Metal Mouth Message Board

Hello all,
I thought I'd post my story in case it's useful for others. I also have a few questions for those that have been through this already.

I am 4 weeks post op tomorrow. I had BSSO and Lefort 1 (2 piece, I think you'd call it), and my two top back molars were removed.

On December 6, I had my surgery. All went very well, according to my surgeon. My time in the Recovery room was excellent. In hindsight, I must've been heavily medicated to be so relaxed and so sleepy I watched people come and go for hours, with barely a coherent thought in my brain. I remember coughing quite a bit and couldn't clear the mucous in my throat. It didn't bother me but the nurses were concerned and watching me closely. I felt a bit nauseated at one point and told the nurses and they pushed something into my IV and that was the end of that. This also happened the next day with a similar result. Lucky me. Eventually, I was shipped off to my shared room with my surgeon's other patient for the day. We were pretty quiet. We had a night nurse assigned just for us. I guess people have trouble breathing and freak out. While my airway was small I could breathe and slept, dozed and laid there quite comfortably all night. I didn't even hear my roommate. I used the little morphine (or whatever it was) pump to give myself more pain medication very consistently.

Day 1 the nurse took out the tube that went from my nose to my stomach, after confirming that my stomach was actively digesting any blood that might be dripping into it. He was impressed. (Good for me! Go stomach). Eventually they took away my pain meds from my IV and I was expected to swallow the liquid form. Not very good. They had me on an every-six hours schedule tylenol+advil, which no one bothered to tell me, so I thought they'd forgotten about me. Things started to hurt a lot after about 4 hours and no one came by. Swelling was increasing also. When I went to the bathroom, with help, my nose would drip blood. But in general, it was OK. The dietitian that I'd met with prior to surgery gave me meal plans that included 8 "meals" per day. Crazy I know, but based on this, I felt like they were starving me in the hospital when they only brought me food 3x per day. I managed to swallow down my 3x per day apple juice, milk, and ensure. I was not hungry at all. And it hurt and was difficult to swallow. I think the difficulty was due partly to swelling, pain and numbness. In any case, it took me close to an hour to have each meal. The crazy thing, for me, was being able to lay my head back and any time and just fall asleep. Really unlike me! I complained to the surgeon when she came that evening that I wasn't getting enough pain medication, that they weren't feeding me enough, and my ice pack had broken and they didn't know where to locate a replacement. I was ready to go home. In hindsight, I was totally cranky from the pain. I was discharged.

The first week was very hard. Yes, I was swollen (although not a lot according to my surgeon. She said I barely bled during surgery and it was so easy for her. TMI!). Yes, I could barely get in air through my nose and my banded teeth and my nose was raw. Yes I was exhausted and could sleep at a moment's notice. However, the real worst part was the pain, which really unexpected. I spent a lot of time on this forum to help myself be prepared but was very unprepared for the pain. I think I'd focused on the (more common) situation of people having only minimal or moderate pain. Mine was more. Even the surgeon seemed a little bit taken aback when I described it. I had to call for refills of codeine and then asked for something stronger. I was taking either tylenol or advil or codeine (and dabbled in morphine) every few hours, on a rotating schedule around the clock, and even then my pain was only knocked down to a 7 or 8 out of 10. Sometimes it didn't feel like the pain medication was doing anything at all. It felt as though I could feel every incision, every cut and it was deep fiery pain that was relentless. Even more, the whole inside of my mouth as though it was covered in blisters or sores (it was not). My tongue, my throat and all through my mouth. My teeth ached. Swallowing food was a trial and the liquid medication was awful and burning. The inside of my mouth, as far as I could tell, was NOT covered in sores. The surgeon described it as neuropathy. She said there were three types of nerve sensations: numbness, tingling/buzzing (not her terms, just my recollection), and pain. My chief complaint was the latter (though I had all three!) and it was not common. She even went so far as to describe remedial actions that could be taken in a few months--anti-epileptics and anti-depressants, which at low doses can address nerve pain. This freaked my out (why not start me on those now! make it go away! what is happening!) but my husband told me after that what he heard is that in the off chance that it does not go away there are ways to address it. So that calmed me a bit. However, this pain was really all very difficult and scary and is my main reason for writing here. I don't want to freak people out but I felt like it would have been easier if I'd been prepared for this a bit better. I'm holding onto the fact that it IS improving and that it WILL continue to get better. My first week was also plagued by migraines, which unfortunately I get very frequently. They were not very well controlled in this first week. So that meant the front of my face was on fire and the whole rest of my head had a migraine. Not at all fun. Much of the time I just sat in place and looked around, with little energy or ability to focus on anything. It gradually got better starting at about day 6.

