Monday, June 30, 2008

Ask Bella: Hot tips

Q: Knowing what you know now, would you still go through the surgery? Is there anything you would change?

A: No regrets. I'd do it all again. Only this time, I'd be taking the homeopathic remedies before the surgery as well as after to help get the swelling down faster, I would have gone to lymph drainage massage as soon as humanly possible after the surgery instead of waiting two weeks to help get the swelling down, and I would have moved my expectations about being perfectly healed from three months post-surgery up to six months post-surgery. Oh, and I definitely would have upped my iron intake during my recovery.

Q: Any random tips/recommendations for any part of the process?

A: Do your research. Read all you can, look into natural remedies, know exactly what you're getting into, and keep a positive attitude and a sense of humour and you'll breeze through it (as much as anyone can "breeze through" major surgery, that is.)

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Thursday, June 26, 2008

Read it and weap, my friends!

Last Friday, in physiotherapy, I hit...

...wait for it...


Oh yes, my pretties, you read that right. That's like a normal jaw opening, people! (As if anything about me or my jaw could be considered "normal", but that's beside the point, isn't it? And did I mention 40 freaking millimetres? Oh, yes, I guess I did.)

It's interesting to me that after all of the struggling and being stalled at 38 mm for the past several appointments, last week, my jaw joint and muscles seemed to loosen up for no apparent reason. By the time I made it to physio, it was as though my body was just ready to go there.

My physiotherapist said she could tell something was different. "Before, I was limited by your jaw joint. Now, I'm just limited by your pain," she said as she wedged her hands into my mouth and pried my jaw open, causing tears to roll down my cheeks.

"Cool! I made you cry!" she exclaimed.

I don't even care about the pain anymore - bring it on. I just want to hit 45 mm by the end of summer.

Tuesday, June 24, 2008

Ask Bella: Drooliscious

Q: When your jaw was wired shut, did you drool constantly, or is it just me? I feel like a rabid dog. It's not cute.

A: It seems so long ago that I had my jaw wired shut, but from what I remember, I didn't drool all the time - just when I was eating, which was decidedly not cute. (Though my boyfriend found it endlessly amusing when I would smear chocolate pudding all over my face without knowing it, because my chin and lower lip were numb.)

I have a feeling that I didn't drool much because I was able to get my swelling down quickly, and swelling would interfere with being able to close your mouth and keep the lovely liquids where they belong. Or maybe some people have more drool than others? I dunno.

Hang in there! One day, the wires will be gone and the drooling will be all but a distant memory. That, or all the drooling will dehydrate you to the point that your mouth will be no longer able to produce saliva; either way, it's gotta end sometime, right?

In any event, I bet you're still pretty darn cute, Chinderella.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Sunday, June 22, 2008

Ask Bella: The real basics

Cecilieaux asks: Okay, what I have never understood is...why? (Or maybe I missed it.)

A: You missed it only if you've read all my archives, because I've been dealing with jaw problems for more than two years now. So you don't have to go digging for it, here's the story of why I subjected my face to the bone saw.

I had an overbite, which isn't a big deal for most people, but in a few, it can cause jaw joint problems. I was fine the majority of my life, until I started doing a lot of stage work, singing, acting and using my jaw a lot more than I was used to. Then, I developed crippling migraines and jaw pain while I was a poppy/jitterbug/citizen of the Emerald City in an extended run of the Wizard of Oz musical. Because of the overbite, I was thrusting my lower jaw forward in order to sing and enunciate properly, and that was putting strain on my jaw joint.

I saw an orthodontist, jaw physiotherapist, and orthognathic surgeon and all suggested that this surgery could help my TMJ problems get better. Of course, it wasn't guaranteed, but the stats I was told were that 70 per cent of people get better, 20 per cent stay the same, and 10 per cent get worse.

Singing is such a huge part of my life and my expression of who I am that I couldn't imagine not being able to do it because I was in too much pain. The TMJ pain was also interfering with my social life - I found myself not spending as much time with my friends because I had too much fun. After a night out of talking, laughing and smiling, I had migraines that kept me at home and alone for four days straight.

I had a strong feeling that for me, the surgery would work. I'm still recovering and haven't tried going back to the stage yet, so we'll see what happens in the next few months.

