Dental Trauma

By: Loolwa Khazzoom, Founder, Dancing with Pain

July 6th, 2009 • Patient AdvocacyPrint Print

Here’s the back story on my experience of dental trauma, in the form of a letter I sent to the head dentist where I had a botched crown procedure a few years ago.

April 16, 2006

Dear Dr. P,

I am writing to share with you my experience in trying to get a crown done at your office. My intention is to give a balanced picture of what I have gone through – both because I feel the need to express it and so that you have this feedback for future patients.

When I returned to the Bay Area about two months ago, I asked one of the staff at my doctor’s office for a dental referral. She spoke very highly of you, so I scheduled an appointment shortly thereafter, specifically requesting to see you. I was therefore surprised to be taken to Dr. W when I showed up for my initial consultation. She seemed very caring and professional, however, and I had not yet met you; so I felt fine scheduling to have my crown done by her.

When I showed up at my appointment on Wednesday March 15, I expected to be in and out within an hour, as has happened with previous crown work at other dental offices. I further expected that I’d be numb for a couple of hours after, then that would be the end of the dental work. Instead, I entered a nightmare I could not have anticipated, and I’m still suffering from it today.

Dr. W started off by giving me two injections of novocaine in the lower left side of my mouth. About 10-15 minutes later, she checked for numbness. While I was numb on the whole front side and left portion of the back side of my lower left gum (I could feel the pressure but not the prick of the instrument), a portion of the back side was not numb – ie, I could feel the prick.

Without consulting me anymore than saying, “I’m going to give you more novocaine to make you numb,” Dr. W then injected me two more times, in the upper left side of my mouth. After one of those injections, I felt terrible pain, and my jaw seemed to freeze. I told Dr. W I’d need some time before I could open my mouth for the crown treatment.

After about 15 minutes passed, the entire left side of my head was numb – from my chin to the top of my head, including my ear and up to the edge of my eye. I had never gotten numb all over like that previously, and I had never had more than two injections before, so I felt frightened that I may have been given too much novocaine.

When I expressed to Dr. W that I was still in pain and stiff in my jaw, she suggested my taking ibuprofin and brought me 800 mg. I asked for some food to buffer the effect on my stomach, and she brought me an orange. It was painful and difficult to eat. At that time, Dr. W said we’d need to reschedule. I was terribly upset by the prospect of rescheduling, because 1) I hate needles, 2) I hate the feeling of being numb, 3) I didn’t want to go through it again, and 4) I didn’t understand at that time that something other than numbness had happened to my jaw.

Dr. W soon explained that she had shot novocaine in the large nerve on the left side of my head, and that in doing so she had apparently “aimed too high.” Once I understood what had happened, I appreciated her caution and wisdom in not performing the crown procedure. When I asked her to check if I could open my mouth wide enough for the procedure to be done, she said that the tool was scraping the top row of teeth and that my jaw was spasming. She strongly advised against proceeding, and I took her advice.

I felt worried and frightened, because nothing like that had ever happened to me before, despite the fact that I’ve had plenty of dental work: Almost all my molars have fillings; a number have crowns; and one has had a root canal. I asked Dr. W about the dangers of getting too much novocaine, since I’d had four injections instead of the usual two. She told me that the novocaine would wear off and then it would be safe to reinject me for a future procedure. She seemed very caring and apologetic, and took accountability for the mistake she had made. I very much appreciated the integrity of her response. In addition, she called me that night to make sure I was OK, and left her cell phone for me to reach her. I further appreciated this comforting gesture. 

Once the novocaine wore off on Wednesday afternoon, my jaw was in excruciating pain. In addition, I had a terrible headache and dizziness; I felt off balance; my left ear felt strange – fuzzy and shallow is how I described it at the time; and both ears were popping, making me internally echo when I talked and making my breathing sound like Darth Vader inside. I also had the ongoing sense that something was sitting on top of my left lower gum (when there wasn’t), and a noxious taste seemed to be leaking continually out of my teeth.