Currently, I am only taking pain medication rarely during the day. The pain is almost always there but is at a manageable level (2-5 out of 10). At night, I feel it more (5-7) and am still taking about 2 doses of tylenol or advil. I rarely take the codeine anymore. I am using heat packs. It feels nice. Is there anyone out there that can identify with this level of pain at about 4 weeks? Is this "normal" or still well outside the norm?

I feel a lot of stress/tension from my jaw joint. It feels like it's all pulled taut, which makes total sense when I think about it. It's very sensitive to the touch, on the outside. However, even though it makes total sense, I didn't really expect this pulling/tension feeling, either because I didn't pay attention in my random walks through this forum, or didn't see it very often. I've done a bit of super gentle massage but am not sure if it's making a difference.

My teeth hurt as though I've just gotten an adjustment (see "splint" paragraph below--I'm guessing this is the reason). You know that loose-tooth itchy kind of feeling?

I did have a two instances of clenching my teeth or biting in my sleep (in one instance I was dreaming of eating frosted flakes. ), which caused me to awaken to searing pain but this diminished pretty quickly and I don't seem to have done any lasting damage!

But enough about pain.

Unlike most people, I have not lost weight. At most, I've lost a pound or two, but I don't think that counts. I forced myself to eat, and I had the image in my head of 8 meals per day from the dietitian, so I had a high standard to look up to! In the first few weeks it was difficult to eat and I still don't have much appetite. Smoothies and even milk were too acidic. Ensures were thick and gross. Soup was yuck. Everything was bad. Perhaps my metabolism is strange because I was not able to gain weight before the surgery either. Lucky me, I guess. I have been having at least 2 ensure a day, and have some really great smoothie books that were useful after about the first week (ask me if you're interested). I'm aiming for tons of protein and the smoothies are giving me lots of vitamins from fruits and vegetables. Raw eggs with milk (aka eggnog) have also been useful for giving me calories and nutrition. I'm also taking vitamins (some liquid ones, yuck). I added in extra B vitamins to help out my freaked-out nerves. I was able to drink, slowly, from a cup after about the first week. That made it easier to get more food in more quickly and it wasn't as tiring/tedious, and wasn't as painful because it was over with quicker. My favourite meal so far (tried in week 3) has been refried beans with finely grated cheese, salsa and sour cream. A break from the sweet!

I have a splint wired into my top braces. I sound like I have mouth full of marbles when I talk, but my family is all used to it and I'm not yet back at work so it hasn't mattered too much. Honestly everything else that would've been aggravating has been eclipsed by the pain . I'm not sure when the splint comes out but I hope by 6 weeks. Maybe sooner?? I see my surgeon next week (4.5 weeks). Dare I hope? The split has also been a bit of a pain because I think it has forced many of my teeth to be pushed further into my gums (retruded) and I imagine, but am not sure, that it's putting stress on my jaw joint because it's forcing my mouth open at a different angle than it would otherwise be. It's been interesting to track my perceptions of the splint over time. In the hospital I had the surgeon describe the splint because I couldn't open my mouth wide enough to see what was going on and couldn't really feel things well because I was numb. Then, I could feel my lower canine tooth "hooking" into it's assigned grove on the bottom side of the splint. Over time I could feel my left molars fitting into their grooves, then the right molars. All of this progressed as some of the numbness went away. I now know what the splint looks like and how it fits in my mouth and where my teeth are supposed to go in relation to it! It's reassuring to know my teeth are fitting in their assigned places. I use my Waterpik with the pitpocket attachment (I think that's what it's called) to clean the splint. This attachment gives a narrow jet of water and is only supposed to be used on the lowest setting. I position it just above the edge of the splint and angle it down toward the inside of my mouth. I can feel the water coming out the back end. It's the best I can do for cleaning this blasted thing.

