TALES OF DENTISTRY CHAPTER TWO

What is a crown lengthening procedure? It’s simple, really. It’s when they remove a swath of gums from under one of your teeth, thereby making the crown look bigger. This is what Dentist Two had in mind for me. The idea was to have the procedure done so Dentist One could see under the gums to see how far down the decay went. He would then make a decision about what we need to do with my bad tooth at that point.
Dentist Two was a chipper woman, whose abundance of energy somehow put me at ease. Not enough at ease that my blood pressure wasn’t rocketing, of course, but still, I was more relaxed than I expected to be.
About the high blood pressure: Dentist Two doesn’t do anything to you if your blood pressure is beyond a certain point. I was right there on the cusp. She kept testing me until I was relaxed to the point where she felt it was safe to give me Novocain.
There was really only one problem with the procedure: when they do this, they only numb your gums. You can still feel your teeth, and the bad one was pretty tender at this point. Every time she brushed up against it, I felt a jolt of pain. Now, speaking as one who had been through an immense amount of pain recently, I was able to take most of it, but there was one point when she actually tapped the tooth with a metal tool, and I jumped up hard enough to almost fall off the chair.
The procedure itself was pretty quick, though, which was merciful. It didn’t even seem all that scary. The worst part was watching her closing me up. The idea of stitches in my mouth absolutely terrified me. I didn’t even need to see the result to be frightened by it. Just seeing her pull the thread back was enough to gross me out.
When she finished, she handed me a mirror, and I saw that my tooth did, indeed, look bigger. There were two black blots in there, which I took to be the stitches. All in all, it didn’t look too bad. I showed it to some friends later, and they were shocked by it. In fact, they were kind of surprised that I could be up and about, knowing that there were stitches in my gums.
She gave me post-op instructions (including do not sip through a straw or spit for a day, and rinse my mouth out with saltwater a few times) and told me to come back in a week to have the stitches out. After that, I can go back to Dentist One for an examination. And if I experienced any pain, I should take a couple of Advil. Well, that sounded kind of small for oral pain, but as it turned out, it wasn’t so bad. I hardly felt a thing. Every once in a while, while eating, I felt something tug at the stitches, and that wasn’t comfortable. But that was the worst of it. Oh yeah, and I couldn’t eat anything sharp, like potato chips. That was actually the worst part, as I’m a huge fan of chips.
Anyway, I followed instructions, and when I got the stitches snipped and pulled out, Dentist Two said everything was looking very good. Cool.
I went back to Dentist One, and after poking around a bit, he said that he thought he could clear this up with a root canal. This wasn’t a promise. He said that things could still fall apart, but he thought it was worth a shot, that a root canal could possibly fix this.
Root canals are done in two parts. The first is to cut the top off your tooth and then to go in and file all the decay out, all the way down to the roots of your teeth. The second part is to close everything up with a crown after a few finishing touches. The tooth would then be a dead tooth, but it would still be in your mouth, right?
Okay, so I went in for part one, after having heard horror stories all my life about root canals. In actuality, it’s not all that bad. There is ZERO pain when they’re doing it. There is some discomfort because you have to keep your mouth open for a long time, but that’s the worst of it. The dentist then puts a bunch of files that look like needles into your tooth. It looks scary, I’ll tell you that, but again, there is ZERO pain. I was so loaded up on Novocain, you probably could have hit me in the mouth with a hammer, and I wouldn’t have felt it.