I took some anti-inflammatory supplements, which somewhat lessened but did not quite take the edge off the various pains. Dr. W advised me to take 800 mg of ibuprofin. That night I took it with food, and it helped; but I woke up early in the morning with a bad stomachache.

I spent Thursday in bed, unable to function because of the severe pain in my jaw and head, as well as the terrible dizziness. Dr. W continued checking in, which I appreciated, and advised me that these sensations would pass with time. She also, however, said that what was happening was not at all normal — that she had never seen it before, and that she didn’t know why my body was reacting as it was. Her uncertainty made me feel nervous. I called my doctor’s office and spoke with the nurse practitioner, who assured me that the sensations would most likely pass with time. I also called to speak with you, but we missed each other in our calls back and forth.

I was at a critical juncture in my work – starting a new company, hiring interns, and finishing the content of my new website. This ordeal put me way behind. Among other things, I had to cancel all my meetings with key community leaders interested in promoting my work – potentially jeopardizing my tenuous relationship with them — and every day I lost much-needed income from not being able to do my journalism work.

On Friday I was able to work for a few hours, and you called me during that time. Though I appreciated your concern during our conversation, I felt renewed nervousness, and even fear, when you said you did not know what was happening to me, adding “I don’t know what to do now.” Where, then, could I turn for answers?

By the afternoon that same day, I again suffered from a terrible headache and dizziness. My mother suggested that I go in to the office to get my mouth checked, so I called you again and asked about coming in. I appreciated the care and responsiveness that you and the staff showed – getting me in right away, and giving me an X-ray and evaluation to ensure that I did not have an infection. The dentist who saw me said that what had happened in fact was not an uncommon response to novocaine accidentally hitting a muscle. I felt relieved and calmed to hear that, especially when he told me the condition typically passes within a week or so. 

I spent all of Saturday in bed, again with terrible pain and dizziness. On Sunday, I was delighted that I could get out of bed, and it was the first day I worked productively from the morning to evening. My jaw was still very tight – it hurt too much to laugh or even smile – but by the evening I was able to slowly eat soft food. Up until then, I was only able to drink protein shakes. Given these improvements, I thought I was on the mend.

On Monday, however, I woke up again with terrible dizziness. I tried to push through working anyhow but could not focus. My headache grew worse over the course of the day, until I had to give up trying to work. I had a completely unproductive day. It got so bad that I was afraid to drive. In the late afternoon, I interviewed an intern applying for a job at my company. I struggled to concentrate on what she was saying.

That evening, I went for an emergency appointment with the cranio-sacral specialist who works out of my East-West doctor’s office. The specialist asked me to move my jaw in each direction – which I did slowly and cautiously – to test my jaw’s mobility. When I moved my jaw left to right, I felt a violent shot of pain from the left side of my jaw up that side of my head. While I felt better at the end of the cranio-sacral treatment, I continued to have severe headaches and dizziness later that night and for the next two days – during which time I also felt a burning sensation in the area of my cheekbones, as well as mild shaking and renewed pain in my jaw while it was stationary.

In the days that followed, the severe headaches and dizziness gradually decreased; the feeling of a foreign object on the lower left side of my gum for the most part went away; and though my jaw continued to be tight and painful to move, I slowly began to be able to chew regular food.

As the extreme headaches and dizziness ceased to dominate my entire being, I became aware of other abnormalities: Most significantly, the entire left side of my head felt deadened. While I was able to feel my finger touching my face, the sensation lacked the vibrancy I felt when touching the right side of my face. Every time I looked in the mirror, in fact, I expected to see the left side of my face drooping — reflecting how it felt inside – and each time, I was surprised to see it looking normal.

