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ralph robert moore


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ralph robert moore

Copyright © 2001 by Ralph Robert Moore.

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one of my own little miseries
june 23, 2001

Into each life a little pain must fall.

I enjoy visiting acquaintances in the hospital, because it underscores by contrast my own good health. I hate seeing them bedded, weak, wrapped in white linen, but I love the smugness of knowing, wandering down the white corridors, looking for a room number, that after my visit, unlike them, I get to go home.

That something bad, and there's always a something bad, is this time happening to someone else, not me.

In this same spirit, I thought I'd tell you about one of my own little miseries, involving my teeth. Hopefully, you're not having a problem with your own teeth at this time, so that you'll be able to thoroughly enjoy this narrative, sympathizing with me, certainly, but more importantly, grateful to gloat that what is happening to me is not happening to you.

Let's start with a brief history of my teeth.

My mouth has always been my Achilles heel.

For one thing, my teeth have exceptionally long roots. Where others' are simple stubs, mine taper an elegant length up into the maxilla, down into the mandible. This luxuriance of length has caused me problems and pain since childhood. Extracting my baby molars, for a succession of dentists, was like pulling teeth. I remember one session in particular, where the black-haired dentist, unable to loosen a tooth, sweat on his brow after several forearm-tightening attempts, had me move, mid-yank, to another room, where the chair cranked down even lower, so that he was able to get even more of a gravitational grip on the tooth before again pulling up on his pliers. Around the early sixties, this problem of extraction was relieved somewhat when dentists began using a separate instrument, which looked like a plump, round-tipped dagger, to press against the different sides of the selected tooth, slanting it this way and that in the gum, loosening the root's buried red grip in its socket. I still remember the reverberations in my head during this procedure, which, in its gradual loosening effect, produced a loud sound behind my nose that had a distinct ratcheting quality. The length of my roots also foiled the one root canal I needed back then, because the dentist my parents took me to, whose face I can remember, but not his name, only had lances that would push about three-quarters of the way up to where the infection lay bubbled at the top of my tooth, and not able to get up any farther, he simply sealed the back of my tooth with a metal filling and sent my parents a four-figured bill (his attempts had extended over a year, with several visits a week). Twenty years later, that unpierced infection had grown so festering it ballooned into a tumor across the palate of my mouth, which had to be carefully carved out, curved steel scalpel drawing large, dripping circles across the roof of my mouth, by a better dentist. Even with Novocaine, the pain was extraordinary, because by cutting up into the roof of my mouth, he was, because of the neurological shortness of the signals, in effect stabbing up into the bottom of my brain.

For another thing, I happened to contract Scarlet Fever when I was around twelve, one of the last people in America to do so, according to my doctor at the time, which in addition to ten days' absolute isolation, meals left outside the door of my bedroom for me, my mother's muffled voice on the other side, meant the protective hard dentin surface which would normally form on my teeth during that period didn't, so that the surface of my teeth remained "soft", and therefore far more susceptible to cavities, even though I was never much of a candy eater. I eventually had to have nearly all my teeth capped, and root canals in eight of my anterior (front) upper teeth, despite my daily brushings and flossings and rinsings.

About a half year ago, I noticed the rearmost molar in my lower right quadrant (the tooth closest on the bottom row of teeth to my right ear), was becoming sensitive to pressure. This was the only gold crown in my head, the rest being porcelain, the oldest of all my crowns, and one which, if I gave a particularly broad grin, as I sometimes do, produced a momentary pirate's glint. Over a week or so, this molar developed such a sensitivity, it became difficult to eat. Every bite produced a wince. The side of my gum under that tooth swelled out, tongue-malleable red bubble against the normal pink.

I went to my regular dentist, who took an x-ray and found I had developed an infection within the tooth itself. He prescribed some antibiotics for me, which reduced the gum swelling and eventually made the tooth again feel normal.

Three months later, the sensitivity came back. We had an orange, white-capped vial of antibiotics in our bathroom cabinet left over from an upper respiratory infection that cleared up much faster than expected, so I gulped them over a period of several days. The infection went away again.

A week ago, it came back.

This time, looking at the ghosts on a new black and gray x-ray, one of those films the size of a big postage stamp, my dentist suggested I make an appointment with a specialist.

I don't like specialists.

As long as you can restrict your visits to a regular doctor or dentist, you're not in trouble. But once you need to see a specialist, you're fucked.

My dentist explained a little bit about what would probably happen. I'd "likely" need to have bone tissue transplanted to the sides of that tooth. Under the gums. How, pray, would the specialist be able to get the bone tissue under my gums? Certain words rang out during his casual elaboration. "Surgery." "Incisions." "Flaps." "Stitches."

I drove back home, hands in the ten o'clock and two o'clock positions on my steering wheel, glum.

Made an appointment with the specialist for this past Friday, June 22, for an evaluation. His receptionist seemed really nice.

I walked around the house the rest of that day with worry in my eyebrows and stomach.

That night, after I finally fell asleep, trying not to think of shiny silver scalpels cutting across my tender red gums, I had another instance of a recurring dream.

