| Part Two
| Part Three
| Part Four
| Part Five
By: Jean Johnson for Dental1
Sigh. It’s time to talk about my front teeth. If they haven’t been up, down, and around the pike, I don’t know what has. There have been root canals, including several new ones this past fall and winter that my prosthodontist wanted me to have done before he got under way with the restoration. Also, back when I was still in the care of various family dentists in small towns, the teeth were cut down for first crowning and then ultimately bridging.
Indeed, if there’s one thing I’ve learned from all of this, it’s that patients who have complicated mouths need to get into the care of first-rate prosthodontists earlier rather than later. Once you start losing teeth and dentists put bridges on, not only do the two teeth surrounding the sad, gaping hole in your smile have to carry the weight of three, those stalwart soldiers also have to get ground down to do it.
| Advice from the patient’s mouth:|
Oftentimes looking in the mirror when old front (and back) crowns are removed can help. Patients often discover that the image is not as bad as they thought it would be. Also by knowing the extent of the damage to the teeth, you can better appreciate what your dental professional is doing and also take more cautious care of your restoration work once it is in place.
The temporary phase of dental implants can be a difficult time since temporaries can come off easily during different stages of the restoration.
Remember that temporaries are only that — rather rudimentary teeth designed to keep one’s appearance and function going until permanent crowns are placed.
Temporaries have neither the luster nor the detailed sculpted appearance that permanent crowns have. Nonetheless, it’s good to communicate with your dentist about which aspects of the permanent crowns you hope will be different from the temporaries.
When I think of how much perfectly good tooth structure I’ve lost to that antiquated form of dentistry, I shake my head. Then again, I was just like the next person and feared the expense of the specialist. Only now, years down the road do I see that I would have saved both money and my teeth.
At least there’s something left to work with, though. Every shred of tooth that’s still left saves me the price of an implant, so I appreciate that. But, back to the front teeth… the old ‘all I want for Christmas is my two front teeth.’ Only in my case it’s not just two, and I ain’t no kid any more… chuckle.
Two upper bridges currently span my smile. The first one came off easily, but the second one took some doing. While my prosthodontist tapped and drilled and prodded, I checked out the herringbone pattern woven into the perfectly white cuffs of his shirt. Nice fabric with just enough backbone to stay looking crisp all through the day.
I drift off to the land of clothes and imagine the lovely threads I’ll buy once I pay for my dental work. Wool flannel slacks. Lined and made from a lovely gabardine that doesn’t even think about wrinkling. I think of a three-quarter length black dress and jacket so I’ll have something decent to pull on when I find myself out and about.
He finally gets the second bridge off, and there I am feeling very exposed. Quite a rude awakening from my fine fashion daydream. His assistant gives him two cotton rolls which go politely under my upper lip. I ask for a mirror and check the grisly scene out. It’s bad, but not as monstrous as I had always imagined — I definitely feel better looking even though it’s pretty hard to see yourself that way. With the mirror and a question now and then, I feel part of the team instead of just a passive, dependent patient.
He starts in with the cording that they put around a tooth when they work on crown preps. It’s blue the same color of the sky on this particular day — what we Portlanders call a ‘sun break.’
There’s weird taste on the cording. “It’s a vaso-constrictor,” he said. Something about keeping the bleeding down so they can see just what it is that needs tending to. Also, he added, “It keeps the gum away from the neck of the tooth—protects it and gives us better visibility of how much tooth structure is left.”
His assistant reminds him to put on his glasses. “Oh, yes. I want to look smart while I do this,” he quipped. They have black rims and are non-prescription. He wears them exclusively for protection. I appreciate his sense of humor.
Clearly the man is intelligent. His parents must have seen that early on since they invested in a private high school education for him, not to mention undergraduate work at one of our nation’s better private liberal arts colleges right here in Portland. Then there’s the fact that he had the good sense to listen to his advisors in dental school who pointed him in the direction of prosthodontics and dental implants — the wave of the future. Finally, there’s his practice that he has developed over the past dozen plus years. All that takes way more than a bit of smarts.
