Dentist Visit - The Stages of Periodontal Disease
January 26th, 2005
The Reason
As I'm leaving for China in 24 days, I figured, better get as healthy as I can to fight off malaria, typhoid, bird flu, hepatitus, etc..
So I went to the dentist (for the first time in 5 years).
The Meeting
The dentist was kind, gentle, and kind of a hottie, too. Couldn't have been older than me, but I couldn't hold that against her.
Her first question was one I hadn't prepared for. "Do you floss once a day?"
Damnit. What lie can I tell and get away with? Damnit! Why can't she be uglier? Damnit! Why didn't I floss yesterday!? "No... more like two to three times a week," I told her.
"Well," she smiled approvingly. She bought it. Awesome! "That's better than nothing," which was closer to the truth, "but you really should floss at least once a day."
The Examination
She started the exam. I wasn't worried. I had been through these before. I haven't had a cavity yet, and I knew that any personal neglect would be hidden by my super-genes. My tooth angels had not failed me yet, and I had paid them overtime during the last few days with extra brushings. Yeah, Maybe I was smug, but I had the precedent to be so.
She dug right in with an unknown sharp and shiney object. There was pain, but not alot. I could tell she was not out to hurt me. This was an extremely good sign. I have it on good authority that if you piss off a dentist, they have been trained to stab you in a nerve that will make you fill your collostamy bag and then some. The longer my pants were clean, the more at ease I felt.
"Mmmm," she would grunt ambiguously as she worked away at my mouth. Though I couldn't tell whether it was a sign of approval or disdain, I did note that the groans were not unpleasant. They were not unlike the sounds one might make if they found an unexpected chocolate, or similarly, if their significant other found an unexpected G-spot. However, I was skeptical that either had been found in my mouth, so I clenched my buttocks in anticipation and simply hoped for the best.
The Verdict
Apparently, the lifespan of tooth angels is closer to dogs than to humans. The one thing I had not counted on was that five years earlier, I was not old and decrepid, and my tooth angels were still with me.
The dentist leaned back, turned around, and handed me a mirror. "I want you to see something," she said. It quickly occurred to me that she was probably not going to show me how wonderful and amazing my teeth were. Damnit...
"Hold this up while I floss." She flossed between two teeth. "You have to get below the gumline," she demonstrated, "on both sides of the gum." She spoke with authority, but not accusingly."
She pulled the floss back out and showed me that it was red where she had used it.
"Do you see the blood? This tells me that you haven't been flossing for the last six days."
Damnit! "Oh yeah, I... uh... didn't floss this last week, I... uh-"
"Do you see the little bit of wetness?" she continued. "That's bacteria. It eats the same food you do."
Damnit, Damnit! no way to save face on this one... Just look apologetic and a bit confused.
She went on to tell me that the two back bottom teeth had separated from the gum nearing 5 millimeters accompanied with a slight bone loss below the tooth, both of which were signs of Moderate Periodontitis.
The other teeth had been anywhere from 0 and 1 millimeters in the front to 3 and 4 in the back, only signifying Gingivitis and Early Periodontitis. These could be cleaned and would show improvement through better care and maintenance.
The good news. Still no cavities. That's right, I finally won one of the gene pool lotteries. 26 years old and still not a single cavity.
"You have good teeth," she told me. Yes! I was so proud. A perdy girl saw my teeths, A-hyuck. One of the angels must have survived. "But," she said
Damnit! There's a but!
"You need to have your wisdom teeth removed. Usually the cut-off age for this procedure is 25 because of the way the bone develops and there may be permanent damage during the procedure to older patients."
D'oh! I've known this for five years, everything except the bone damage thing.
Through it all, she was still as cordial as one could be, even playful, not talking down to me at all, not threatening to make me crap my pants, but just showing what seemed genuine concern. I felt... guilty, but still very comfortable and quite cared for. It became my mission to make my teeth the whitest things on the face of the earth. It was the right thing to do! She deserved it!
She finished up and told me she'd check to see if they could get me in for a cleaning today and dissapeared behind the wall.
The Pitch
A few moments later, the young woman from the front desk came out to explain my options...
She explained that, though my insurance pays for 100% of the cost of "routine" cleanings, it only paid for $140 of the $230 cost per quandrant for a deep-cleaning procedure known as SRP (Scaling and Root Planting). "Luckily" for me, the dentist had only deemed the two lower quadrants as needing of SRP. The upper teeth only needed regular deep cleaning (which after insurance, would only cost me another $156). Lastly, the cost of the antiseptic mouthwash to keep the blood clear during the cleaning was another $110.
