Wednesday, October 14, 2009

Dentistry notes from all over

I had my teeth cleaned by an expert today. He really knew his business. It was over in less than an hour but by the end, I could really feel the difference. He was not too timid to scrape off the plaque, although it was not entirely painless. And he showed me that I have been brushing my teeth wrong for, oh, more than 50 years. Here's the deal. You don't want to approach your teeth with the toothbrush at a 90 degree angle. Rather it should be at a 45 degree angle. And scrubbing hard does not mean getting the job done. As he asked me, do you use a scrubber on your fine china? Ooh. That hit home. He also said not to use a mouthwash that had alcohol in it--too harsh on the gums, even when they are at their healthiest. Finally, he suggested doing my evening dental hygiene routine an hour before bedtime, so I am not crashing while I am brushing my teeth--I will pay better attention to the tasks at hand. And there are three that should be done in the following order: 1) floss, 2) brush teeth for 2 minutes or more at the 45 degree angle, and 3) rinse with the non alcohol mouthwash. If I manage to eat or drink something afterwards, he said I should just floss or brush again depending.

So nothing like upending a 50+ year habit. We'll see if I can do it.

He also told me about some of the travails of Dr. W, the specialty dentist. As I mentioned before her practice is focused on cancer patients but also patients who are waiting for transplants. In order to do a transplant, one of the requirements is that you cannot have a mouth infection and she works to make sure that her patients are 'clean' there and ready to go otherwise. But not so fast. She has had situations, where a $250,000 transplant, after years of waiting, has been approved by Medicare or the state or a private insurance provider. But they won't approve the $1,000 in dental work that is a pre-requisite for the transplant to take place. This is absurd. In some situations, she has (forgive the expression) eaten the costs and done the work without compensation, so that someone who had been waiting 15 years for the transplant could finally get it. Again, this does not make sense. It's being pennywise and pound foolish.

Being at the dentist twice in less than a week, sent me on a reminiscence of dental visits past. I grew up in a small town in northwestern Ohio and our family dentist was a very nice guy, but he didn't believe in anesthetics for fillings. I remember a number of fillings installed where he hit the nerve and I jumped rather high. It's amazing I didn't lose part of the inside of my mouth or worse as a result. I wonder if he changed his practice at some point.

I also remembered my torts class my first year of law school. Our professor, who was just starting teaching law, was a nervous fellow who had a tough time standing in front of the class and talking for 50 minutes. But he was discussing one day the doctrine of res ipsa loquitor which translates to "the thing speaks for itself." And the example he used to illustrate this doctrine was a story about a woman who went to a dentist's office for a major treatment of some kind, one where the dentist had to put her under general anesthetic while she was in the dental chair. He administered the anesthetic and she went under, only to wake up and discover that one of the fingers of her right hand was broken. She inquired of the dentist and was met with stony silence. So, she eventually sued the doctor for negligence, alleging that the broken finger was res ipsa loquitor of the negligence because obviously she was not being treated for anything other than something wrong with her mouth. At trial, on the witness stand, the dentist finally broke down and confessed that the anesthetic he had given his patient was one, that at times, would cause the patient's muscles to seize up as she went under. And when the patient went under in the dental chair, her hands had clenched and the right hand had caught his testicles in a vise-like grip that he could not release until he broke one of her fingers!!

The story was amazing, but the fact that it was told to us by this fellow who was probably the shyest professor I ever had, was all the more amazing.

Off to brush my teeth--the right, no, the 45 degree way!

1 comment:

alphawoman said...

I have always heard (60 minutes maybe 20 yrs. ago) that a healthy mouth is a healthy life.