Chapter 249
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Translator: Ace
Chapter: 249
Chapter Title: The Skeptical TMJ Patient
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Park Siha had introduced a patient to me.
Typically, when Patient A refers Patient B to me, it means Patient A likes both me and B.
They wouldn't make the introduction otherwise—they want B to get better and trust in my skills.
But this case was a bit unusual.
"Um... I don't really know what's wrong with her. Someone asked which clinic I go to, and I couldn't exactly refuse to tell her, so I gave her your name."
A Korean medicine clinic is a place anyone can walk into.
Even if they refer someone, they often don't give me a heads-up.
At most, they'd say something like, "Please take good care of them."
"Some conditions are hard to discuss even with acquaintances. I'll talk it over during the consultation and make sure to treat her properly, so don't worry."
I tried to reassure Park Siha.
But...
"She's not exactly an acquaintance... Um... Director, you'll treat her well, right?"
Her response was ambiguous.
It was unclear if she hoped for a cure or not.
Whatever their relationship, once someone came in and registered, they were my patient.
Three days after hearing from Park Siha, I met Lee Da-jeong.
"Hello~ Director~."
A woman with fairly heavy makeup sat down, her eyes crinkling into a smile.
"Nice to meet you. Park Siha mentioned you'd be coming."
Park Siha had said she didn't know what was wrong, so I figured there might be some personal issues involved.
But the staff's initial check at registration hadn't shown anything unusual.
"Your temporomandibular joint isn't doing well?"
"Yes, my jaw joint has been giving me so much trouble. It makes noises around here, and there's occasional pain."
"How long has it been?"
"Quite a while now. About two years, I think?"
Her speech was soft and gentle, with clear pronunciation.
Now that she'd mentioned the jaw issue, I noticed her facial muscles moved more exaggeratedly than average when she spoke.
Two years—that made it chronic.
TMJ disorders generally didn't have great prognoses.
Choo Mi-young's case had improved quickly because the cause was clear-cut.
The misalignment of her joint surfaces was obvious, so we corrected that and eliminated the stress source.
But for someone like Lee Da-jeong, working at a call center where she had to use her mouth constantly and deal with stress, it wasn't possible to cleanly remove all aggravating factors.
"What treatments have you had so far?"
Acute cases might resolve with one or two acupuncture sessions, drawing people straight to a Korean medicine clinic as a first choice. But chronic patients usually bounced around everywhere—other Korean clinics, dentists, orthopedists, you name it.
From the patient's perspective, when jaw pain first hits, it's unclear where to go.
They might think "joint issue, so orthopedics," get seen, prescribed basic physical therapy and anti-inflammatories, and told to see a dentist for an occlusal splint if it persists.
Local dentists often don't handle TMJ much.
With such specialized fields, they lack experience in musculoskeletal issues. For expert care, you need an oral and maxillofacial surgery specialist.
Even Korean medicine clinics... Anyone can needle nearby points, but few specialize in TMJ.
"For the first three months or so, I just let it be. It'd hurt for a day, then be fine for four or five, so I thought it'd get better. But it dragged on for months, so I finally went to a hospital. A general dentist just gave me anti-inflammatories and told me to go to a specialist."
As expected, Lee Da-jeong had missed the early treatment window.
"Did you go right away?"
"The meds helped, so I waited another two months."
Hmm... She'd let it worsen like that.
"Anyway, I went, but they said I needed a custom splint. 800,000 won? Way too expensive. I passed and just did Botox and physical therapy."
For a patient who'd essentially ignored it for five months, balking at an out-of-pocket 800,000 won fee was understandable.
Especially since it wasn't constant pain.
"It must've been better for a while after the Botox?"
"Oh, yes! Exactly. How did you know? It was perfect for three months!"
Lee Da-jeong's eyes widened in slight surprise.
Just as I'd predicted.
Botox is well-established for TMJ treatment.
But like cosmetic Botox, effects last 3 to 6 months.
That's both its strength and weakness.
'If she rested her jaw and corrected habits during that time for natural healing... but no, predictable. She probably let it flare up again once it felt better.'
Botox uses purified botulinum toxin, a neurotoxic protein in tiny doses. It blocks nerve signals to muscles, relaxing them and preventing contraction.
For TMJ, it's injected into the masseter muscle—from jaw to cheek—to reduce tension there.