Then, there is the filler. If you hollow out your roots, you need something to fill the spot, right? He stuffed four rods into the tooth, which he then had to seal by setting them on fire. The assistant produced a lighter, which the dentist used to heat up a metal tool. As soon as it was hot enough, he pressed it into each root. The sizzle and the smell of burning tooth was kind of off-putting, but again, there is ZERO pain.
He then cooked up a temporary crown, which he glued in place. He told me to come back next week, and we’d finish up. He said everything looked very good, that he thought this was really going to work.
I went on my way. He told me if there was any pain, I should take a couple of Advil. This time, though, I did feel pain afterwards. Actually, a lot of it. That’s when it all catches up to you, after the procedure is done, not during. I got a jumbo bottle of Advil and slogged through the week.
There was one problem: half of my tongue remained numb when the rest of that side of my mouth came back to me. I couldn’t taste anything on that side for that entire week. Why? I’ll explain in a moment.
I went back, expecting everything to go smoothly. In fact, Dentist One said that since it was now a dead tooth, I wouldn’t need Novocain. But I was paranoid, so I asked him to shoot me up, anyway, which he gladly did.
At this point, I mentioned my half-numb tongue, and he said that it’s actually a common thing. When injecting Novocain, you’re supposed to just touch the nerve with the needle, but occasionally, the drug gets INTO the nerve. When this happens, numbness can continue indefinitely. Now THAT is scary. I asked how long this would last, and he said sometimes it takes a few weeks, sometimes a few months. There are some cases in which the tongue remains numb forever.
I tried to keep that out of my mind as he started poking around in my mouth. He took the temporary crown off and probed into the tooth. As he was doing this, he cursed.
“What’s up?” I asked, or at least, I tried to ask. My mouth was open too wide at this point.
“It might be too late to save the tooth,” he said. “I need an x-ray to make sure, but just sit tight for a moment.”
They took an x-ray, and when Dentist One returned, he pointed out the trouble area. “The tooth’s got to go. This is why.” He pointed out a crack in the root of the tooth, right there by the jaw. Apparently, the bottom of the tooth was in two pieces, and nothing can fix that. “The decay just went too deep.”
As he put the temporary crown back in, he told me my options. There were three. First, I could get an implant. It would take a lot of time, almost a year, and a lot of money, thousands of dollars. But it was the best option. Secondly, I could get a bridge. This involved sanding down the teeth on either side of the gap and affixing a piece over the space, using the filed down teeth as anchors. This was the most popular solution, but it tended to wear down the bone in the jaw in the blank spot, and it put undue stress on the anchor teeth. Lastly, I could just let it go. Just deal with the empty space.
The last one wasn’t an option for me. At the time, I was 31 years old. Too young for missing teeth. If I was in my sixties, I would have just dealt with it. I didn’t know about the other two, though. I spoke with my friend, Jason, about it. He lost one of his upper front teeth, and he wound up getting a bridge to fix it. He never had any complaints about it, but in the end, I chose to get an implant. It sounded sturdier and healthier from what the dentist told me.
Dentist One then said for me to go back to Dentist Two. She specializes in implants, and she knew how to prepare for it when pulling the tooth. (I was also told about same-day implants, but those are actually not very sturdy at all. They’re actually kind of a scam.)
So, I made an appointment with Dentist Two to have the tooth pulled and the preparations for an implant to begin. Tune in next time for that account, and to find out how a THIRD dentist got involved . . . .