What is so often missing in healthcare providers, in my view, is the lack of pretension that is so obvious with my prosthodontist. I did find a marvelous physician once that, like my prosthodontist, didn’t take himself too seriously. Anyway, it must be my karma to have the pleasure, now, of dealing with yet another medicine man that can go the distance without all the puffery. Like fresh, northwest air coming straight in from the Pacific.
There’s the usual high whine of the drill — all the old things I remember from when various dentists did crown preps on my failing teeth over the years. But while those days were marked by decay and dissipation, this is a different experience — one of restoration. My poor neglected mouth is finally getting the attention it needed all along.
The highlight of today’s four-hour appointment is the re-angulation of my front teeth. As I mentioned a couple installments back, over the years as all the crowns and bridges went in, the front teeth got larger and flared out. Now, my prosthodontist is changing all that. After he takes his impressions today, he’ll have custom posts made at his lab that will enable him to make more polite crowns than the ones presently in place.
It’s pretty weird having the hollows of your teeth reamed out, believe me — especially the top uppers. But that’s the science of the game, and at this point, I’m glad to participate. As a typical baby boomer, I’d do almost anything to avoid dentures, and I’m already thrilled to have left the world of partials and retainers behind.
My prosthodontist, of course, is sold on implants, but he takes it beyond any one particular generation. “Look at it this way,” he said. “Portland is one of the top 10 affluent cities in the nation. Patients don’t want to have to deal with partials or dentures. They want the best dentistry has to offer, and that means implants.”
Indeed, since he has seen me taking an interest in the field and has read the installments of my Dental1 stories, he invited me to a session where he spoke about implants to a room full of general practice dentists. “We’re not waiting any more,” he said. “The future of dentistry is here.”
I sat in the back of the very well-appointed conference room and thought: Wow. He’s right.
His assistant comes with her suction again. Like him, she always seems to know just when you’re starting feel like you might be drowning a little. And she knows exactly where to go, first gently way in back on one side and then on the other. Her movements are feather-like compared to his firm, all-business grip. Yin and yang, right there in the dental chair. It’s great. Between her keeping me comfortable and him ever ready to zap me with another hit of Novocain if I need it, they make it pretty easy for me to take it easy.
I take another look in the mirror. Yup. The teeth nubbins really are bad news. I really do need to be here.
The mirror goes down after a bit, though, and I close my eyes while he drills and his assistant suctions and air dries. The overhead beam has an amber-rose hue through my lids, and I’m lulled by its warmth and the sounds of them working. Eventually when I do open my eyes, the warm rose light turns white-blue too abruptly, and it’s startling to see two human faces looking down at my mouth so intently.
“Cindy can you give me a brand new size 15,” he said. She hands over a fresh file and he goes back to smoothing away on the hollows of the teeth. One is particularly pathetic with hardly any tooth left at all. It wasn’t all that bad when we first started, but during the root canal at my endodontist’s across the hall — a procedure that I once again watched with a mirror—pieces chipped off.
I learned back earlier in my life when I did a stint as an operating room technician that it’s all the game. The pros never know how much integrity they will find until they get into a job. In my case, the idea that more tooth would fall away in the process than we initially hoped, does not surprise me. Thus, his comment today wasn’t all that unexpected.
“There’s so little left on this one that it probably won’t last the rest of your life,” he said, pointing out my worst offender as I gazed into the mirror.
Damn. No happily ever after sleeping beauty story for me it seems. Then again, who knows, he says. I might get by with it. “The thing is Jean,” he said. “We can never tell with these teeth that have had root canals.”
I try to be objective and trust my prosthodontist and not freak out, but it brings up a whole other fear I have; a recurring fear that I’ll get all this work done and then it will start needed replacing when I’m frail and plum out of cash.
