| Part Two
By: Jean Johnson for Dental1
I scheduled my first official reconstructive appointment the day before Thanksgiving – a move I do not recommend to others since I ended up mincing my way through a five course meal not 24 hours later.
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Prosthodontists are specialists in mouth reconstruction.
The American College of Prosthodontics (ACP) was established in 1970 and currently has 2700 members in North America and abroad enrolled.
Members of ACP must have completed dental school and three additional years in a prosthodontic education program accredited by the American Dental Association.
The numbing routine – normally something I tolerate without too much thought – pushes my level of comfort right up there even if my prosthodontist does have on a gorgeous silk tie in wide silver, black, and pink stripes. His deep voice is – as they say – quiet but firm. “You’re going to feel a pinch, Jean.”
There’s the familiar glint of the stainless steel circle on the end of the plunger, his gloved thumb placing steady downward pressure on the syringe. I try not to hunch my shoulders or fold my arms over the chest the way I want to. Instead I focus on keeping my breathing even – or at least trying to.
The pain of the needle in my gum tissue subsides as the anesthetic takes over, but just as soon as he finishes up in one quadrant, he moves to the other side of my lower jaw. I take another deep breath and try not to lean away from him and close my eyes until he’s finished.
“Is that it?” I said, since sometimes he has to inject one area several times.
“We’re finished with the lower, but now we have to do the upper,” he said.
The surprises these folks can have in store for you are sometimes a bit much, and I confess, having anesthetic injected into all for quadrants of my mouth in one fell swoop gets my attention. He grips my cheek and does that quick, repeated shaking motion as he pushes more and more of the medication into the tissue. His technique helps enough for me to keep my sense of humor, and I start off on how it’s like movements in a symphony – me wanting to clap before the piece is finished and the conductor is ready to take a bow.
Worse, after he’s finished with the last side on the upper jaw, he has an encore waiting: He nails me one last time on the oh-so-tender the roof of my mouth. He taps with his mirror on the gum tissue nearby to distract my mind and stimulate something other than pain receptors. It helps, but really… the whole thing’s a bit much even for a seasoned dental chair veteran like myself.
Instead of hearing applause when he finishes all he gets from me is an “I don’t like you any more.”
He laughs and says, “You might not like me, but you need me.” Indeed, this is the day he uncovers my implants.
After they place an implant in the jawbone, they suture the gum closed and let the whole works heal for six months or so while the bone structure fuses to the titanium. At least that’s how it works with the kind of implants I have. There are new types on the market that are designed for what manufacturers call "load-bearing" immediately, but my prosthodontist prefers to work with technology that has a proven track record of several decades.
His assistant gets the shush-hum of the suction going. I eye her shock of light brown bangs that curve stylishly over one side of her forehead. There’s a reddish streak tinted into the hair – a cross between auburn and scarlet. Also, she’s picked up on the secret of how men manage to look so good in plain clothes, and she sports a silk scarf wrapped around her neck and knotted just so. It has grays and blacks just like my prosthodontist’s tie. The flash of color above her white lab coat does as much for her as his tie does for him. They make a classy pair.
She sweeps her wand lightly around the tissue where he works, and in the stillness that invariably comes whenever he has a needle or scalpel in hand, I hear what sounds like a blade cutting through gristle in tiny delicate movements. He stops for a moment to adjust his light. In one practiced sweep, swings the whole contraption up and back around so the beam more directly illuminates the interior of my mouth. They lean in, brows knit in concentration to study the object of their work. Two humans peering into my mouth so seriously, all up close and personal. I’d chuckle – if I was able.
“I think I feel an implant under there,” he says and picks up his forceps. He pushes and pulls and prods on the gum tissue and pretty soon it’s “There it is.”
Out comes his box of screws – he has to put in temporary devices around which the gum tissue can form a socket. So there’s much twisting and turning and finally a last tightening with what seems to be a petite, dental-sized tire iron. All the while I take my entertainment from the white press on the cuffs on his shirt.
Prosthodontists are interesting characters. An Internet search shows that they earn way more than physicians and work less to boot. (My guy enjoys regular three-day weekends.)
I don’t begrudge him Fridays off, though, since he needs to really be on the four days he comes into the office. Working on a live mouth at the level he does takes considerable energy where success is measured in millimeters.
I remember last year when he was placing an implant he said that the reason he kept measuring and drilling so slowly was to avoid “going where no man wants to go.” I assume he meant hitting all manner of facial nerves that if damaged could leave a patient with a serious sag.
So it’s a groove to check out his clothes. Square-toed shoes that I presume are Italian or at least handmade by some expert cobbler. Shirts of the finest fabrics, perfectly laundered and pressed, with the collars not too tight or too loose.
I’ve not seen the type of cuffs on the shirt he wears today before. Instead of rectangular, the point of the end with the button hole is mitered fairly substantially – just a small tailoring detail, but one that speaks much about my prosthodontist’s tastes and more importantly, his eye.
I sigh. Rest easy while they go about their business in my mouth. Confident that they are taking pains. And that in the end, I’ll have implants and a set of custom teeth that are as fine as the cuffs on my prothodontist’s shirt.