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A Mouth Restoration – Conclusion of an Implant Patient's Story

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A Mouth Restoration – Conclusion

A Mouth Restoration – Conclusion of an Implant Patient's Story

August 16, 2006
Part One | Part Two | Part Three | Part Four | Part Five | Part Six | Part Seven | Part Eight | Part Nine | Part Ten | Part Eleven | Part Twelve | Part Thirteen | Part Fourteen | Part Fifteen

Part 15 – The Conclusion

By: Jean Johnson for Dental1

A mouth restoration story. To be typing those words for the last time gives me pause. For two years now it’s been: “Oh yeah, an implant here, a root canal there,” but now with the last of the crowns going in – the last of the restoration work coming down within inches of my eyes – I’m a little taken back. My breath is quiet, and tears are lurking. Tension that normally lives in my arms is absent. My shoulders rest heavily on my limbs.

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Once the dentist is done, the maintenance ball is in the patient’s court.

Nader Rassouli, DDS, MS, Jean Johnson’s prosthodontist recommends using Sonicare’s Elite electric toothbrush for something not as aggressive on the gums as a water pic is, but nonetheless highly effective in removing bacteria that leads to plaque.

Brushing routines, according to Rassouli, need to be something patients can manage. After every meal is ideal, he explains, although at least every 12 hours with particular attention prior to bed. “If you do a careful job then with your Sonicare, you can brush for six minutes. Eight is even better. And then you have to floss which takes some time to do right.”

“You have to really get your teeth clean,” said Rassouli. “How long restorations last depends on how well patients take care of their work.”

Restoration. I don’t want to spoil the magic and consult some dictionary since the word naturally brings connotations about old, classic things that are worth restoring.

Like old houses and historic districts and cars. The idea that rather than bring in the wrecking ball, someone thinks an object is worth enough to pick up the sand paper, take the varnish down to the original grain, and polish until a righteously restored patina emerges.

There’s a reverence about restoration. Gratitude even. People who get into it have at least some of the artist or the romantic in their souls. Plastic deck chairs might be had for cheap at some loud Memorial Day sale, but if they can find an old wooden lounger to refurbish, they consider themselves among the blessed.

Blessed. I guess you could say that’s how I feel, but it’s not quite the ticket. Blessed in my mind might be someone who has all their teeth and didn’t have to go through what I did. So the feeling is more that I’m glad spent the time and money to finally do right by my mouth. It’s a quiet sort of feeling. Not terribly exuberant, but instead one that brings a fair bit of peace. Like the hint of a good perfume wafting your way.

But, as my prosthodontist said appointment before last, it’s not done until the fat lady sings. Before this lovely peace will truly roll over me, I have to navigate one last dental appointment.

“Today is your graduation day,” my prosthodontist said after he greeted me.

“Good, I can’t afford these expensive dates any more,” I said thinking of the husky check I’d have to write when we finished. “Then again, this is probably some of the better money I’ve ever spent.”

He was quick to agree on that, of course, and he swung into the gentle rocking action it takes to get the upper front temporaries off. As usual it takes a while, but finally there I am exposing six gold posts to two other human beings for what I hope is the last time in a long, long while.

Cindy is doing her mother-hawk thing. Seated in her chair facing her tray which is in back of my head to one side, she has her one arm on the chair rest and sort of looks over her shoulder at the scene taking place in my mouth. From this deceptively causal-looking perch she speaks with her usual low tone once they get all the residual glue cleaned off.

“Do you need to check anything?” she said. “Want floss or do they all feel pretty good?”

He tells her that they did all that last time and that things are good. Still he fiddles and fiddles, mumbling something about the mesial and drilling on one of the posts that’s not suited to his specifications.

It’s a rainy afternoon in Portland, Ore. The first day of June. Six years into the 21st century.

“Perfect,” he said after slipping the one tooth he was working on back into place. “It’s perfect.”

I’m glad for the report, but at the same time I remember way back when I read something about high suicide rates, the dental profession and perfectionism. I’ve never forgotten it and always have been troubled by the thought. The idea of one human being driven to despair by having to get something perfect for another. Not too cool in my book. Then again, my prosthodontist laughs a lot and seems like a happy person. So as long as he can burn the candle at both ends, I won’t quibble.

“Okay Jean, I’m going to put everything in and have you take a look at it. I made some modifications since the last time,” he said and slips the six porcelain crowns into place over the posts. “Okay. Close down and keep your teeth together. Don’t open your mouth or they will fly off.” He sits me up while I imagine shining crowns with wings flying around the dental suite.

The teeth are gorgeous of course. He points out this and that about one canine because the tooth root is a little more prominent than we’d like. He shows me where he thinned it and tempered it as much as possible and how it blends with the adjacent teeth.

I nod my head in approval and through closed teeth tell him that he’s the boss.

With two thumbs up, the cementing begins. “Okay Jean,” he said, “We’re going to do this first one. I need you to hold still.”

