I don’t remember the first time I broke a tooth, but by the time I was a teenager, I knew it wasn’t normal to chip teeth as often as I did. I had the typical yearly checkup and cleaning with my dentist, but more often than not, I would need to book a second, third, or fourth appointment during the year to help patch up a tooth that inexplicably broke. Things like raw carrots, almonds, chewing gum, and candy were eventually all "no, thank you"-ed to avoid yet another trip to the dentist.
As an adult, I would come to find that a variety of factors played a role in my awful teeth. After genetic testing, a group of doctors and dentists determined that I had a condition called amelogenesis imperfecta; long story short, my enamel sucks, and I need crowns. But, in order for the crowns to be most effective, jaw surgery was necessary to correct a misalignment in my jaws.
My lower jaw grew straight down, instead of curving outward as it should have, and my upper jaw (palate) was too narrow. This created about a 4mm gap between my upper and lower teeth. Without surgery, the crowns would not have proper contact points and would wear down at an accelerated rate.
I wasn’t thrilled with the diagnosis, but I began the process of reconstruction. Three years after the initial consult, and a year and a half of braces later, it was time.
Waking up in that hospital bed October 8, 2014, was one of the most surreal moments of my life. I knew what had happened, but had absolutely no feelings about it. My surgeon took about 4.5 hours to install a variety of titanium screws and plates in my face, widening my palate and lengthening my jaw from my sinus cavity all the way down to my chin. My x-rays became a lot more badass really quickly.
I spent the first 36 hours post-surgery recovering in the hospital, hooked up to intravenous morphine. My first night, I remember waking up each hour to click the button on my patient-controlled pain device that would give me an extra hit. I didn’t know if the machine would continue to distribute medication while I was sleeping or not, and I couldn’t very well open my mouth to ask after being wired shut. I didn’t feel any pain, but I was also going to do everything in my power to make damn sure that didn’t change. I was completely terrified of the pain that (honestly) never came.
Then there was the swelling. Oh, the swelling. It tends to peak at about day-three post-op, but that’s not to say that the first couple days are any less freaky.
I remember the scariest moment in the hospital was when my swelling starting to compromise my ability to breathe. It started slowly; throughout the first full day of recovery, it got more and more difficult to take in air through either my nose or my mouth. I pressed the call button to get a nurse into the room. After a couple of minutes, she arrived, and I frantically scribbled out "hard to breathe" and "SCARED" on a sheet of paper. She did a quick check on my vitals and told me my oxygen levels were still fine. I would have shouted if possible, but instead I underlined the "SCARED" again on my sheet of paper, and tapped it twice for more emphasis. I did my best to not cry or hyperventilate, as that would surely just make the situation worse.
After a beat, the nurse nodded and came back with some plastic tubing cut in half. She handed the two pieces to me and said, "OK, stick one of these on each side of your mouth. It will help." While she held a mirror, I successfully found my cheeks, gently stretched the corner of my mouth and inserted the tubes. The relief was instantaneous, and at that point I knew I would be OK. It’s insane to look back and realize that something as simple as a plastic tube (no bigger than a straw!) was the only thing standing between a complete and total freak out and knowing that I was going to recover.
About needing a mirror to find my cheeks — this was another thing I wasn’t mentally prepared for: the complete loss of sensation in my face. From my eyebrows down, everything was swelling and completely numb. I had to use my hands to find the corner of my mouth to insert the syringe that I was using to eat (though perhaps "eating" is not the right term). My glasses pressed against the sides of my face. To this day, I don’t have complete sensation in my lower lip and chin area, but apparently this isn’t totally out of the ordinary. Some patients never regain full feeling as a result of the nerves being stretched or damaged beyond repair during the operation.
Once I got home, I would occasionally run my hands down the side of my jaw; I was looking for the new curve in the bone halfway down that only really became apparent after the swelling had started to subside. One day, I was walking through the kitchen, and I reflexively ran my hands along my face. This time, I stopped dead in my tracks and started to well up. My mom saw this and rushed over, afraid that I’d finally tapped into the pain that I’d been promised by every doctor/dentist/surgeon I’d seen, but through my clenched teeth all I could say was "I have a jawline! And a chin!" as the tears started to fall. If I could have felt my mouth, I would have been grinning like an idiot.
Given that this was the whole point of the operation, she seemed a bit surprised that it was making me emotional a week and a half after the fact. But it truly didn’t feel real until that curve was traceable by my fingertips. Beyond eating, which is obvious, it was difficult to do anything while wired shut.
In the definition of poor timing, our family dog, Ollie, needed to be put down less than a week after my surgery. We weren’t expecting this, and it was difficult to process. My mom and I said goodbye, then my dad loaded her into the truck. My mom was completely heartbroken. As my dad drove away and my mom started crying, I tried to hug her. But I was afraid of her bumping my mouth, so I carefully angled my face away from her shoulder, which put an awkward distance between us. I tried to tell her that everything would be OK, but it came out in an indecipherable mumble. I had to write down my words of comfort, then tap her on the shoulder to show her the paper.
