-browsing; it's meant that every webpage has to be completely restructured, sometimes with some very strange practices: removing italics, bold, even capitals, hyphens, links, headings. It's all very fluid at the moment, but don't be surprised if you see new york written without caps on the web!

It's extremely time-consuming, gnashing of teeth and, in the short term, you won't find much new and original on the web. Webmasters are feverishly trying to fix their pages!

Barrie Lewis DC and Bernard Preston DC!

PS. Feel free to forward this to family and friends, your chiropractor and even your medical doctor!

PS. As you know I love music. This is a must-see video from "Holland has talent." This little girl is unbelievable. Endure the build up in Dutch, you'll love Almira. http://youtu.be/_NfnSgYqM4M