Thursday, June 19, 2008

Informed consent

Before I went in for jaw surgery, I was sent a very detailed (we're talking four pages here, people) consent form about the procedure. Not only did I have to read it and sign it, but I also had to initial each point to ensure I understood what I was getting into. Fortunately, I had done all my research before I even had my braces put on, so I knew the risks, but this form still filled me with fear and dread. How could it not?

I thought you might be interested in the consent form, so here it is: everything that could possibly go wrong with your surgery, but probably won't.


Orthognathic surgery is sometimes called "Surgical Orthodontics" because, just as an orthodontist repositions teeth, an oral and maxillofacial surgeon uses orthognathic surgery to reposition one or both jaws. Just as "orthodontics" means "straight teeth", "orthognathic" means "straight jaws." In fact, because moving the jaws also moves the teeth, orthognathic surgery is usually performed in conjunction with orthodontics so that the teeth are in proper position after surgery.

The objective of orthognathic surgery is the correction of a wide range of minor and major facial and jaw irregularities, and benefits include an improved ability to chew, speak and breathe. In many cases, an enhanced appearance can also result.

Orthognathic surgery is being planned for you and it is important that you understand the risks and benefits of the surgery. This is NOT a minor surgery and you have the right to be fully informed about your condition and the recommended treatment plan. It is important you are fully aware of all material risks and effects during and after the surgery.

For this reason, we are recommending that you read and review this document and ask any questions prior to the surgery. The disclosures and information in this consent are not meant to alarm you, but rather to provide information you need in order to give or withhold your consent to the planned surgery.


1. This is my consent for Dr. X and/or any other oral and maxillofacial surgeon(s) working with him and/or such assistants as may be selected by him/them to perform a mandibular advancement in order to treat the condition described as Class II malocclusion secondary to mandibular retrognathia.

2. The surgical procedure planned to treat the above condition has been explained to me and I understand the nature of the treatment to be to advance the lower jaw to improve the bite.

3. I have been informed of the possible alternative forms of treatment (if any).

4. My surgeon has explained to me that there are normal sequelae (after effects) and certain potential risks of the surgery, some of which may be serious. They include but are not limited to:

*Facial and jaw swelling after the surgery, usually lasting several days or weeks.

*Bleeding, both during and after the surgery, which may sometimes be severe enough to require a blood transfusion (less than one per cent). I have been advised of the opportunity for blood donation before surgery (if applicable) such that my own blood may be given back to me (auto transfusion if necessary). I further understand that there are risks with the process of auto transfusion.

*Allergic reaction to any of the medications or materials used during or after the surgery (less than one per cent).

*Delayed or non-healing of the bony segments; sometimes requiring a second surgery and/or bone graft to repair (less than one per cent).

*Relapse - the tendency for the repositioned bone segments to return to their original position, which may require additional treatment including additional orthodontics, surgery and/or bone grafting.

*Bruising and discolouration of the skin around the jaws, eyes and nose.

*Diminished sense of smell (if upper jaw surgery is done).

*A change in cosmetic appearance. Although this procedure is usually in part to restore jaw function, I am aware of some expected change in my appearance. This change is typically favourable; however, I understand that the changes cannot be exactly predicted.

*Loss of feeling, pain or tingling numbness in my chin, lips, tongue, gums or teeth, which occurs in a significant number of patients. These symptoms may last for several days, weeks or months, and I have been advised that there is a small chance that these changes may be permanent.

*Possible decreased function of the muscles of facial expression, which are typically transient or temporary but may be permanent in rare cases (less than one per cent).

*Scarring from the external incisions if any are required.

*The possible need for additional surgical procedures to remove wires, plates or screws (less than one per cent).

*In certain cases requiring bone cuts to be made in the narrow spaces between teeth, there is the possibility of devitalization of those teeth, which may later require root canal procedures and rarely may result in loss of those teeth (less than one per cent).

*In upper jaw surgery, the sinus will be affected for several weeks and there may be the need for further sinus surgery to remedy any lingering problems.

*Post-operative infection which may cause the loss of adjacent bone and/or teeth and which may require additional treatment for a long period of time (less than one per cent).

*Change in the position of the jaw joints, which may cause post-operative discomfort, bite change or chewing difficulties. If the jaw joint symptoms existed before surgery, there is no guarantee that there will be an improvement, and in rare cases, there may be a worsening of the symptoms after surgery.

*Stretching of the corners of the mouth, which may result in discomfort, cracking and slow healing.

