Archive for the ‘Teeth’ Category

Implant

January 29, 2010

 

   A while back (cf 7/24/09) I mentioned a bit about a tooth extraction.  Even though the gap was unobtrusive enough that wife didn’t fit about my place in daughter’s wedding photos, dentist said that it had to be filled.  Otherwise other teeth would slowly shift and faults would form. Mandibular plate tectonics.

  Both dentist and MD with the pliers said that an implant was the way to go.  Research confirmed their recommendations.  “A Dental Shift: Implants Instead of Bridges” wrote Jane Brody in the NYT 11/17/09.  I read about the procedure and asked my dentist friend what was the longest I could wait before setting something up.

  He told me and I added another month and made the appointment.  Yesterday was the day.  Began with the same daunting consent form.  “Swelling, bruising, and pain can occur…Jaw fracture is quite rare… etc.” At least I still didn’t have to worry about the effects of antibiotics on the potency of any birth control.

  This operating room was much bigger than last time.  “Need more stuff for implants” said nurse.  “And room to move”.  I noticed the defibrillator on the wall as she took my blood pressure.  “Let me cover you up and Doctor will be right in.”  She did a pretty good job, but I had worn a red sweater just in case.

  Doc came in, put the same hockey puck back in the left side of my mouth, numbed me up, and unrolled his tool pouch.  “Just like the ‘surgeon’ at the end of Braveheart” he chuckled. I tried to find something on the ceiling to count.

  “First gotta drill me a hole.  You ready?”  Sounded just like a hammer drill going through a wall.  Only louder.  He drilled and drilled.  I began to worry about an inadvertent trephination.  He withdrew the bit just in time and screwed the implant in finger tight which wasn’t very far.  Could feel the sharp threads with my tongue.

  He fastened a lever onto it and leaned forward.  It was a ratchet.  OMPH clinkity, OMPH clinkity, OMPH clinkity.  “Ok let’s see how we did.”  Put one of those cardboardy bits of film in mouth and took x-ray.   “Dang”.  Ratchet in reverse he backed it out and drilled some more.

  Final tightening underway, all I could think about was the countless number of times I have stripped threads while undertaking some mechanical or home repair.  Just this side of that sort of mess with neck at ninety degrees and all cervical vertebrae in subluxation, he stopped, threw a few stitches with racquet string and “voila”.

  “Uh, that doesn’t feel much like a tooth” I said.  “Won’t celery fibers and stuff get hung up around it?”

  He laughed.  “Don’t worry, we have to wait a few weeks to make sure it’s snug and not infected. Then we’ll spin on a nice new tooth and you’ll be good to go.  Nurse here will tell you what to do to stay out of trouble.  Soft foods for a week…”

  Jeesh.  I wrote the big check, stepped outside, sighed, and took a deep breath.  The way negative wind chill frosted the thing up like a finial on a fencepost in the Gulag.

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Pliers

July 24, 2009

  About six months ago a tooth began to bother me.  It was a molar.  Top right second from the back.  Really began to ache and I called my friendly dentist.  X-rays and probing found nothing definitive.  “Nothing heinous” he said.  “Could be a crack”.

  Pain subsided.  Mentioned again at next regular check up.  Had me clamp down various strange ways with no acute response.  Began to ache though after visit and through the next day or so.  Long as I didn’t chew on that side everything was fine.

   During yurt party last weekend over wine and beer I was flapjawing and distracted.  Chomped a couple handfuls of peanuts.  Great night, but mouth woke me up the next am.  Throbbing got continually worse.  Called dentist.  His sweet wife, also a friend, said he was fishing in Wisconsin.  I replied that I hoped he could squeeze me in on Monday. 

  I called back later and she gave me his cell phone number.  Tooth socket was so swollen that tooth protruded significantly below the others and it was impossible to chew anything without it touching down first.  Throbbed like a heart in the hands of an Aztec priest.

  He met me in his office several hours later.  “Cracked through I’m afraid” he said with a kindly smile.  “It’s a gonner.”  He explained the options all of which began with extraction. 

  Next morning his nurse called with an appointment later in the day at the specialist’s.  Oh boy.  Expansive empty waiting area.  Perfunctory receptionist.  “Fill this out.  Both sides.  Initial every line.” Insurance info sure, but also a harrowing litany of possible complications. 

  I didn’t have to worry that the antibiotics might attenuate the effectiveness of any birth control, but the possibility of: bone chips, socket rupture, nerve damage, infection from the cadaver bone used to fill gaps, jaw fracture, and more didn’t exactly comfort me.

  Led back to the room, I started to sweat.  Doc whirled in. Visage and demeanor of Wallace Shawn. “Who’s beatin’ up on ya?”  I gave him the name of my dentist and started to tell him that the swelling had gone down and maybe… 

  He pulled my jaws apart, inserted a block of rubber to prop it open and wrapped gauze around my tongue (so I wouldn’t lick his fingers he told me).  Swabbed some electric tasting numbing compound.  Stood for a moment – elbows folded, dripping syringe in one hand, cigarette in the other – and then came at me.

  “We’ll give that stuff about ten minutes to numb ya up.”  Back in nine he had the nurse place the meat-hook like suction apparatus for which there was no need – my mouth was dryer than a mummy’s.  Reaching in with the pliers, he grabbed hold of the small half of the tooth and twisted and turned with vigor.  Sounded like a novice shifting the gears of a manual transmission.

  “Got it!” he said.  “Rinse?” I knew that I’d never be able to swallow and didn’t respond.  “Second half will be a little tougher” he said.  “Doin’ ok?  Got a good hold on somethin’?”

  Oh shit.  He grabbed the fat half with the pliers and both hands, rocked back on one leg, and raised the other to a position upon my chest. I stared so intently at the ceiling that it began to smoke.  I was completely soaked and started to slide down the chair.  Nurse grabbed me by the ears and pulled me back up. 

  It was like parts of a chicken being separated by another novice who can’t quite find the joint and so, cursing, twists and turns the drumstick until…

  Finally, it gave and he stumbled back against the wall.  With a backhand toss he flung it out of my field of view. I heard it hit the trash can.  “Two points.  Dry him up and I’ll be back” he said.  I’d forgotten that he was going to have to pack the socket to prepare for the implant I’ll never return to have. 

  Sat there for a few minutes with blood soaked gauze hanging out of my mouth.  Worst had to be over.  Return though he sure enough did.  Pulled the gauze out and with an Eberhard #2 he proceeded to pack the cadaver bone up into the socket.  Then took a fat curved needle threaded with monofilament and threw a few stitches to hold it all in, told a joke, and left.

  Nurse shoved clean gauze back into my mouth while telling me to eat soft foods for a while, not to overexert and thus pop the stitches, and that the gritty discharge, bleeding, and horrible taste and odor due to the anaerobic bacteria sure to soon seethe up there would only last a few days.

  “Drinks?” was all I could think of asking.

  “Long as you don’t mix it with the pain meds.”

  As I struggled to write the check a few minutes later, the cashier told me that I’d been lucky they’d been able to fit me in.  A primal grunt was all I could muster.  But my wife recognized it from across the lobby, came over, and helped me to the car.