I didn't realize it was a recurring dream until I was a little bit into it, when it dawned on me this was not the first time I've visited this particular dreamscape.

I often forget, upon waking, my recurring dreams. It's only during them the recognition comes. I have a lot of different recurring dreams.

In this particular recurring dream, I'm walking through the modest main street of a small seaside town. I think it's in northern California for some reason, but I can't be sure.

What's odd about this particular dream is that each time my feet touch down in the town, I first notice the improvements they've made since my last visit. For example, when I went into this dream about a year ago, as I walked down the main street I saw the townspeople were repainting several of the one- and two- story buildings, where I had noticed in my prior visit the paint had faded under the sea air and sun.

This time, quite a few of the citizens were engaged in a new drainage project, to facilitate the diversion of rain water from the main road.

The small town, which apparently consists entirely of shops on either side of this one modest main drag, although I have some dulled sense of homes within the inland hills, is entirely populated by people I've known in my life.

All of the citizens are people who have been on the margins of my life. Acquaintances. For example, as I went down the sidewalk this past night, I ran into Dick Levitt, bald-headed, with sunken eyes, someone I hadn't seen in decades, who was the co-owner of a stationery store I worked in nights while going to college during the day. I can't tell you how great it was to see him again, and catch up. He was an adult who always thought I was someone special.

While I talked to him on the sidewalk, both of us nodding at each other and laughing, it occurred to me he was probably dead, given that he was in his early sixties when I knew him in real life, and that was thirty years ago.

But many of the people I meet in this town aren't dead. For example, I ran into two older women, one of whom I used to work with, one of whom I still do. Stevie was head of operations for the company I worked for, with an office right next to mine, until she was forced out through politics. Now, in real life, she lives in retirement with her husband in a cabin on the rim of a wide blue lake on the Texas-Oklahoma border. In my recurring dream, she runs her own small art gallery, and you can go out the back door where only a rear alley separates her building from the night surf falling one story below onto the moon-lit sand. Likewise, in Stevie's shop I came across Susan, who happened to be helping out that night, who I haven't seen in years, an older lady who still works in our Duncan, Oklahoma office as an account manager.

The atmosphere of the seaside village is relaxed, sun-lit, happy. Once you die, according to some beliefs, you see the people who were significant in your life. Your soul mate, parents, favorite teachers. Because the people populating this town, alive and dead, are incidental to my life, I don't think the town is meant to be Heaven, but I think it may be where I stop for lunch on my way to Heaven.

I awoke from the dream with a pleasant feeling. It put my worries over my teeth into context, into the diorama of my life as a whole.

The next day, Friday, early in the morning, I drove to my appointment with the specialist.

I had anxiety about going to the specialist, about what he might find, but I also had anxiety about finding his office in time for my appointment.

All my life, I've always had problems orienting myself in space.

If I approach the street where we live from a different direction, I'm completely lost. If I go into a building where the entrance is not visible from where I wind up inside, I get hopelessly mired trying to find my way out, wandering the same corridors, passing the same gray cubicles, over and over again.

Because of this affliction of mine, Mary has been kind enough over the years to write out very detailed instructions for me, filled with lefts and rights, whenever I have to venture by myself on any route I haven't already worn into a rut.

Fortunately, it was easy to find the specialist's office building, so easy in fact I arrived forty-five minutes early (I gave myself an absurd length of extra time, just in case I accidentally made a wrong turn).

I had feared the building might be a high rise situated on a confusing four-way city intersection of tall, unnumbered buildings, but in fact it was located, old-fashioned and two-storied, on a tree-shaded corner in a residential area of town.

After checking my wrist watch every few paragraphs of the book I had propped open against my steering wheel, it finally got unhappily close enough to the time where I could leave my car and go to the office. I searched inside the building for a restroom, having to pee by now, but couldn't find any, although every other door was marked Private, and locked.

I was the only patient in the small reception area. I asked the woman on the other side of the sliding glass partition if there was a restroom I could use, and she buzzed me through to the interior of the office, a short hallway with examination rooms on either side down its length, and nearest to me, an open doorway revealing the chrome and porcelain of a small bathroom.

I stepped inside, flipped up the wall switch. As often happens to me in stressful situations (flying a thousand miles to give a speech at a hotel, or about to argue, with a roomful of seated lawyers with red power ties, about indemnification), the element of bizarreness in my life suddenly increased. In this case, the bathroom was perfectly equipped, plumbing-wise, but as I turned to shut the door, I realized there wasn't one.

I stood dumbly just inside the entrance to the bathroom, in clear site of anyone walking through the hall, staring at the doorless doorway. To be honest, for a moment I was at an absolute loss as to what I should do. Was the office that casual, the staff simply averting their eyes as they walked past, while someone used the toilet? Did I really want to go to a doctor who couldn't afford a door for the most private room in his suite? Couldn't he have just moved a door from one of the other rooms? Or at least put up a shower curtain across the entrance?

But then, examining the doorway even more closely, stooping over, I saw there was a sliding door inside the wall. I pulled it across the entrance, shutting myself inside with the sink and toilet. But the sliding door had no lock. I stood in front of the toilet with my back angled to the 'door', so if someone suddenly slid it open, that's all they'd see, and urinated as quickly as gravity would allow.