Even more disturbing was that the fuzzy, shallow sensation in my left ear did not go away. I continued to feel as if a thin wall was lodged in the center of my ear – making me unable to hear and experience sounds as I regularly did (resulting, among other things, in my constantly asking people to repeat what they said). Normal sounds felt unusually sharp and caused pain in my left ear, whereas they triggered no such reaction in my right ear. As a musician, it was no less than terrifying to experience abnormalities in my ear.

In addition, the left side of my jaw just felt “off” — loose and out of place. It made squeeking noises inside when I opened it wide, and it felt as if some inner hinge had lost its juice – like a screen door that used to open and close quickly but suddenly began taking a long time to close. Though I was planning on leading a Passover seder in Hebrew and Judeo-Arabic in just two weeks, I was unable to practice at all, because it hurt to sing.

 Lastly, I felt an enlargement in my glands. Initially, I wrote it off as meaning I was on the verge of getting sick. I never got sick, though, and the feeling of inflammation persisted.

I called you late in the week of March 20 and left a message, to tell you what was going on. You called and left a message for me in return. I ended up deciding that I needed to get an outside opinion of what was happening; so instead of calling you back, I called my former dentist in Los Angeles.

He and I managed to talk early the next week – I believe on March 29 — at which time I shared what had transpired to date. He informed me that in his practice, the dentists never, ever inject the nerve that Dr. W injected in my mouth, because it is far too dangerous to do. It is easy to miss the spot that one wants to hit, he explained, and to get another spot instead – one that controls the facial muscles and causes not only extended numbness but even temporary facial deformity.

He went on to explain that the deadened sensation I was feeling on the left side of my head was the result of the injection in the large nerve; that nerves heal very slowly; and that the abnormal feelings would probably pass over time, but there was a slight possibility that the sensations on the left side of my face would never return to normal. He said that cranio-sacral therapy was the right way to go, that it would speed the healing process. 

I told this dentist that I did not want to return to your practice; that I would like to fly down to Los Angeles to have him do the crown procedure. He stressed that I would need to wait for my jaw to heal before coming in for this work. Paradoxically, he cautioned, waiting a long time might result in my needing a root canal on the tooth.

I also sought the opinion of my regular acupressure/cranio-sacral practitioner, who treated me once or twice a week since March 23. To help me understand what was going on, she opened an anatomy book with an illustration of the nerve that Dr. W had injected. That nerve, she showed me, is a main one in the head — connecting to a plethora of smaller nerves not only throughout the head — thus the severe headaches and dizziness — but even down the spine. (When I told my mother this information, she informed me that following my dental visit at your office, I had mentioned having some pain and difficulties walking. I do not remember this, but then again, I was consumed with pain in my head and could not focus on anything else.)

Lastly, on April 5, I went in for an appointment with my primary care physician – who among other things confirmed that the nerve Dr. W injected controls sensations in my ear, such as the softness or sharpness of sounds.

It has now been just over a month since I came in for a simple crown, and I have suffered terribly since that time — physically, financially, and emotionally.

Physically:

As I described above, I have been in excruciating pain for a significant part of the past month. This physical pain also has consumed my time and energy – among other things, through going to body work sessions, doing regular jaw and ear acupressure on myself, and icing my jaw and head a few times a day (to lessen the pain and keep the swelling down). The pain also has wrecked havoc on my schedule, as I have needed extra sleep to heal. In addition, it has brought to a screeching halt my exercise routine – which in turn has affected the quality of my life: Among other things, I have gained weight and had more orthopedic pain than usual (regular exercise keeps down the chronic pain I have suffered since a car crash in 1997). 

Financially:

 In addition to losing journalism income and retarding the process of moving my company forward (delaying and possibly jeopardizing income through this work as well), I have spent close to $1,000 for payments of a combination of cranio-sacral work, anti-inflammatory supplements, over-the-counter pain medications, and ice packs. As I need continued treatment until the left side of my face heals, I see no immediate end to these payments. In addition, I will still have to pay $1000 for a crown procedure, or potentially more for a root canal, once my jaw heals.