I’ve talked to him about it before, of course, and he reminds me of how precise his crowns are and how passively they fit and how long they last. And it’s true. His reputation is impeccable.
Over and again, people from my dental hygienist to lab people to an orthodontist I know say that my prosthodontist’s “work is the finest we’ve seen.” And they always add stuff about how “you wouldn’t believe some of the work out there that gets done.”
Still, a root canal is a root canal. And along with the nerve, it strips the tooth of its blood supply and leaves it facing a life without vitality. A brittle life that predisposes it to fracture. Sigh. Here I have five root canals in my front teeth.
My plan is to keep on shredding my apples and carrots and using my molars for chewing like I have been for years. That way I won’t put too much pressure on these fragile front babies. That’s the best I can do, I guess. That and of course practice fastidious oral hygiene.
Indeed, I feel like Agatha Christie’s fussy little Belgium detective Hercule Poirot cleaning my teeth these days. Water pic. Floss. More water pic. Electric tooth brush for two to four minutes on each — bottom and top —trying to work up to my prosthodontist's eight minute recommendation. Fluoride rinse. It’s this whole scene times three in the bathroom a day. Chuckle.
He finishes going over and over and over the teeth and has his assistant get ready to mix the blue goo for the impression. Dave Brubeck’s Take Five is playing on the jazz station.
“There’s Take Five,” I said.
While Brubeck’s drummer does his solo, he tells me to take heed, “Jean. OK,” he said, “This is going to be a tense moment because I have to get all the impression material all around the teeth before it dries.”
I relax my hold on the steno pad and pencil — I’ve gotten better at taking notes without looking than I ever expected. There I am at the ready. They each go to their own trays like two chess players jockeying their pieces into place for the match. Then he gives the signal.
“Okay, Cindy,” he said. “Go ahead and mix.”
From there it’s a matter of him gooping the stuff around the teeth and then putting a whole mouth plate of it around my uppers. There we are. Him holding the thing place, his one hand like a big spider over my face. I’m fairly patient in the dental chair, but this one seems to go on longer than usual.
“About four minutes to go,” he said.
Four minutes? I make some sort of garbled sound that stands for, “That long?”
“This is seven to eight minute material,” he said, and continued to look straight ahead out the windows at the stately evergreens silhouetted by the bright blue sky. “This is the final impression.”
The things they don’t tell you in advance. I try not to panic while I feel saliva building at the back of my throat. It’s not really bad, though, and he apparently realizes this along with the idea that if he stays calm and businesslike, I will also take things in stride. Clearly there’s a little psychology involved in dentistry.
After the main impression there is another one “to capture your bite” and then they finally get me glued back together. The chair goes up and forward without a sound, and I am returned to an upright position and the land of normalcy. It’s as abrupt as opening my eyes was earlier during the four-hour appointment, and for a moment I hesitate making the transition.
But then, there’s my dental assistant unclipping the pink bib and joking about the abstract design of blue goo on it, asking me if I want it to keep it for a memento. And my prosthodontist with his parting instruction:
“Be sure not to bite on this,” he said, smiling and shaking my hand on my way out. “Once we get the buildups done and the temporaries on it will be good, but this week be careful and just call me if it comes loose.”
Famous last words. I really did try to be careful and didn’t bite on the bridge. Instead, it was when I was flossing that the seal popped. Sigh.
First the phone call. Then the appointed time the office. Then more cleaning up and drying and gluing. This time he puts a hand on my shoulder on the way out, and I got his cell number in case it comes off over the week again.
His office manager lent a sympathetic ear as well. “Temporaries are a hard phase,” she said, smiling with a gorgeous set of teeth that I assume are her natural ones. “They come off and people get frustrated because they think their permanent teeth will look like the temporaries.”
The things they don’t tell you in advance. Anyway, it’s good to know I’m a fairly typical case.