*Inflammation of the veins that are used for IV fluids and medications, sometimes resulting in pain, swelling, discolouration and restriction of arm or hand movements for some time after surgery.

5. General anesthesia will be used for this surgery, and I have been advised of the risks of general anesthesia, including bronchitis, pneumonia, hoarseness or voice changes, cardiac irregularities, heart attack or death. We encourage you to discuss this with your surgeon or anesthesiologist. I am aware of the importance of not having anything by mouth, including clear liquids, unless specifically authorized by my surgeon or anesthesiologist (for eight hours prior to my anesthetic.) General anesthesia without a totally empty stomach may be life-threatening!

6. I realize the importance of providing true and accurate information about my health, especially concerning possible pregnancy, allergies, medications and the history of drug or alcohol use. If I misinform my surgeon or anesthesiologist, I understand the consequences may be life-threatening or otherwise adversely affect the results of my surgery.

7. If my teeth are wired together after this surgery, I understand there are certain associated risks and complications: oral hygiene will be diminished, there may be resultant gum disease, my teeth will feel slightly loose for some time after the wiring, and there is always some concern about airway obstruction. I agree to carry wire cutters with me at all times when my jaws are wired and to avoid the use of alcohol and other activities that may cause nausea or airway problems.

Information for Female Patients

I have informed my surgeon about the use of oral contraceptive or birth control pills. I have been advised that certain antibiotics and other medications may neutralized the preventative effect of birth control pills, allowing for conception and pregnancy. I agree to consult with my personal physician to initiate additional forms of contraception during the period of my treatment.


The fee for services has been explained to me and is satisfactory, and I understand that there is no warranty or guarantee as to the result and/or cure and that my condition may return or become worse.

By signing this consent form, I acknowledge that I have read it completely and understand the procedure to be performed, the risks and the alternatives to surgery (if any). I have had all of my questions answered to my satisfaction. I was under no pressure to sign this form and have had sufficient time to fully review this form and consider my choices. I have made a voluntary choice to proceed with surgery. I certify that I speak, read and write English.

Monday, June 16, 2008

Ask Bella: Physiotherapy and range of motion

Q: I was curious about the "opening of the jaws" predicament you've been having. I was wondering, if you had tried harder or more often during the beginning of your recovery, do you think you would have needed to visit a physiotherapist at all? At what point did your oral surgeon suggest you see one? Do you have any advice about these exercises?

A: Once my jaw was unwired, my surgeon gave me jaw opening exercises to do. You put your index fingers on your bottom teeth, close together in the middle, and your thumbs on your upper teeth, far apart. You use your fingers to push your mouth open as far as you can, and then you hold it for ten seconds and do four repetitions, four times a day.

My surgeon wasn't the one who told me to go to physio, though I'm sure he would have at some point. I had been having problems with jaw pain for years, so I have a physiotherapist who is a jaw specialist; he was the one who recommended I start going as soon as possible after the surgery. My surgeon didn't want anyone putting pressure on the jaw for one month after the surgery, so I waited exactly one month and started going every week ever since.

At physio, they did stretching exercises and massaged my jaw muscles, and I did the finger exercises at home. A few weeks or a month in, they gave me the jaw jack to help. The thing with "the opening of the jaws" is no pain, no gain, so the rehabilitation is not fun.

I would take it slow at first, because your body is healing and you don't want to do anything to damage your jaw so soon after the surgery. Do some research in your area to find a physiotherapist who specializes in jaws and just talk to them and see what they think. Your surgeon or orthodontist might be able to refer you as well.

Q: I am six weeks post-surgery and have an opening of 27 mm, which my oral surgeon is not thrilled about. I try every day to do the exercises, but I do experience a lot of pain, particularly on one side of my jaw. Do you think 27 mm is that horrible? I've read about your struggles with that device your physiotherapist gave you. Do you have any recommendations to make the exercises easier? Or to help me get a bigger opening, without using any kind of device?

A: When I was at six weeks post-surgery, I had an opening of 25 mm as well, and my surgeon said that this was average. So, if you're at 27 mm, you're on track in my surgeon's world.

I'm a very big fan of physiotherapy, myself. My physiotherapist will massage my jaw muscles and do milder stretches before getting into the bigger ones. This helps with the pain and also advances my mouth opening far more than I could myself. You could always do some massaging of your own muscles before and after the exercises to help make them easier.