I'm still sleeping on my wedge pillow. I don't know what I would've done without it. It's been great. I also use an airline neck pillow (based on a tip from someone on this forum) and it's also been great. I position it so I'm resting my head sideways, but nothing is touching my jaws. I don't think I've even tried laying flat at all. It doesn't sound inviting. How long did you sleep on an incline. Is there anyone out there that was still sleeping on an incline after 4 weeks or later?

Stitches all are healing and they have fallen out. They looked like little insect legs in the sink. I didn't even look at the incisions for the first few weeks. Too sensitive an area and too swollen to really see

In terms of swelling and how I look, I have swelling in the front of my cheeks and my upper lip. There is some swelling in my lower cheeks and along my jawline, but less. I mostly look like a normal person to the casual observer as long as I don't try to talk (what with the splint and all). My nose is different but even my mom can't see it. Other than that, I don't think I can tell yet if I look different. I mean, I certainly look different because of the swelling but other than that I'm not sure. Even my side view looks about the same (?) except for my nose. I have a hard thickness along my jawline on the bone, well ahead of where the jaw was cut for the advancement. I'm not sure what it is. Because of the splint, I look like I still have a significant overbite, as before. Really, also because of the splint, I can't see much of my teeth at all! I look a lot like Hannibal Lecter. My lower teeth have come out of alignment because a bracket broke during surgery. I guess they think they now have free reign to wander around! Also, because my left maxilla was moved to the left a bit, there's a few milimeter new gap between two of my teeth on the left top side (in front of the canine)! I'm not sure how that's going to get fixed. Anyone know? I'm sure the orthodontist didn't have this in her plan, as my upper jaw surgery was a bit of a last-minute addition. Are all the molars going to have to come forward and won't that screw up the alignment of how my upper and lower molars are meeting?

I am still brushing with a 0-2 year old toothbrush most of the time. In the beginning I only brushed the front teeth. After about 3 days, I could get a bit further back--outside of teeth only. After about a week I was able to get inside my mouth to brush my long-suffering teeth and gross tongue (I got inside by forcing all the bristles down as they made their way inside, past my teeth as I opened as wide as I could). Based on a tip from someone on this forum, and especially in the beginning, I brushed each tooth with little circles. The normal side to side movement that I would use for brushing seemed too risky for the very sore back of my mouth and hurt my sensitive swollen cheeks. My routine now consists of swishing a few mouthfuls of water to get rid of larger particles, then using Waterpik (low setting), then brushing, then using the Waterpik with the pik pocket attachment to clean the splint, and then rinsing with salt water (I"m all done with the Peridex mouthwash that was prescribed for the first 10 days). I haven't flossed. That's normal, right? When did people start flossing?

I think that is all I have to say. I hope some of you are still reading! Feel free to ask questions or share experiences, and I'm hoping for inputs for some of my questions. My best to all of you. Definitely an experience so far!

I’m just in regular braces so can’t offer you any practical advice, but just wanted to say that you posted an interesting, eye-opening read. By the sound of it the pain is slowly reducing for you, so hopefully in time it will get even better! I’m sure the outcome will be worth all the pain.

AndAndAnd: Thanks! I'm glad my long, long post was interesting. I appreciate you posting to say so.

I wanted to add that my surgeon gave me the go-ahead to use the Water pik right after surgery (I know some people have been advised against using it, so check with your surgeon) and that I'm super careful with the pocket pik attachment. Basically I place it in position at the top margin of the splint for each tooth (just below the bottom edge of the braces on my top teeth) and check it visually. I keep it on the lowest setting. I am especially careful on the sides of my mouth and don't go all the way back. I can imagine that if the strong stream of water were directed into a suture line it could cause damage and so I'm especially careful in the back where I have newly healing skin on both top and bottom and, as far as I can tell, at the back of my cheeks.

I'm over 3 months post-surgery and I no longer have pain or tightness. In retrospect, aside from the nerve pain that dogged me for the first several weeks, I think the splint and tight elastics were the source of many lingering issues. I am still wearing fairly tight elastics. I only need to wear them part of the time and I wear them during the day to avoid clenching during my sleep. This seems to have slowly resulted in my teeth becoming less sensitive/painful.