Back in the reception area, I picked up the clipboard with the questionnaire first time patients are supposed to complete.

I decided to sit on a long, brown leather sofa against one wall.

Leather sofa makers pride themselves on the comfort of their products, but this one was way too soft. As soon as I sat down, my ass fell about a foot into the cushion, lifting my feet off the carpet, knocking the clipboard against my face. Warily returning to the sofa after leaving the completed questionnaire by the sliding glass partition, I lowered myself more carefully this time, at least avoiding the sudden back flip, but winding up sitting with my knees up around my jaw, like an ape.

A few minutes later, a dental assistant opened the interior door, and asked me to follow her.

I was put in the rearmost room, lying down with my shoes at a higher level than my head in one of those long, padded dentist chairs that resemble the seats used by astronauts.

While I waited, because of course you always wait, I looked at the pictures on the wall. They were all enlarged snapshots of gargoyles, not just the snarling faces, but the entire naked stone bodies, most of them posed oddly, resting on their haunches, elbowy arms stretched down monkey-style to the parapet or whatever it was they were guarding. In my regular dentist's office, he has pictures on the wall of waterfalls and restful forest glades, and big-eyed animal babies.

The specialist, a periodontist, showed up about ten minutes later, in a white coat, looking at me over the rims of his glasses, about sixty or so, with white hair and a short white beard.

He seemed like a nice guy. We spent about twenty minutes taking all sorts of measurements of my mouth, not only of each side of each tooth, but also of my mouth itself when the lower jaw was flexed all the way over to the left, all the way over to the right, etc.

After that, apologizing in advance for his lack of artistic skills, he used his pen to draw a Disneyish tooth on the back of one of his brochures on periodontal disease.

What somewhat detracted from what he characterized as his "exhaustive" explanation of my problem, was that he had obviously given this same speech so many times, it completely discombobulated him whenever I asked a question, because it threw him off his recitation. ("Well, I was going to get to that in the next section of my explanation, but since you asked at this point, here's the answer...").

For one happy moment, near the end of his patter, it appeared as if he were saying all I needed to have done was to grind the surface of my molar down, and that would be the end of my problem.

But I had misunderstood him. Big time.

Now remember, I went to him to see if there was anything he could do about one tooth in particular, my rearmost molar in my lower right quadrant. My regular dentist, who had referred me to this guy, thought the specialist might be able to do a bone graft. In this procedure, the gum around the tooth is sliced open, a section of the gum tissue surgically removed, at which point the periodontist, using various slicing instruments, reshapes the buried bone underneath the gum, then fills the space left over from the removed gum tissue with sterilized bone tissue. This tissue, in theory, stimulates the growth of bone, causing the tooth to fit more snuggly in its socket, to where bacteria can't get between gum and tooth and further deepen the pocket there (the deeper the pocket between gum and tooth, the easier it is for bacteria to get in, resulting in bone loss to the jaw).

What the periodontist was now suggesting to me, though, was an extended series of procedures. First, I would be given local anesthetic over two separate sessions, and have a complete mouth root planing (where he slips a thin scalpel under the gum of each tooth up to or down to the jawbone, scraping off any bacteria). Then, in a separate session, he'd resurface all my teeth, to make them meet better (a problem I hadn't noticed). After that, we'd start with the actual surgeries, which would take place over several sessions, grafting bone tissue not just to the tooth I was having a problem with, but six or seven other teeth as well. After all that, a couple of months later, I should have pocket depths of about 3 millimeters throughout my mouth (a pocket depth between gum and tooth of 3 to 5 millimeters is considered acceptable. Anything above that is cause for concern. Most of my pockets were within the acceptable range, except for a few that went up as high, in one case, to 7 millimeters.)

All this effort would cost somewhere between $6,000 and $7,000, nearly none of which would be reimbursable under my insurance, as well as pain, pink spittings, and days of holding my hands around my mouth, waiting for the discomfort to fade.

So where I'm at now is trying to decide if I really need all this painful, expensive work. I've made two appointments, one for next Thursday, June 29, to have two quadrants root-planed, and another for the following Tuesday, to have the other two quadrants done, but more and more I'm thinking I might want to consult with my regular dentist first, who knows the history of my mouth better than anyone other than myself, to see if all of it really is necessary.

Two interesting facts I learned from the periodontist, interrupting his spiel at a couple of points, drawing him up short: (1) Smoking, of course, tends to increase your risk of periodontal disease ("You know I'm required to give you the standard anti-smoking speech," said with a self-deprecating smile). I asked him if there was some level of smoking where it didn't affect the gums, and he told me that after seeing tens of thousands of patients, it's been his observation that people who smoke ten cigarettes a day or less don't adversely affect their gums. (2) He found some evidence on the surface of my molars of teeth grinding (he himself grinds his teeth, and wears a plastic guard every night). He asked me if I work with computers. "The worse cases of teeth grinding I see are in people who work on the computer, and truck drivers."

I'll let you know how this all turns out. But in the meantime, don't you feel a little better now, having read this, realizing you don't have to go through something as gruesome as what I've just described?