I stop scribbling notes on my steno pad, the way I do; a few large lines per page scrawled without looking – and relatively legible if I transcribe them fairly soon after my appointments.

“Okay Cindy, go for it,” he said taking a hold of my lower jaw and shooting a jet of air on one of the posts. “Put your chin up, Jean. OK. Thank you.”

There’s a trumpet in the background with notes like bubbles in a bottle of Perrier. Cindy mixes the cement and fills the tooth for him. He moves quickly and puts it into place.

“It’s going to be a lot of pressure,” he said. “I’m going to be holding this down.”

It’s the first of the two front teeth. I close my eyes against tears that are threatening and let the piano that’s joined the trumpet wrap me up in its music. It works, as do my prosthodontist’s observations on our lovely day.

“Actually it looks good when it rains after all the sun,” he said looking out the window while he holds the tooth in place for the cement to set. “That is if you’re inside and you’re working.”

Point well taken. While we Portlanders can do some serious basking on our sunny days – and are quick to call down to our friends in Arizona and tell them the sun is out – we do have an acquired taste for the colors and texture cloud cover can coax from the world.

The timer starts beeping and they go to cleaning up the cement around the gum lines: Stainless steel explorer, water, and suction – all part of the dental concert, me watching the performance through his gloved fingers that so firmly hold my upper lip back from the stage.

Basically it’s this routine times six. As he reminds me once again, while some dentists cement in three and four teeth simultaneously, he does one at a time so he can get perfect seals around the tooth roots or posts or whatever it is that needs to not let moisture and bacteria penetrate. So that’s cool. I’m glad.

The downside is, however, that all gain comes with pain, and it takes forever with much, much fiddling. I like it of course. Am nothing but thrilled that some one is bothering so over my well-being. Then again, a short-timer is a short-timer.

Today I came in at nine in the morning and he’s expecting to finish by 11:30. Consequently, instead of settling down into my dental chair mode for the long haul, I stay in another less patient place where I keep thinking that things will be winding up much faster than they actually do. Human nature. Chuckle. I look around for a diversion.

My prosthodontist’s tie is always good for some interest. Expensive, of course. Dark ties. Conservative with all the fine detail that money can buy. Today it’s a brownish short of checkered affair. Small checks and then smaller ones still, like a chess board in a chess board with the dark squares decorated with a simple asterisk-like design and the lighter ones harboring another tiny, mini-chessboard within their borders.

Both my prosthodontist and Cindy have on white shirts under their white lab coats, but while his is buttoned down and tailored, hers is loose and open at the collar. They visit some about the different cements they are using today. All the while the jazz station starts off on a program of crooner music like “Frankie and Johnny” and another one with Frank Sinatra singing “Look Down That Long Lonesome Road Before You Travel On.” I could do without crooner music in a heartbeat, but our public jazz station with its volunteer DJs is commercial-free so far be it from me to grouse much.

Like having to take music you like with music you don’t on the radio station, nothing’s ever just done deal on the high side in the dental chair either. There’s a last shot of Lidocaine needed because my prosthodontist had to get one of the gums pushed back with piece of cording. And then there’s all this vigorous flossing.

I let him know that my tender gums feel it, but he’s a man on a mission. “I have to clean up the cement. If I don’t your gum will puff out like a balloon. Just hang it there. Almost done.”

I’ve heard that “almost done” line a number of times over the course of all that has taken place. It’s a good one; I like it. When he says that, I’m usually able to settle in for the last of the intensity without needing any more numbing.

He finally finishes and while he’s out of my mouth I quick search with my tongue. Yes! They’re all in. No gaps. Yes!

Back he comes, though, and pulls a tooth out of my mouth.

“What?” I said. “Here I just made a note that they were all in! And now there’s still one to go? Only one I hope? Or are you going to pull a second one out?”

He chuckled. “No, only one. How about instant replay?”

So instant replay we did, and the last of my restored teeth was cemented into place on a rainy morning with summer trying to come into its own.

“Those look nice. They really look nice,” he said. “And more than the appearance, they fit really well around the posts and gums.”

“Thank you,” I said. “Yes they are lovely, and I know you did superb work. Thank you. To you, and Cindy, and Stacy. Everyone has been so wonderful. Thank you.”

A last check to write. A last follow-up appointment to schedule for two weeks out. A last walk down the stairs from the third floor dental suite.

Outside in a fine rain that mixes with my tears. Into my car and me weeping and weeping. Sobbing really. Get a grip, sweetie. This is supposed to be a good thing.

Finding a hankie. Starting up the engine. Drying tears. Looking in the mirror. Looking in the mirror some more. No dentures. Pearly crowns instead. Fine custom jewelry.

My own mouth restored. I turn up jazz and even the crooner sounds good. The hiss of the tires on the pavement as I pull out into traffic. The smell of a warm rain freshened day in Portland.

Previous Stories

Teeth in an Hour – Dr. McAndrew’s Implant Patient is a Believer

Shooting, Scoring and Saving Your Teeth

A Mouth Restoration Story – Part 14

more Feature Stories

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