ralph robert moore
the official website for the writings of
Copyright © 2001 by Ralph Robert Moore.
Print in HTML format.
Return to lately 2001.
the lady and the periodontist
july 7, 2001
When we last left me, I was trying to resolve all the troubles I've been having with my tooth.
For those of you who have missed the saga so far, about a year ago, the farthermost molar in my lower row of teeth, all the way over by my right ear, developed an increasing sensitivity to pressure (such as when I eat).
This tooth is the oldest crown in my mouth, going back about thirty years, the only one made of gold. As I've said previously, it is the one glint of pirate in my smile.
My first reaction to the pain I experienced whenever I chewed on that side was to fervently hope the pain would go away. This course of treatment proved ineffective over time, however, so I made an appointment with my regular dentist to get the tooth examined.
It turned out my gums had receded around that tooth to a degree where the tooth developed what is known as a 'bifurcation'. Bifurcation refers to a branching into two parts, such as occurs with incisors, but when used in this context, bifurcation means a cavity has formed, not on the surface of the tooth, where it's easily treatable, but under the gum line of the tooth, where it pierces the buried white downwards-tapering chamber of the root itself. The only way to successfully treat this sort of cavity is by a bone graft, a procedure in which a smile-shaped section of gum is sliced away, the bone of the root patiently reshaped with the curve of a silver scalpel, sterilized bone tissue pressed down against that scraped surface, and stitched over, to protect it, with the same material used in water-repellant raincoats (because that material "breathes", but keeps out food particles).
If successful, the graft takes, stimulating the root to manufacture new bone tissue, which eventually covers the cavity and resolves the problem. Resolution may take anywhere from one to several years, depending (and whoever thought a word like 'depending' had such power).
My regular dentist, who knows the history of my mouth, and who I trust, suggested a specialist to me, a periodontist, to see if I were a likely candidate for a bone transplant.
Unfortunately, when I went to see this specialist, as detailed in the two prior columns, he seemed less interested in treating this one tooth of mine than in completely revamping my mouth, root-planing all four quadrants, resurfacing all my teeth, putting bone grafts around seven different "trouble areas", etc. You get the picture. I walked in expecting to arrange for a procedure that costs about $600, and walked out with a course of treatment estimated at $6,000 to $7,000.
I decided to hold off on proceeding with the periodontist's grand schemes for world conquest until I talked to my regular dentist again, to get his advice. I tentatively scheduled the planing of the first two quadrants, but called the periodontist's office to cancel. The receptionist, cheerful when I set up my initial consultation, was now snippy.
Everything above may be considered to fall under, "When we last saw Rob...".
My dentist left me a message to call him on my answering machine last Thursday, but I didn't have an opportunity to talk to him until Monday of this week (July 2).
He asked how the visit had gone.
I was honest with him. I felt the periodontist was less interested in taking care of my immediate problem than he was in racking up as much revenue for himself as possible.
"Well, of course, that pretty much sums up most specialists I've known."
"I'm sure it probably would benefit me to get all this work done. Ideally. But do I really need all this treatment?"
He laughed. "Ideally? Your only real problem, the one a specialist needs to do, is that one tooth of yours. But you have to let him know that."
So there I was. It wasn't a case of going to a specialist and getting an honest appraisal of what I had to have done, and getting it done. It was a battle of wills with the periodontist to have him focus on what I wanted, and not what he wanted.
My dentist gave me the name of another periodontist in the same area who might be more agreeable to just doing what I asked him to do. However, this second periodontist didn't perform the type of minimally-invasive bone graft surgery the first periodontist did (which the first periodontist, in fact, had invented). If I went to the second periodontist, I'd have a more radical surgery, with a longer recovery time. But I'd also be much less pressured to have unnecessary work performed.
I called the first periodontist back, to talk about my case a little more before making my decision.
I got his receptionist, who remembered me, and seemed smug at the idea I was changing my mind again.
"Could I arrange with the doctor, because of the costs involved, to only have the tooth that's bothering me root-planed, and then go to the surgery on that tooth?" Root-planing a tooth means slipping a long, thin metal instrument down under the gum, to the root, scraping off any plague that has attached, and its resultant bacteria, in the hopes this deep cleaning will cause the gum to bloodily heal around the tooth.
"Oh, you have to have at least that whole quadrant planed. You'll get abscesses in your other teeth if you don't." (Which made no sense).
"Is the doctor refusing to plane only the one tooth that's causing me a problem?"
She hesitated. "Well, to do that one tooth would cost $135. To do the whole quadrant only costs $165." One tooth costs $135, but six teeth cost $165? That didn't make sense either. It sounded like the bait and switch tactics used by some fast food outlets, where a small soda costs $2.05, and an extra-large soda costs $2.15. You buy the extra-large soda because it seems like it's underpriced, when in fact the small soda is overpriced to get you to buy the extra-large soda.
I had heard enough to decide whether I should go with this first periodontist, or the second periodontist.
I made an appointment with this first periodontist.
Some of you, at this point, may be surprised by my decision.
Let me explain.
When I was a child, I was fascinated by the story of The Lady And The Tiger.
For those of you unfamiliar with Aslan's tale, a gardener's son must choose between two doors, as punishment for having fallen in love with the king's daughter.
Behind one door is a beautiful woman, who will immediately marry him.
Behind the other door is a ferocious tiger, who will immediately devour him.