[WHAT FOLLOWS IS A PICTURE OF THE TEMPORARY CROWN, EVEN THOUGH IT'S NOT VERY CLEAR.]

TALES OF DENTISTRY CHAPTER ONE

Most adults have had some kind of work done on their teeth. In fact, most of the people you talk to on a daily basis probably don’t have all of their teeth. Maybe they have dentures, or maybe a few crowns, or even some bridgework. It’s incredibly rare to meet someone who has never had a dental problem. It’s all a part of growing up. Some people run into trouble earlier than others, and others luck out and get to keep all their chompers into old age.

I am of the former camp. Since extensive dentistry is a lot more common than one would think, I hope this serialized story will help people understand what it is like to go through something like this. Perhaps it will help someone, or perhaps this is a cautionary tale. You be the judge.

First, a confession: until recently, I had not gone to the dentist since I took the exam to get into high school. The reason I stopped going? Mostly it was fear. I don’t like people putting things into my mouth. But the big reason was that shortly afterward, I was no longer insured. I had been under my grandparents’ insurance, and they had to drop it. There was no way for me to get insurance at the time, and I never managed to get a job working for a company who would give me dental.

Until February 2008, when I was hired at my current job. By then, however, I figured that if there was something wrong with me, it was too late to fix. (Stop laughing. I can hear you.)

So, I went happy-assholing on my way until one day, somewhere back in October 2009, I started getting these really bad headaches. Imagine having gnomes with pickaxes hammering away at the inside of your skull, and you’re not even close to feeling what was going on with me. The pain ran up and down the right side of my face, from my jaw line to my temple. It was unrelenting. It started out every morning on my way in to work, it would continue through the night, preventing me from getting all but one hour of sleep.

I tried everything, but the only thing that seemed to have any favorable effect was booze, and I couldn’t have that at work. I muscled my way through my job every day, and as soon as I got home, I started hitting the bottle as hard as I could. If I was lucky, I was in a drunken stupor by seven o’clock in the evening.

But at work, there were times I seriously considered suicide, the pain was that bad. I was starting to fear that I had trigeminal neuralgia, which is a condition my grandfather has. It’s a stabbing, constant pain, and no one knows how it starts or how to cure it. Suicide sounded a lot more appetizing at that point. There was no way in hell I was going to deal with that for the rest of my life. Finally, I couldn’t take it anymore, so I took the day off to go to doctors.

No one knew what it was, so my trigeminal neuralgia fears did not go away, but one doctor suggested that I go to a dentist, just in case.

I decided to make an appointment with the last dentist I had seen, the one from just before high school. We’ll call him Dentist One. When I showed up for my appointment, he did not remember me (no surprise there), but he was not pleased with the idea that I hadn’t sought care with anyone since I had seen him last.

After a few x-rays, he determined what the problem was right away: a piece of an upper molar was missing, and there was some heavy decay in what remained of the tooth. He numbed the area and drilled the decay. As he did this, he said there was the possibility that we’d need a root canal to fix this, but as it turned out, the decay had not reached the nerve yet. It was pretty damned close, though, as I saw when I looked at the x-ray. All it took was a quick filling, and the pain was all over.

But while he was in there, he noticed that I had a significant buildup of tartar on the backs of my teeth. I needed a deep cleaning, and it wouldn’t be fun. It was under my gum line, so they would have to go in with sharp tools to see what they could do about getting me back in action.

For the initial cleaning, they have what I best can describe as a sonic screwdriver (not the kind the Doctor uses on the BBC, sadly) which shakes heavy tartar away. It was shocking. It felt like they were knocking my teeth out, but when I saw the slivers of tartar, I was surprised that there was that much crap in my mouth.

Next came two separate visits, both for the deep cleaning. One would be to numb one side of my mouth, the other to get the other side. After the Novocain injections, everything went very well. It was kind of scary to see blood get suctioned out of my mouth through the clear plastic tube, but it was painless.

It was on the second cleaning visit that Dentist One decided to drop the bombshell on me: he had noticed a dark spot on my x-rays, and he had no idea as to what it was. He wanted to open it up a bit to see what was lurking inside that tooth. Since I was already numbed up, he set to work on me with his drill, and soon thereafter he had bad news.

“This one might have to go,” he said. “There’s a lot of decay in there. It came in from the side, which is highly unusual. I don’t know what could have caused it to happen.”

“Is there a way to save the tooth?” I asked.

“Root canal,” he said. “And even that is a bit iffy. I can’t see all of the decay, so I’m going to send you to a gum specialist. She’s going to perform a crown lengthening on you, and then you’re going to come back so I can take a better look, okay?”

I agreed. Next time, we’ll talk about what a crown lengthening is when we meet Dentist Two.

(The picture below shows me pointing out the trouble tooth.)