"Now, your wisdom teeth are impacted. The two partially boney extractions (bob giggles) will cost you $90 each. The two fully boney extractions (tee-hee) will cost you $110 each after insurance."
"So... What exactly is the difference between a partially boney and a fully boney?" I asked ;)
"Well, non-boney is completely outside the soft tissue."
I thought, "Where else would it be?"
"A fully boney is still completely inside the soft tissue..."
Heheh. Sounds about right.
"And a partially boney has just errupted from inside the soft tissue."
Bwahahaha (wipes teary eyes). I physically chuckled this time.
As pennance for my transgression against the gods of flossing and mentally equating dental terms to "doing it" in various stages of flacidity, I was also forced to pay for Arestin for the two teeth that were having the worst Periodontal problems in the back.
"Arestin is a fairly new antibiotic that actually remains in the pocket between the tooth and gum for 14 days and helps shrink the size of the infected periodontal pockets," or so I was told. The cost of Arestin to me - $90 per tooth. Aaaauuugh!
While I'm all for shrinking the soft tissuey pockets around my bony erruptions, $90 a pop is a bit steep. Thank God it was just the two teeth.
"You'll have to be put under general anesthesia for the procedure to pull all four wisdom teeth, and after your insurance, the anesthesia will cost you $454."
This is the awkward silence where I silently choke and shit a brick.
"Is there any way I can just use local anesthetic during my partially boney and fully boney extractions?" I asked. I though to myself, "I really wouldn't mind being awake while you ripped teeth out of my head. It would probably hurt less."
"No, the surgeon won't do it unless your under."
"Kinda takes all the fun out of the boney eruptions :("
Swing and a Miss
She smiled and continued, "and the Rota-dent Toothbrush is $120. So your total comes to 1,460"
"I'm sorry, the what? How much?"
"The Rota-dent Toothbrush is a far superior toothbrush offered only at dental offices with special training. It's much better than.. Have you seen it? I think we've got some literature on it around here somewhe-"
"Yeah, I've got the pamphlet here... and... I don't think I'm gonna be getting that today, but thanks."
Strike Two
A bit flustered, she said, "Um... Okay. Well, I know its alot of money to pay at once and not alot of people have that just layin around, so we do do financing - "
"How much is just the cleaning today?" I was already told they couldn't get me in for the extractions 'til next month anyway. I didn't see any reason to finance something I wasn't getting now. Besides, anyone who's seen the Sanford and Son episode with the stereo company and the Grey Foxes knows that credit is just another word for rip-off. If I couldn't afford to fix my mouth, I wasn't about to do it.
"Um," she was even more flustered now. I wasn't mean, just quick. I used to work in a marketing department with a bunch of soul-sucking demons :P. Poor girl never had a chance. She already got me on the Arestin and deep cleanings, so I was getting a little defensive. The $120 tootbrush just wasn't gonna happen. "I'll have to go check," she said and meandered off a little confused and wounded, but not before I got a discount on the Arestin as well.
The dentsist came back. I asked here how neccesary the Arestin was. Quite convincingly, she assured me it was. When she described the alternative, I was sold.
The Procedure
The cleaning itself was quite surreal. The topical novacaine came first. It numbed me faster than I expected. Then the shots. God, she pushed that needle in deep. Four shots on the bottom. Two on the inside and two on the outside gums. The ones on the inside hurt bad, real bad. I could feel it slide down to the bone, dull and deep. She shook my cheek as she did the inner shots. It did seem to lessen the pain. No idea why, but I was very impressed.
As I was having my mouth cleaned, I looked up past the masochistic dental tools working away at my spongy flesh, through the hazy mist of mouthwash hovering over me illumiated by the harsh and blinding dental light, and into the purple eye-shadowed eyes of my dentist and those of her also-quite-adorable assistant. I had an overwhelming urge to tell them, "If I'm ever abducted by aliens, I hope they're as pretty as you two," but my mouf wuz fuww ob cwap, tho I didnd.
There was one 'incident'. She slipped with the grinder and cut a gum or something. They didn't explain it or even really stop the work, but the assistant dove in fast and hard with the mouthwash and dental vacuum right after the mishap. Ah, sweet novacaine. I didnt feel a thing :)
The rest was almost calming. They worked quickly and smoothly. She finished up by showing off the Arestin applicator (which you could tell she was very proud of) and giving me four quick injections into the fleshy pockets around my periodontally inflicted back teeth. I have to admit, it was quick and painless, and seeing as how the alternative is having a specialist cut back your gums to prevent more bacteria buildup between the gums and teeth, if the Arestin actually does what it promises, then... I don't feel like it was money wasted.
Not quite an appifany, but nontheless, my day. I was kind of sad when it was all over. It was like a spa for my mouth. :(
