Yesterday, Dr. Schmidt finished removing my leaky amalgam fillings in my upper left quadrant. Last week he did the lower right and two weeks before that, the lower left. He replaced them with state-of-the-art composites and ceramics. My teeth look great now. He also built the most remarkable brux guard for my lower teeth that has been crafted for me and can be adjusted as we do work on my teeth.

My friend Adam told me about Dr. Schmidt at Pacific Spirit Dental Centre . I am really grateful that he did. I have never met a dentist as committed to communicating and teaching in the way he does. All you have to do to get a sense of his commitment to dentistry is to look at the amount of valuable information on his website. After my first assessment last October, he sent a long e-mail describing what he saw and a recommended course of treatment for the long-term maintenance of my teeth. That was really amazing.

What really has made him stand out is his curiosity about my facial pain and the thought he put into it before the cause of my pain was diagnosed. By working through a differential diagnosis together, we both realized in early November that the pain was most likely from the MS and ‘somebody’ would need to look at the MRI closely in order to see it. That’s what happened after I was finally seen at the MS Clinic.

When you are in the office, sitting in the chair, Dr. Schmidt pulls up photos and x-rays of your teeth as you discuss procedures and plans. Having the visual tools is so valuable. While you are getting work done, they take photos to submit to your insurance company to help with your claim.

Dr. Schmidt has a great team of people in his office. They do their own lab work, so if you need a crown, they can do the whole procedure in one visit, instead of having you leave with a temporary crown and come back in to place a crown that is made at another facility. The admin people are really nice and helpful with any questions you have.

When I took this photo yesterday, I promised I would say nice things. It’s easy to say nice things when you feel grateful for thoughtful, kind and professional care.

This past week has been a most positive experience, working with Dr. Ernst Schmidt at Pacific Spirit Dental Centre . With 32 years of experience, great equipment, friendly staff, and a flair for diagnostics, I am in great hands. He recognized that I have been doing what I can to coordinate my own care but that I really need a ‘quarterback’ to make referrals and to maintain objectivity.

On Saturday evening I reviewed the assessment results I received by e-mail. It was thoughtful and you could tell he had spent a lot of time thinking about what was going on. A few more back and forth e-mails and scanned reports, and we are moving ahead with a plan to rule out possible complications. His approach is to opt for minimally-invasive interventions and to note changes, as they will all be informative.

We reviewed my digital panoramic x-ray on Tuesday. I learned that I have a very long styloid process. They’re long on both sides but particularly long on the right. Dr. Schmidt said it was the longest one he has ever seen.

I went to see a new dentist yesterday for complete oral care. He did a great assessment and is really knowledgeable about facial pain, trigeminal neuralgia and multiple sclerosis. He did not want to be biased by the other information and reports I had, so he asked me specific questions and will spend time thinking about what’s happening. His approach is to start this way and gradually add more information to complete the picture. He’ll send me a preliminary report within a few days and we will establish a treatment plan. He asked me if anyone had done a ‘differential diagnosis’ for me —  I hesitated because there have been lots of ‘diagnoses’ — nobody has done what I would consider to be a differential diagnosis. So, that’s where he’ll gather objective information and then he’ll review the many inconclusive reports I have. He is smart, treated me like I was an intelligent human being, and I have great confidence that we will manage what’s going on. The very best part was that he seemed interested in figuring out the complex picture. He does acknowledge that my tooth clenching at night is a problem and the ideal would be to have me not do it at night without a mouth guard. The fact that the NTI device has had such in impact on my pain was helpful to him.

My other dentist is a very good dentist and I would stay with her if I didn’t have the complex issues that have arisen. What I need now is a great dentist and I think I found him, thanks to my friend, Adam.

The deep pain in my face is gone. The remaining pain/discomfort is around my upper lip, upper buccal gumline and generalized odd feelings in my face. Each day is a bit better and I don’t have to worry about food temperature or acidity any more, which is nice. And tomorrow night I’m going to the opening reception for the Women’s Campaign School — hurray!!!!