Not being able to talk to my mom and give her support when she needed it most was awful. I also had to be careful with my own emotions and tears; nose-blowing is forbidden for the first six weeks post-op, and if I cried and got too congested, my breathing struggles would only be amplified.
It was my face that underwent the most dramatic transformation, but I struggled with the changes to the rest of my body as well. Before the operation, my doctor advised me to gain at least 10 pounds, because maintaining my weight after surgery would be impossible. I spent the four weeks leading up to my surgery date eating everything, exercising little, and struggling to fit into my jeans. After waking up in the hospital, the combination of weight gained and the steroids used to combat potential infection had me at 15 pounds over normal. I felt awkward, uncomfortable, and unattractive. In the grand scheme of life, it isn’t a lot, but 15 pounds in just over a month felt like I’d lost my body. I was worried that I’d never feel as strong and capable as I had before. I’ve been athletic my entire life, and it scared me to think that I may never reclaim that identity.
And the doctors weren’t kidding about the weight loss either. Less than a month later, my weight had dropped to eight pounds under normal. This was a total swing of 23 pounds in less than two months. I also picked up a stomach flu somewhere in my third week of recovery, and couldn’t keep even simple juices and shakes in my system for long. After a couple of days of this, I felt completely weak and defeated. I’ve never felt that helpless before or since, and waking up each morning with a face that was still twice its normal size was just the cherry on the sundae I still couldn’t eat.
In the early recovery days, I had an intense fear of my face being bumped, or of contracting an infection in any of the surgical sites. The stitches inside my mouth terrified and disgusted me. I was worried that I’d need to have the plates or screws removed, that my body would reject them, and I’d be stuck in a never-ending cycle of revision operations. It felt like at least one of the complications would be inevitable, and I was constantly on edge waiting for the other shoe to drop.
And even though it was seemingly unrelated, I remember talking to my mom and aunt about my failed relationship from the previous year, the partner that I had started this process with. Despite having no doubts about our break-up, I mourned the fact that I was now in this alone. He was supposed to be there, to be by my hospital bed those first few days, and to help me eat after I came home, and to comfort me when I was scared. During the whole process, my family was absolutely my bedrock, but our break-up wasn’t quite a year gone before the surgery. It was much harder than I expected to mentally process a major operation while simultaneously handling the fall-out from our relationship, which included a phone call to the police and court dates that only recently ended. Some friends and family told me that the loss I felt was hard for them to understand.
The waves of emotions carrying me through recovery felt unrelenting. I noticed after the first week that I felt every emotion at 10 times its normal strength. I wasn’t just angry that I couldn’t recognize my face and body, I was furious. I wasn’t just sad to be missing out on six weeks of my normal life, I was completely despondent, almost inconsolable. I had more than my fair share of "Why me?" pity parties, cursing the universe that I had to be the one to be dealt these cards. I felt out of control of not just my body, but my mind.
As the swelling went down and my body started feeling stronger, I’d just be coming to terms with my appearance, abilities and limitations before that would all shift again. Even four days could make a dramatic difference, and then I’d see no visible changes for months at a time. It was emotionally exhausting to relearn, over and over again, how to love and accept my body and my new face.
I was pronounced safe to return to normal activities after six weeks, and fully healed after three months. But my head and heart took a little longer. My teeth were pretty ravaged by the braces and the surgery, and if I had thought that they didn’t look great before, it was much worse after. They were heavily stained and chipped, and there were new gaps between teeth that the braces had pulled into new positions. There was nothing that could really be done about it — not until the prosthodontist began his work with the crowns.
I tried not to let it bother me, to see the bigger picture and the light at the end of the tunnel. But there were days where I felt completely demoralized when I caught my smile in the mirror in all its wine- and coffee-stained, chippy glory. I love to smile, but some days I just couldn’t bring myself to do it. It was a little heartbreaking every time I felt myself cover my mouth with my hand or pause before doing something that once felt so natural.
Slowly, I started to find myself again. All the work was finally completed on April 25, 2016; start-to-finish this process took almost five years. My permanent crowns have been placed, and I’ll now be able to visit my dentist on a once-a-year schedule again, like a normal adult. There’s no visible scars on my face, and no outward reflection of the amount of time, work, and money I’ve put into repairing what I was unlucky enough to have been born with broken.
I actually find it hard to wrap my head around the fact that this process is finally complete. I’ve been looking forward to this day for so long, and now that it’s here I don’t know what to do next.
I would do this all over again in a heartbeat, no question. I’ve been fortunate in so many ways to even be offered the chance to correct all my dental issues. But I wish I had understood from the outset just how difficult it would be to totally recover from this.