It's also used for migraines, muscle spasms, hyperhidrosis, wrinkles, and slimming the face.
Fast-acting relief.
But over time, nerve endings reconnect, and it reverts.
"You didn't get more after that?"
Some do it every three months.
"I did... but..."
Lee Da-jeong's face twisted.
"The second one wasn't as effective."
"Exactly!"
She clapped and nodded vigorously.
"Yeah. Even after physical therapy, the pain came back. I asked if the first injection was botched, but the doctor insisted it wasn't. It doesn't improve, but they just tell me to keep coming. What gives?"
"Botox itself isn't the problem. It reverts once the effect wears off, but it doesn't worsen things."
"That's what he said. But who knows if they messed something up? We had a huge fight, and I switched hospitals."
She used the word "fight" for her spat with the doctor.
'Tough patient.'
I understood why Park Siha hesitated to call her an acquaintance.
"Other dentists were no better. Machines are all the same, right? Physical therapy did nothing, and the pain got more frequent."
From what I'd heard, Botox hadn't caused worsening.
She likely resumed aggravating behaviors while feeling relief.
"That doctor pushed the splint again. Said surgery was the only other option. But I hate both. Surgery for a little clicking? If I quit my job, it'd probably fix itself."
And she knew what was aggravating it.
"No time for a splint with work anyway. Office jobs staring at computers might manage, but I'm at a call center. Talking all day with my mouth open—when would I wear it?"
"At night—"
"No teeth grinding or clenching in sleep. Dentist said occlusion's fine. I don't buy it. They couldn't guarantee it'd work. And that place charged 900,000 won... How do I drop that on maybe?"
Lee Da-jeong explained calmly in her gentle tone.
The dentist had offered viable options but failed to convince her.
"I see. Even with a splint, it might not have helped much in your case."
I thought spacing episodes would still have value.
But her convictions were ironclad.
Siding with an unseen dentist would just erode her trust in me.
With patients like this, caution and empathy are key.
Instead of arguing, I nodded in agreement.
Her face visibly brightened.
"Right? I just said it didn't make sense, but they treated me like a nutcase for refusing the splint."
"...Pardon?"
What was this sudden outburst?
"They said call center stress must be it. What do they think call centers are?"
"They suspected a mental illness? Just stress-related?"
"Some study said a percentage of TMJ patients have somatization disorder, anxiety, depression. Suggested psych consult. Is he crazy? My jaw hurts—not depressed. I'm the furthest thing from depressed."
Her slow speech quickened, clear displeasure showing.
I recalled such studies.
'I thought causation was tricky, but hmm...'
Stress can lead to mental issues—no debate there.
Clenching from stress can cause TMJ pain.
Chronic pain can loop back to more stress.
Real somatization or psychogenic pain exists, sure.
But modern medicine can usually differentiate.
"Didn't you mention clicking at first? If it's just pain without sound, maybe. But disc displacement always has musculoskeletal signs. You got tests at the big hospital, right?"
She'd ranted about history without detailing symptoms yet.
But I had to clarify this.
Especially with no articulation issues and normal tests—mental factors might warrant suspicion.
"That's exactly my point!"
So it was musculoskeletal?
Lee Da-jeong clasped her hands prayer-like, gazing at me.
"Started as clicking, now it's like sandpaper rubbing. Tests every hospital switch—disc wear confirmed."
Mental issues aside...
The disc was definitely problematic.
"I told them that, they agreed and wrote a referral to university hospital. Ha, unbelievable. So irresponsible?"
She feigned teary eyes.
Plenty badmouth doctors here.
Doctors probably hear the reverse.
Today, I got the doctor's side.
Maybe too many monsters at the call center... turned her into one.
As I reeled, she continued.
"No treatment after. Pain lessened, actually. Was gonna live with the grinding, but Siha said you're a miracle worker, so here I am."
Her anger at dentists softened; back to polite, expectant gaze.
Dizzying.
Choi Eunhui's warning flashed.
Murim patients I'd saved from the brink, demanding pouches in return.
Still smiling warmly at me.
But I activated a crisis sensor.
"G-Good you came. Let's check the muscles that could cause TMJ issues first."
"Yes! I'll follow your lead, Director. You agree it's not mental, right?"
Not an easy one.
With her track record, higher compliance means more vigilance.
But...
She wasn't my match.
Fine, I'd just treat her.