My TMJ Story: Meeting Dr. Piper!

After hearing from another specialist that surgery would be the way to go, I decided to follow my dentist's advice and contact Dr. Piper. I was ready to get better, seeing that conventional non-invasive options were not working for me.

I read up on him of course, did as much research as I could, and he simply is the best. Patients travel from around the country to seek his care, and even from around the globe. See the link below to read more about his practice, experience, and methods.

The Piper Clinic

(Gathered from the Edward White Hospital Physicians' Directory:)

Medical Education & Training

Medical School: Harvard School of Dental Medicine
Residency: Vanderbilt University Medical Center
Specialty Board Certifications: National Board of Dental Examiners
Northeast Regional Dental Boards
State of Florida Dental Boards
Commonwealth of Massachusetts Dental Boards
State of Florida Medical Board
State of Tennessee Medical Board
National Board of Medical Examiners
American Board of Oral and Maxillo-facial Surgery (Diplomate)

Upon contacting them in July/August, I was told they couldn't see me until December just for an initial consult. Disappointed but hopeful, I asked them to keep me in mind in case anyone cancelled. I received three calls from the Clinic saying they could squeeze me in early, and missed the opportunity the first two times. The third time was the charm, and I was in the books for September!

I felt like I was seeing unicorns.

INITIAL CONSULT: This is an extremely long day.

It is grueling, tiring, busy, and somewhat frustrating, but it was so worth it.

Bring lots of quarters! There is street parking requiring that you pay a parking meter that must be fed every two hours. Keep an eye on your meter! Parking garage option also available.

Arrival: 7:00am

The cost: $1,800 up-front; The Piper Clinic does not work with insurance companies. They will prepare a claims form for the entire visit for you to submit to your insurance company. We received very little back as our insurance deleted and altered some of the medical codes and to this day, we are still waiting to hear back about the appeal we filed.

The process: The Piper Clinic sends you a huge packet to fill out months in advance for you to bring with you to your visit, including your past and current medical history, injury/trauma forms and anything and everything that you want them to know.

Cassie, the young woman who manages the front-of-house, is delightful. She kept us updated every step of the way and made sure that we understood every single thing that was to happen. I'm not sure that I have ever met an nicer person.

Dr. Piper's wife, who is wonderful, went over my medical history with me and did a short physical examination of my pain levels, measurements of opening, and some auscultations and palpitations. She was so personable, and told me that she had had the jaw surgery herself, and that their daughter would soon need it as well (due to an injury).

Multiples molds were taken of my bite. This is a bit uncomfortable if you've never had them done before, but everyone here is very aware that we are in pain, and usually cannot open our mouths very wide. This process took no more than 30 minutes.

Pictures were taken of my bite; these are not appealing, so don't expect them to be! No need to get dolled up... You're handed two "spreaders" to hold your cheeks/mouth open as wide as possible, and, photos are snapped of almost every angle imaginable of your teeth as well as profile.

Yikes... here's mine!

A CT and MRI are done. The CT was painless; the MRI was not. Everyone is different. I had a very, very restricted opening and could not hold my mouth open for almost any amount of time without pain. I had never had one done before. Holding my mouth open was quite painful, but reminding myself that if I moved or readjusted, I had to re-do the scan and elongate the process got me through it. My MRI tech was wonderful and coached me through the scans, giving me breaks to breathe, rest my jaw, and made sure I was nice and warm (it was FREEZING in there).

Here's one of my CT views.

And an image from my MRI. (The left side shows my right, and vice versa.)

Everything but the MRI is done at the Piper Clinic. The MRI is done just a few blocks away, within walking distance. We had a lunch break after the MRI, then went back and they had my scans ready for me to take back to the Piper Clinic, as well as a personal copy for me to keep.

When we returned to the Clinic, we met the man himself! Dr. Piper brought my mom and I into an exam room, along with his wife, and we went over my medical history, as well as the notes that Mrs. Piper had taken earlier. He was so patient, kind, and thorough. He took his time to answer every single question we had. This examination was mostly for him to make further observations and collect information about me. He asked me many questions, listened to everything I said, and took notes. I brought with me every X-ray I had which were practically useless to him, but showed him at least that there was a huge size difference in my condyles. He told us then that my CT and MRI would reveal what was really going on and that he would meet with us again once those were prepared and a room was open for us to look at them; he would then formulate a plan of action for us.

The waiting began while they prepared things for us to meet again with Dr. Piper. We met other patients in the waiting room from all over the country. This is where I'd recommend you'd bring a laptop, tablet, homework, a good book... something to keep yourself entertained.

After waiting for a bit, we were called back to meet with Dr. Piper and Lisa, one of his amazing techs. We were brought into a small room with three huge computer screens; all reflecting my scans and a software that Dr. Piper invented. He hadn't looked at the scans until this moment, saying that he wanted us all to see them at the same time and talk about what the CT and MRI showed. Lisa took notes and recorded everything that was said, so we didn't have to worry about remembering everything. He showed us the scans, explaining the condition my jaws were in, how much damage was done when I fell on my face, what my treatment options were, their success rates, statistics of his other patients, and so much more information. He used he molds that were made earlier to create a model of my mouth, and show what a corrective surgery would do for my jaws. He also utilized his software to show what it looks like to talk, chew, and grind with jaws that were in the condition mine were in. He also used it to reflect what normal jaws look like.

Size matters!

This showed Dr. Piper where my discs were and their size/diameter. He measured them using the software to determine what steps should be taken.

We were given many options... To operate, not to operate and live with the pain, to operate on just one side, and to do both. We decided on a bilateral arthroplasty with diskectomy and retrodiscal autologous fat graft. Uhhh... what? He was going to remove both discs from my TMJs (they were dislocated, having slipped out of place and deteriorated, the meniscus was dislocated, and there wasn't much hope for saving them by pulling them back into place). He then would take fat removed from my abdomen to be used as new discs. This would minimize my chance of ever needing a repeat surgery, and would absorb impact much better than disc relocation (being pulled back into place) if I were to be struck in the face by anything. He also said that they would last much longer, pretty much lifetime guarantee.

This decision didn't come easy. Not only is it expensive, but we had to decide if we wanted to try to pull my left disc back into place as it wasn't in as bad of condition as the right, and do a fat graft on that side. We didn't know if we should leave the left side alone, and operate on the right. What if we later needed to have the left side corrected? There was a lot to think about. Dr. Piper did not push us to do anything. He gave us just as much choice to do nothing than to do the surgery that he himself would perform. He didn't persuade me to do both sides over one, or to select a fat graft over trying to pull the discs back into their original position.

We made our decision based on the ever-increasing pain I was in, the way that my left jaw had been pulling the weight of the lack of strength in the right side for all these years, and the coordination of healing and recovery that comes with having both sides done at the same time.

Up until now, I had gone to most of my appointments by myself. Tried to alleviate my pain by meeting with specialists multiple times a week. I felt alone in my struggle. Who could afford the time to accompany me? I now had my family. I had this team that wanted to help me. I had hope.

We have a plan.

I have support.

I don't feel alone.