Farewell, Tooth

Farewell, Tooth

My dentist is calm, softly spoken and sympathetic – good set of characteristics for a dentist to have. What took place on a recent visit therefore gave me quite a jolt.

I presented myself as having some persistent gum bleeding, at the site of a rear molar, that I had been unable to brush away – was there something else to be done? The dentist said, “let’s take a look”. Then, peering in, he muttered “oh dear..”.

I was bewildered – it’s a minor problem, surely? What does he see?

He said, “ you’ve got a split tooth. It’s beyond saving”. I said that I had no idea. I’d felt no pain, other than occasional sensitivity that I had put down to the “gum problem”. How long had I had the bleeding, he asked. Two or three weeks. Was there any traumatic incident? No; I had not felt anything that had jarred the tooth.

Well, the dentist said, the tooth is split so badly that one half is hanging off like a flap. And what happens next, I asked. Well, he replied, I can take it out – but I’m concerned. Sometimes this sort of extraction requires unforeseen excision of bits of jawbone. It would be safer to send to a specialist surgeon with more equipment than I have.

There was also the matter of sedation. Last year it had proved impossible to anaesthetise my jaw so as to remove all sensation for routine filling work. In the end, a valium pill did the trick. But I was now determined to have proper IV sedation for a tricky extraction.

So I was referred to a private dental surgery practice in the far suburbs (NHS surgery was a possibility; but weeks would pass).  A consultation was quickly arranged. The surgeon took all of 10 minutes to assess the work. He said it would be quick and straightforward. A half hour slot was booked, during which period I would be sedated, numbed, and the tooth ripped out.

The bill for all this, of which I was then advised, began to represent an extremely good hourly rate for the surgery.

Some days later I returned for the procedure. By contrast with the first visit, when there were a fair few people waiting for consultations, I was the only person in the reception area. Right on time, I was called in.

The surgeon ( different to the one who had assessed me) told me the running order: sedation, numbing injections, extraction. But first, and most importantly, please sign this disclaimer form. And second, blood pressure measurement. Another “oh dear” moment. It was high. I withstood a cross-examination about its usual level (borderline high)) and a threat to suspend proceedings pending a GP’s reassurance (apparently sedation can do dangerous things to blood pressure levels).

And so we began. The surgeon explained that the sedation would involve the insertion of a cannula into a vein; that its effect would be that I should have scant awareness of  being numbed and the extraction, and that I wouldn’t remember anything.

He took my arm; I looked away. He said, “slight scratch”, which words were followed by agonising pain… Apologies; he had missed the vein. Again, “slight scratch”; again agonising pain. “It’s not my day “ he muttered. The third attempt and a change of location to my hand. This time success.

He said he’d start with a low sedative dose and top up if needed. A few seconds later he asked if I felt light headed. I’d not noticed any change in myself, and said so. However, very rapidly, and without my feeling concern, he injected my jaw and (so it seemed) almost immediately reached into my mouth… “All done”.

I was bemused, suffering no pain from the extraction, nor, so it seemed, much sedation. A dressing was applied, and a nurse appeared with a wheel chair, into which I was ushered. (After sedation there is a mandatory wait time of approximately one hour, so that one’s re-emergence can be observed.)

I sat in the recovery room, reading a book. My son, who had volunteered to escort me home (no escort, no sedation is the rule). The nurse said that I wouldn’t remember what I read. But I did.

Apart from the recovery time, the whole process, including initial consultation  and the surgery, had taken less that half an hour. I have learned that a very small level of sedation , far short of rendering one “out of it”, is still pretty effective in distancing one from the procedur – even if one is not really aware of the distancing.

I also learned that a procedure to lessen pain can actually be the cause of greatest pain, if cannulas and veins do not meet. Or, perhaps after that pain, anything else is negligible.

Nov 2017