I saw neurologist #3 on Tuesday morning. I booked the appointment with him as I believed it was his responsibility as a professional to review the MRI that he ordered. He was obviously in no rush to see me as I had to wait for almost three months for the follow-up appointment. He hadn’t viewed my MRI images and opened the radiology report when I was in his office. At this point, he doesn’t think I have MS because of a lack of observable clinical symptoms, like changes in vision or reflexes. So, that is potential good news, i.e., not severe MS. It still doesn’t explain the MS type lesions seen in the MRI or my constipation. He told me that constipation had nothing to do with MS. I tried pulling a book out of my briefcase that I had with me, written by a doctor with MS, but he wasn’t the least bit interested and gave me a dismissive gesture with his hand. He told me that since I was going to the MS Clinic in December, he would arrange to have me seen by the top MS neurologist. I told him I’d be happy to see Dr. Traboulsee. He’s made similar promises like that to me in the past, so I will not hold my breath. It seemed odd to me that a neurologist would ‘brag’ about his influence as he had done nothing to help me other than botox and poorly-written and lean reports. I don’t think he ever believed I was in pain. Regardless, the appointment in December will tell us more, one way or the other. He didn’t think that the mouth/facial pain was associated with a central nervous system problem, as dental manipulations or appliances shouldn’t make any difference. He did tell me that the NTI could cause inflammation at the TMJ (temporomandibular joint) and to be aware of that. I let him know that I did not plan on using it for the long term.

As for the teeth/mouth pain. I am now off medications — last pill on Monday evening. I have pain that feels like a mild burning pain that is localized but not runaway nerve pain. I can eat hot oatmeal and drink tea now. I took a closer look at the molds made from my teeth that my dentist used to make the mouth guard with in June. I am not surprised that I have had problems for years. I can’t recall my old dentist ever checking my bite again, even when I told her I had discomfort in my lower jaw.  All this recent pain has been around the third tooth from the right on the bottom . When the oral medicine specialist whacked on that tooth, the nerves fired above my lip and around my nose.

I have made an appointment with the prosthodontist for October 29 to make a plan for fixing this bite. I had seen another dentist in July who was eager to replace the upper and lower crowns but he seemed a bit too eager to get my insurance coverage information and he didn’t have a plan for a bit more cautious approach. In hindsight, I almost wish I had done it then but I needed to be sure that it would be the right thing to do. It’s not worth it to take risks with this type of pain.

It is so odd to feel full of hope again. This whole situation has been a nightmare.

On September 24, I went to see the prosthodontist. He wasn’t sure about how to proceed as he read the report from the oral medicine specialist. He put a temporary bond on my lower molar and had a couple of suggestions for minimizing the sensitivity in my mouth. I think he had hoped for more information to work with. He asked me to let him know if the bond helped at all. He would be out of town for the following two weeks.

When I got home, I had a copy of the oral medicine specialist’s report in the mail. It was disappointing and inconclusive and he suggested waiting to do any dental work based on the outcome of the MS investigation. What bothered me about the report is that he messed up the history and missed about two years worth of information. This is the problem with specialist appointments now. If your case is complex — and he had been told in the referral that mine was — you don’t get the time you need. He told me he wanted to hear my history from me in my own words, but he rushed to the exam without having heard the salient points.

What was interesting to me is that the bond that the prosthodontist put on did help and I ate my lunch with a bit more ease. This got me thinking. Pain from a lesion in the central nervous system should not be affected by dental manipulations. In  fact, the neurologist had been puzzled by it in the past too.

My pain was usually worst in the morning and I would often do better later in the day. I wondered about the efficacy of the night guard I had. Perhaps the tooth clenching at night had something to do with the pain in the lower tooth. So — test trials were on. I modified a soft mouth guard I had to fit over the front teeth only. I used it on the night of the 25th and 26th and noticed an improvement. I stopped using the lidocaine ointment at that time. Then I made an appointment on Saturday September 29 with a local dentist who fits the NTI device. I started to notice a difference from the first night last Saturday. I have used it now for 7 nights and continue to be encouraged.

There are potential problems with the NTI device if you clench with the front teeth. I hope to need it only for the short term. NTI stands for Nociceptive Trigeminal Inhibition. The trigeminal nerve is responsible for sensation all over the face and the lower branch of the nerve controls the movement of the jaw.