I've also taken painkillers before doing the exercises on my own and gotten good results. Though you do have to be careful not to push yourself too far and injure your jaw. Good luck!

Oh, and in case you were wondering, I'm now at four months post-surgery and I have a 38 mm opening. Two to seven millimetres to go. Hooray!

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Saturday, June 14, 2008

Ask Bella: The basics

Q: What exactly was done in the surgical procedure? Was it upper or lower jaw? What was done?

A: My lower jaw was advanced 4 mm. I was in braces for two years and then had the surgery on Feb. 12. It was a bilateral sagittal split osteotomy (BSSO) where they bisect the bone, slide it forward on itself and then secure it with three screws on each side. The screws stay in my jaw forever and don't dissolve. I have my X-Rays posted on the site, before and after, as well as an animation of what the surgery involved and actual pictures of someone getting the jaw surgery (very gory, just so you know.)

Q: How far along in recovery would you say you felt "normal" again (little to no swelling or bruising, easier to eat/drink/talk, etc.)?

A: I did a lot of research about homeopathic and natural remedies before the surgery and I feel like those really helped me get the swelling and bruising down fast. My swelling and bruising was pretty much gone after two weeks. If you can get the swelling down quickly post-surgery, it's easier to talk and be understood as well as eat when your jaw is wired shut.

After I had my jaw unwired, I was unable to chew anything - just eat mushy foods, as my muscles were quite weak. At about the six week mark, I was eating most things without problem, though at the 4 month mark, there are still things I can't eat, like fresh veggies and other hard, chewy foods. My surgeon says it will be six months post-surgery before I can eat everything.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Thursday, June 12, 2008

Ask Bella

Making the decision to have jaw surgery is a big one. I remember how scary it was for me. My brain was whirring with questions, but I had no one to ask who had been through it. I finally did find helpful people in some of the online jaw surgery support groups to answer my questions.

Since starting this blog, I've been getting a lot of questions via email and comments about my experiences from others considering jaw surgery. Since I know what it feels like, I'm happy to answer what I can.

And so, I present to you: Ask Bella. Over the next while, I'll be posting the most common questions I've been asked about my surgery and recovery. If you have any questions of your own, ask away!

Just send an email to smilingbella at gmail dot com or leave a comment on one of the Ask Bella posts.

Looking forward to your questions!

Tuesday, June 10, 2008

Soft doesn't mean bland

I wanted to share some of my favourite "soft food" recipes for those of you who are unwired but are still having problems chewing. These savoury dishes will hit the spot, for sure.

Hot Spinach and Artichoke Dip

1 package frozen spinach, thawed and squeezed out
2 cans of artichokes, drained and chopped
1/2 an onion, chopped
3 cloves of garlic, pressed
1 cup light mayo
1/2 cup light sour cream
1 cup Parmesan or Romano cheese
crushed chili pepper flakes, to taste

Mix it all up and cook in a slow cooker on high for one hour, or on low for 3-4 hours, until the cheese has melted and is no longer gritty. Serve with tortilla chips, wedges of pita bread or torn up pieces of soft bread if you're having problems chewing.

(This recipe is great because it is low-fat and is more vegetable-based than cream-based, unlike other spinach and artichoke dips.)

Eggplant Parmesan

1 eggplant
2-3 eggs, beaten
1 cup breadcrumbs
3 Tbsp grated Parmesans or Romano cheese
2 tablespoons parsley
salt and pepper
olive oil
tomato sauce
1-2 cups mozzarella cheese, grated
Parmesan cheese, to taste

Slice eggplant and sprinkle with salt. Set aside for about one hour to drain. Pat dry.

Mix breadcrumbs, Parmesan, parsley, salt and pepper in a bowl. Dip drained eggplant slices in egg and then into dry mixture. Brown eggplant slices in olive oil.

In a baking dish, layer tomato sauce, breaded eggplant slices and grated mozzarella cheese. Sprinkle with Parmesan cheese, cover with tin foil and bake in a 325 F oven for one hour.

Chana Masala

Olive oil
1 onion, chopped
4 cloves garlic, pressed
1 Tbsp curry powder
1 can diced or crushed tomatoes
2 Tbsp cilantro leaves
2 cans chickpeas, drained and rinsed
cayenne pepper, to taste
crushed chili pepper flakes, to taste
kosher salt, to taste

Cook onion in olive oil until caramelized. Reduce heat and add garlic and curry powder, stirring constantly, for about 30 seconds. Add tomatoes, cilantro, cayenne, crushed chili pepper flakes, salt and chick peas. Bring to a boil, then reduce to low and cook until chick peas are tender. If sauce gets too thick before chick peas are fully cooked, add some water. Adjust spices to taste.