He stands before both doors, agonizing over his decision. Finally chooses a door.
The fairy tale itself ends before the selected door opens. We never learn his fate. Was he kissed, or eaten?
What fascinated me about the tale was its essential fakeness. Fake, in that it suggests the gardener's son had the actual power of choice, when in fact he didn't. Because he had no knowledge of what was behind each door, his decision was not based on a true choice. It was based on a guess.
And that's not what life is like.
We spend the length of our lives constantly making decisions, but nearly all of these decisions are informed decisions. They're not guesses. When we decide whether to major in film-making or business administration, we know at the time of our decision its ramifications. If we want to think of the two choices as doors, we can only honestly think of them as glass doors. We can see what's behind each one before we choose. To suggest otherwise, that we're going to somehow be surprised by the consequence of our decision, that our decision turned out unexpectedly, is to indulge in a shirking of responsibility for our actions.
Frost speaks of the path not taken, which he expresses eloquently, but his interpretation of the workings of life is in reality just another example of fakery. We choose one mate over another, one career instead of another, but rarely are these decisions irreversible. If we stay on an unsatisfactory path we chose at one point in the past, it's simply because we've lost the courage to strike out off that path, to brush through the crowd of tree trunks and slide our feet over uneven ground to the path we originally rejected, or an entirely new path, or no path at all. Life is not a series of forks in a path. Life is a forward direction we can traverse any way we want. Forks are for sissies.
Another falseness associated with The Lady And The Tiger is that one decision is wholly awful, and another decision wholly wonderful. I don't believe I've lived such a beset-upon life that I'm the only one who sees the naiveté in that presentation. Nearly all the decisions I've made in my life haven't been between gold and brass. They've been between one way that seems at least marginally better, and one or several that seem marginally worse.
So too with my decision to stick with the first periodontist. Unlike the second periodontist, who I hadn't met, this first periodontist was skilled enough in his profession, and dedicated enough, to have created an entirely new approach to performing the procedure I needed, a minimally-invasive surgery for which he had invented special tools and techniques widely recognized in his field as an advance.
He seemed money-hungry to me, and his receptionist would certainly benefit from customer service training, but pragmatically, he was the most talented individual available to me to perform these procedures.
The key words here, of course, are 'available to me'. Often, in life, we don't get to choose between 'good' and 'best'. Often, and isn't it in our worse times, certainly far worse than my minor tooth problem, all that's offered us, when we're alone, unprepared, is 'maybe okay' and 'worse'. A bitter choice, but still, always, a choice.
This past Tuesday morning, the day before the Fourth of July, I drove back to the parking lot of the first specialist, this time arriving just a few minutes before my appointment.
I smoked a last cigarette on the hot walk under the parking lot trees to the front of the two-story building.
Creaking open the front door, exposing to the sunlight the long, silent first floor corridor, shuttered doors facing each other down its length, as if no one had ever walked there, I recognized again the comforting museum smell of the place, not the modern museum smell of open spaces and interactive exhibits, but rather the museum smell from childhood of wood and dust.
I was a pro this time, turning around in the office rest room to rumble the wooden door shut from its hidden slot in the frame, carefully lowering my ass into the soft brown marshmallow of the reception area's leather sofa.
A smiling Mexican woman escorted me into the interior of the suite a minute after I opened an archeology magazine. In the magazine, on the letters page, was a photograph of an ancient beige sculpture of two dogs up on hind legs, facing each other, paws on each other's shoulders and head. The sculpture had, all these years, been referred to as the 'Dancing Dogs' sculpture, but as a letter writer, a dog owner, pointed out, the strategic placement of the paws suggested two dogs who were not dancing with each other, but fighting. The editor in his reply stated that interpretation had not occurred to anyone in the archeological field before, but looking at the sculpture in that light, the reader was obviously right, and the sculpture would therefore be renamed. Which made me wonder. Do archeologists not own dogs? Are they too busy watching the magnification of their tooth brush tapping atop the irregularities of a rock to notice their dogs fighting, the shut-off of electricity, the silhouette of spouse and suitcase at the distant front door?
The periodontist showed up in the back office, where I had been laid out on a dental chair, my eyes staring up at the large white squares of the drop ceiling.
He explained every step of the process to me, which I appreciated.
"Vickie is going to smear some vaseline across your lips, so they don't dry out during the procedure."
Smear upper, smear lower.
"You're going to feel a prick in several places in your lower gum now."
The long syringe slanted around inside my mouth, casually stabbing down into my gums here, there, everywhere.
"Now we're going to wait until the Novocain takes effect."
I was left alone.
In fifteen minutes, my lower lip on my right side swelled with numbness. My tongue went thick, to where I was afraid I might bite it and not know.
The periodontist came back.
The procedure itself, the root planing, although his steel hooks and barbs went way down the sides of my teeth, caused at the most only muffled pain, easily tolerated.
Twenty minutes later it was over, and I was at the front desk, writing out a check.
He did the root planing because there's a chance - slim - the planing will cause my gum to reattach to the side of my tooth, to where the pocket depth will be shallow enough to seal over the cavity leading into that tooth's root.
Unlikely, but possible. He's going to see me in three months. If the healing isn't miraculous, the tiny cavity smothered under regrown, healthy gum tissue, we'll proceed with the bone tissue transplant.
So this should be my last column, at least for a while, on my tooth.