Disjointed: Vancouver dentist advocates for integrated health care after experiences with chronic jaw pain

Vancouver dental practitioner Suzie Bergman has struggled with chronic pain for 35 years.

At 19 years old, she was run over while pushing a stuck car, causing damage to her temporomandibular joint — the hinge connecting the lower jaw to the skull. Over the next 10 years, her pain worsened.

Between 2001 and 2022, she underwent five surgeries to entirely reconstruct her jaw — but not without enduring decades of chronic pain rooted in the limited understanding of the temporomandibular joint.

Today, her jaw comprises two titanium plates, and her pain is manageable.

Bergman, now 57, owns a dental practice alongside her husband called Dentistry on Officers Row, 701 Officers Row, Vancouver. Within her practice and research, she advocates for an integrated approach to care — combining dental, medical and mental health services — to improve the understanding and treatment of temporomandibular disorder, or TMD. This disorder can affect the jaw joint, as well as the associated muscles and nerves.

“There is some stigma associated with having this kind of pain, because if people don’t experience it, they don’t really understand how bad it is,” Bergman said. “My mission is to bring mental health and psychological care into that picture, because nobody who experiences severe pain on a daily basis can say they’re not depressed. But a lot of times that will be dismissed.”

In June, Bergman spoke at the TEDxStrathcona Women event in Alberta, Canada, a conference dedicated to sharing women’s ideas. There, she shared her experience living with temporomandibular disorder — a disorder that is often misdiagnosed and misunderstood, she said.

“I think what is really important for people to realize is somebody can be in a lot of pain and look like they’re perfectly fine,” Bergman said. “When somebody says that they’re experiencing pain and it’s invisible, you need to believe that person.”

Disjointed

When Bergman was 31 years old, she began experiencing jaw pain so severe that she could no longer ignore it. She could barely open her mouth and lost 10 pounds in two weeks, she said.

Her husband, Ryan, took her to see an oral surgeon, who asked if she had ever been in an accident due to the significant amount of scar tissue and joint degeneration in her jaw.

That is when a memory from when she was 19 came flooding back.

“Even though my jaw was doing all of those weird things, we weren’t making the connection,” she said.

In 1987 on country roads in West Virginia, Bergman was riding in a car with a friend when they drove off the road. Bergman got out to help push.

“We were on an incline, so the car flew backwards, throwing me over a huge hill and landed perpendicular with me underneath it,” Bergman said. “I blacked out. When I opened my eyes, my friend was kneeling beside me.”

At the emergency room, Bergman said her whole body ached, but she was eager to leave because she didn’t want her parents to know what truly happened.

The ER doctor did not conduct any significant examination of her jaw or mouth, Bergman said, which exemplifies the separation between medicine and dentistry.

“What the ER doctor and I failed to realize that day was that I had hit my head so hard that the impact had caused bleeding and cartilage damage inside my jaw joints, and lack of early intervention led to a lifetime of pain and dysfunction that changed my life,” Bergman said.

Poorly understood

The temporomandibular joint are the two joints in front of each ear.

The muscles controlling the joints are attached to the mandible and allow the jaw to move in three directions: up and down, side to side and forward and back, according to The TMJ Association.

“Temporomandibular disorders are a complex, under-researched, and poorly understood set of conditions characterized by pain in the jaw joint and surrounding tissues frequently associated with limitation in jaw movements,” The TMJ Association said on its website.

Bergman underwent her first two surgeries starting at the age of 31.

“My second surgery failed,” Bergman said. “Once you’ve had your jaw operated on, you usually have chronic pain for the rest of your life. It’s really sad people aren’t aware how big of a problem this is.”

Bergman held off on any more surgeries until 2019, because she wanted the technology to advance first.

She underwent her first titanium jaw surgery then, completing two procedures on the right side that year. The final stage, addressing the left side, was completed in 2022.

In Bergman’s experience, people who suffer from TMD can have upwards of 20 surgeries in their lifetime, she said.

Interlinked

According to the National Institute of Dental and Craniofacial Research, conditions related to the temporomandibular joint affect 35 million people in the United States — the majority being women.

As a patient and physician, Bergman understands how chronic pain can transform a person’s life, especially their mental health. Bergman’s experience living with chronic pain has greatly influenced her approach as a practitioner, she said.

According to the American Psychiatric Association, people living with chronic pain are at heightened risk for mental health problems, including depression, anxiety and substance use disorders.

At Dentistry on Officers row, about 70 percent of the patients Bergman treats have TMD and have experienced years of chronic pain, she said.

“That’s why I’m really interested in educating other providers,” Bergman said, “I feel like my patients are very grateful when they meet me. I feel like it definitely gives me the perspective and empathy that is necessary.”

Bergman said when health care providers look at each part of the body in different exam rooms, they can fail to see the whole person. It is why she wants to continue to advocate for breaking down the silos that separate medical, dental and psychological care.

“In my ideal world, physicians, dentists and behavioral health providers would all be under one roof, and they would discuss each patient together,” Bergman said. “My hope is that we’ll be able to make a clinic like that.”

During the pandemic, Bergman became more involved in advocacy and education, including working with federal agencies to create more pathways for patients and researching TMD at Oregon Health & Science University. She has also served as the selection chair for the TMJ Foundation’s online fellowship program since 2021.

Since Bergman’s TEDx Talk, she’s connected with other patients who have stories similar to her own.

“The more we speak about what this is, and the more awareness we bring to it, people in the future won’t have to suffer as much,” Bergman said.

Editor’s note: This story has been updated to clarify 35 million people are affected by temporomandibular disorders in the United States.