Serve over basmati rice.


Saturday, June 7, 2008


This post-surgery anemia business is far more complicated than it first seemed. You think - okay, my iron levels are low, so I'll just take iron pills and eat some spinach.

Not so much.

The first thing I learned was that you have to take iron supplements with Vitamin C or your body won't absorb them. My doctor never mentioned this when she told me to take the iron; I got this information from a friend. So, one more pill to take.

Then, I decided to look up information on foods with high iron content so I could be sure I was eating right. I was surprised to learn that not only there is a list of foods that enhance iron absorption, but there is also a list of foods that block iron absorption. These include sweet potatoes, red wine, soy and spinach.

What? Spinach inhibits iron absorption? Isn't it supposed to be chock full of irony goodness? Well, it is, but it also contains an acid that blocks iron absorption. In order to absorb the iron in spinach, you have to eat it with iron absorption enhancing foods, such as meat, tomatoes, and Vitamin C-rich fruits.

Note to self: people put strawberries, oranges and bacon in spinach salad for a reason, not just because it makes the salad look pretty. Go figure.

Not surprisingly, the iron that is most easily absorbed by our bodies is found in meat, poultry and fish. Making it extra difficult for vegetarians.

So, I took my iron supplements with Vitamin C like a good girl for a few weeks and...nothing happened. I didn't feel any better. I was still exhausted and sick all the time. What the heck was going on? Was there something else horribly wrong with me?

On Monday, I went to see my naturopath and mentioned it to her. She asked what else I was taking the iron supplements with, and I named off my arsenal of capsules and pills.

"You have to make sure that you don't take calcium and iron supplements together. The calcium competes with the iron for absorption and the calcium always wins. Then, the iron is just this toxin floating around your body."

In other words, all that iron I had been taking these past few weeks was not absorbed, even though I was taking it with Vitamin C, because the calcium blocked the iron.


On the plus side, I started taking the iron away from the calcium on Tuesday, and by Friday, I had already started feeling better. So, there's hope for me yet.

Sunday, June 1, 2008

Homemade mouthwash

I have been making an effort lately to use products that are more natural and don't contain chemicals that could be carcinogenic. A lot of toothpastes and mouthwashes contain chemicals like sodium lauryl sulfate or sodium laureth sulfate, which are skin irritants and potential carcinogens. These chemicals give products the foam that makes us feel like they're getting our mouths extra clean. They're there for psychological reasons more than anything and may actually be harming us.

And let's face it, those of us with the train tracks on our teeth are going to be brushing and rinsing more often than the general populace, so we have a greater exposure to these chemicals.

So, I've switched to natural toothpaste with fluoride and I've actually started making my own mouthwash, something I never in a million years thought I would do. But my naturopath gave me a really simple recipe for mouthwash that I could make with ingredients that I just happened to have lying around my house, so I figured, "Eh, why not?"

It was worth a shot, and it would certainly be cheaper than anything I was using now, particularly in the quantities I've been using it.

Here's the recipe:

Homemade Mouthwash

2 ounces of water
¼ tsp of baking soda or sea salt
1 drop of pure peppermint oil
1 drop of tea tree oil

Mix together. (I quadrupled the recipe and mixed it up in an old mouthwash bottle so I'd have some on hand for awhile.)

I used it for the first time a few days ago and, at first, was a bit put off by the taste. The baking soda (or salt) makes it salty and the taste of the natural oils takes a bit of getting used to, as they're not coated in sweeteners like they are in manufactured products.

But after awhile, it's not so bad. It works really well in my Water Pik to help get the crud out of my braces. I think it would have been handy as a variation on a salt rinse when my jaw was wired shut as well, had I known about it.

Also, I discovered that if you let it sit for awhile instead of using it right away, the salty taste goes away as the flavours meld together. So, mix up a batch instead of just making it when you need it, and it will be fine.

If you don't have the essential oils handy, it will cost a bit upfront to start making your own mouthwash, as the oils are usually $10 each for a small bottle. But, as you're only using a small drop (or four), that little bottle of essential oil will last a long, long time.

If you try it, let me know what you think.


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