Emotionally:

As a musician, I am no less than devastated by the loss of hearing in my left ear and the jaw pain that has affected my ability to sing. Especially considering that I am on the cusp of moving my music career forward, I am terrified how this injury may affect my ability to perform. Beyond this consideration, I feel like a central part of me has died: For me, having a compromised sense of hearing is like a painter having a compromised sense of sight. Beyond jeopardizing the painter’s ability to do her art, it affects her entire relationship to the world. I sang before I spoke. Sound is at the essence of my being and is the primary way I relate to the world. What happens to me if my hearing and singing abilities never return to their normal state?

Last Wednesday, eleven people gathered in my home to hear me lead the Passover seder in the Iraqi tradition. It has been painful enough to speak English (I have had to adjust how I hold my mouth for many sounds, due to this jaw injury), but singing in Arabic was impossible to sustain, as the sounds are very guttural. Quite simply, I was unable to lead more than half of the seder, and even that was a terrible struggle. I went to bed depressed that night, then woke up in tears. Who am I without my music?

August 23, 2006 

Dear Dr. P,

It has been about four months since I started writing the previous letter. It was so emotionally upsetting for me to write that I never completed it.

Since I began writing that letter, I have continued to suffer from Dr. W’s injection. Though my jaw has healed significantly over the past four months, it is still not back to normal. In addition to the complaints I listed previously, I have suffered from the following:

  • Vocal pain and difficulties phonating – leading to ENT appointments, speech therapy, and voice lessons to regain my speaking and singing voice
  • Extreme sensitivity in my head, making cranio-sacral treatment difficult
  • Nerve pain with eye movement
  • Enlarged and painful lymph nodes at and extending down from my jaw line
  • Continued difficulty and pain chewing hard foods like nuts

I have had to seek medical treatment for all these symptoms –causing additional financial burden and a significant loss of time and income, in addition to severe emotional distress. Regarding the latter, words cannot describe the despair this ordeal has put me through.

In addition, because my jaw is not yet back to normal, I still have not been able to get crown work done on my tooth.

I am grateful to the practitioners who have helped me heal from this trauma, and grateful that my body has healed as much as it has. I remain, however, no less than outraged that Dr. W took the risk of injecting the main nerve of my head, when it had the potential to cause – and ultimately did cause – so much damage. I do not believe that she meant to hurt me, but regardless, I find her actions both unconscionable and unforgivable — tantamount to medical negligence.

Sincerely,

Loolwa Khazzoom



Comments

Robert Nicholas July 22nd, 2009

my name is Bob Nicholas
I saw a dentist several weeks ago and following during a numbing injection felt an electric type shock go down my jaw to the tip of my
chin. The next day I experienced a sudden change in my hearing in
my left ear.  Have you encountered or heard of other people experiencing this type of fuzzy, sharpness of sound in their ears
following dental work?
 
 

melodie May 1st, 2010

I am having terrible trouble with the right side of my jaw since my dentist visit two weeks ago. I was to have a simple cleaning done with the help of freezing. I was given a numbing injection and felt a shock go through my lower lip and up into my head. The same reaction as Robert. Now I am left with a ‘locked’ feeling in my jaw on my right side, I can no longer bring my bottom teeth out and up to meet my top teeth ( I have an overbite) and my ear is in pain. I have contacted my dentist twice who has told me to stretch my jaw, use warm compresses and take advil and or muscle relaxers. I can not eat food that isn’t ‘flat’ and it aches all the time. I am suppose to have the left side cleaned on Wednesday and I am terrified.

Rogelio Krigger June 1st, 2010

thanks lots, I am obliged to say your blog is amazing!

Lucynda August 6th, 2010

I am having a similar problem. I too was given four shots for a dental cleaning. I am still having nerve pain three weeks later. If this does not stop, someone is going to have a lawsuit on their hands.

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