Two weeks ago, I was in pain all day. I couldn’t walk without the vibrations triggering nerves in my face around my nose and upper lip. When eating, these nerves would fire and when it got big, it involved the lower tooth as well. These could be triggered by talking as well. As I told the prosthodontist, all the pleasure in my life was gone — socially isolated, unable to eat or drink or talk without pain, even on drugs.

Today, I have been able to eat and do things around the house, talk to my husband — getting pretty close to ‘normal’. I was able to go on a couple of long walks this week.  I still have a deep, achy pain in my mid-face, but there is no runaway nerve pain. I am still on drugs and will come off when I feel a bit more confident. I’ll book a follow-up with the prosthodontist. I suspect that three poorly shaped crowns from the dentist I had up to June 2010 has led up to this problem, as well as my tooth clenching at night.

Next steps — book an appointment with the prosthodontist and write a response to the oral medicine specialist — and focus on the healing of the nerves in my face.

Over the past month or so, I had pain on my nose, then on my upper lip. These sites were associated with cold sores. Over the past 10 days, the pain has moved and is being triggered again in my mouth, especially when I eat. The painful spots are on the gumline on both sides of my upper teeth. When the pain breaks through, it throbs and includes my lower right tooth where I had gum graft surgery in January, 2011.

I saw an oral medicine specialist last week who diagnosed me with atypical odontalgia, or ‘phantom tooth pain.’ He told me that he didn’t think that the MS was related to the pain. I wrote an e-mail to him on September 15:

I am inclined to think that my pain is from the MS — however; you are the expert! I would be ecstatic to find that it was not connected to the MS but nothing else makes sense to me, unless a herpes simplex virus attack can induce this pain.

I had been hopeful that it was another sinus infection. I saw Dr. Javer briefly yesterday. Unfortunately, there was no infection. Funny that I had hoped for an infection — at least it would be treatable! He said all of my sinuses look good and healthy.

I started taking nerve pain drugs last week again. I am also using a topical ointment that the oral medicine specialist prescribed for me to numb the sensitive spots in my mouth. The drugs constipate me and the sensitive spots in my mouth are worse. The pain must be originating in my trigeminal nerve at the pons, the part of the brainstem where the trigeminal nerve originates.

I can’t stop crying. I am sinking into a deep depression. I am very lonely.

If I had been smart enough to have Dr. Zwiercan as my dentist years ago, I would have saved myself two unnecessary root canals and avoided a lot of pain and suffering. She was my husband’s dentist and I had my own dentist. Unfortunately, my old dentist didn’t consider the possibility of sinus problems when I first had a bit of facial pain in the shower in 2007.

I first met Dr. Zwiercan when I wanted to have a second opinion about my teeth on June 1, 2010. She identified a problem with a crown and when she fixed it, a lot of the pain was alleviated. I left my old dentist and started seeing Dr. Zwiercan after that. When she reviewed my panoramic x-ray from the other dentist, she showed me my sinus nerves. She said they went down deep and she said that I probably had had a sinus infection and she would have recommended I look at that before she would have considered a root canal. At that point I hadn’t even thought I had sinus problems. I was still ignorant about sinuses and didn’t know about acute versus chronic infections.

I had continuing fluctuating problems over the next year as she identified problems with my bite as well as gum disease on my lower right. I had gum graft surgery that was successful but I still had sensitivity to acidic food and occasional reflux. She provided me with extra support and she was the one who recommended that I get help quickly through False Creek Healthcare Centre instead of waiting for months to see specialists in the public health system. I was losing weight in the fall and she recognized that I needed help.

When I learned about CT scans of the teeth in January this year, I needed to work with Dr. Zwiercan to order one at Orbit Imaging in Richmond. It was that dental scan that identified the chronic sinus infection. As soon as she saw the results, she called me and recommended I see an ENT and get surgery. You see, her mother suffered for 15 years with severe facial pain until she had sinus surgery. That’s why she is so aware of sinus problems. So, five weeks after the dental CT scan, I was able to see Dr Javer at False Creek.

Dr. Zwiercan is the ideal, caring professional. She saw me frequently for quick checks and helped me through all the suffering. Without her, I don’t know where I’d be right now.