Thursday, June 26, 2008

Review, Now With Moral

Oral Surgery, 6/20/08

Floss. For fuck’s sake, floss.

I have rather crooked teeth on the bottom. Yes, I had braces and all that, but without a retainer, they shifted back into their crookedness. This crowded jumble at the bottom of my mouth makes it hard for me to get in there with floss. Like the hull of a whaler, old style floss used to shred when it met the jagged rocks of my lower jaw. The newer stuff, this more durable floss recent years have seen, is less prone to the shredding, but old habits (of not flossing) die hard and new habits (taking up flossing) founder.

Receding gums are no joke and mine had been receding at the tongue side of my lower front teeth for several years. At least two dentists have written me over five referrals to oral surgeons to have this corrected, but I put it off and let it slide. Firstly, they described the surgery as “a slice of tissue is removed from the roof of your mouth then grafted onto your gums.” So, the idea of two burning sore spots in my mouth – not appealing.

But finally, about six months ago on my last checkup, I was shown how bad the recession had gotten in one spot. I could see as much tooth root as I could see above-the-gumline tooth. Yowza. I had a seventh referral penned and that day I made an appointment.

The building housing the oral surgeons did not fill me with confidence. Probably built in the late sixties, the building, like many of that era, has dated architecturally and structurally. The lobby where you get the elevator (the first floor is a hallway size lobby with an elevator – that’s it) was smelly, dirty and just generally run down looking. The elevators were crummy with squashed cigarette butts. The hallway where I was dumped out at was just as bad. Turning the knob to the office, the door shuddered and shrieked open.

Inside, all was cleanliness and cool, fragrant air. I did a double take over my shoulder to see the hallway again. Disgusting. The office? Clean and professional.

So up to the counter, I gave my name thinking this was the appointment to get it all taken care of. Apparently not. The oral surgeon looked inside my mouth, pronounced I did need surgery after all, that my regular dentist was not hopelessly insane, and a new appointment was scheduled for a Friday six weeks later.


Six weeks later, I’m back. 3pm, Friday. I have the whole weekend to get over the worst of it.

Basically, the procedure was described to me like this: the surgeon would go into my mouth, make a few incisions on the gums , peel back that gum tissue, then insert graft dermis tissue, pull my gum tissue back up over that, stitch it into place. Yikes.

With some trepidation, I sat in the chair. For some reason, it appears to be psychologically beneficial or at least amusing to the designers of dental tools to make them as frightening as can be gotten away with. The Novocain syringe is a perfect example. Instead of a normal plastic tube attached to a needle, the dental version is gleaming stainless steel with the large thumb loop at the end. The cutting instruments were scimitars in miniature. And, of course, there’s always those curved hooks they use for scraping the teeth.

All of these tools (save the syringe) were laid out on my chest as operating table after my seat was cranked back. My jaw was pried open for a before picture and then it is on.

A bit of plaque scraping began things since there wasn’t any point to locking up plaque inside your fresh tissue. For some reason, every dentist jabs me with these things while scraping my teeth. That jabbing completed, the surgeon moved on to the Novocain. Why my doctors typically want to be stingy with this I’ll never know, but it was a bunch of little pricks with the needle and a driplet droplet of numbing squeezed into me. Then we move over a tooth or two and repeat. Just pump me full of the shit, bro, and let’s get it over with. The pincushion routine is ridiculous considering what the surgery costs.

Eventually, though, I’m more or less numb (we’d periodically revisit the syringe when a spot that miraculously slipped through the drip drip drip of Novocain was discovered) and the real fun begins. Normally, I’m not too squeamish and if I ever have surgery elsewhere, I’d like to be awake to watch. That stuff is fascinating. Nevertheless, oral surgery is somehow different. I see a man in a mask pick up a curved scalpel, then set it down and say to his nurse assistant “Get me the number seven” and she hands him an even larger hooked blade, well, my interest in watching this imaginary horror show has just gone down considerably. It’s seeing the tools but not how they’re used that is the most frightening part.

The donor tissue looked like a dime-sized communion wafer and I think two were used. Occasionally I opened my eyes to see blood drenched gauze pads being taken from my mouth and the smear of red across the doctor’s latex gloves. The stitching process came next and if you’ve ever pulled a length of fishing wire off the spool, you know how it can tangle. Same thing here. The doctor used needle nose pliers to hold the needle (fittingly enough) and worked it through my gums then with his other hand he patiently untangled the fine blue filament wire. Every time I thought he was finished, he moved to another section of my mouth and went to work. I swear there must be at least 30 stitches in my mouth.

Eventually, almost two hours later, we’re done. “Whew,” the surgeon told me. “That was pretty bad in there. I haven’t seen gums so recessed since I treated a kid with a tongue piercing that just tore his gums up.” He took an after picture of his work, then said, “When you’re ready, she’ll explain what you need to know.” He tilted his head, indicating his nurse.

My seat was returned to upright position slowly to avoid head rushes and I’m given my prescriptions to fill at the pharmacy and care instructions. No strenuous work. Take pills and use antibacterial mouthwash as directed. Perform warm salt water rinse at least four times a day. Avoid chewy foods and stick to soft stuff at first.

Most amusing to me is at the bottom of the sheet. Don’t smoke for at least 6 hours after surgery. Six whole hours? My god, smokers have it bad. I didn’t even want to look at water six hours after all this and, seriously, there’s people ready to begin puffing a lit tube of dried herbs ASAP. The mind boggles.

The prescription painkillers are okay (vicuprofen, a combo of ibuprofen and vicodin) but nowhere near strong enough for how bad the pain is. I grind my teeth at night and can’t wear my nightguard, so waking up feels like someone cracked me one in the mouth with a hammer. Having caught a softball in the face once, I can say that this feels worse. Calls to the doctor were rebuffed with “take some ibuprofen in between the vicuprofen for the pain,” which does me little good. About half an hour after I take the prescription drugs, it’s all I can do to keep my eyes open and the pain is gone. But even though I was only given two 20-pill allotments and the instructions to take every 4-6 hours, I can see this will be insufficient. About two hours in, I pop three ibuprofen just to make it to the four hour mark, whereupon waves of pain radiate out from my lower jaw, from tooth tip to root and it’s all I can do to put myself off for half an hour more, just so the pills will last me a bit longer.

Generally, I’m not much of a whiner when it comes to pain, but mouth pain, like oral surgery, is its own special category of misery. Six days later and my diet still reads like a nursing home special: drinkable yogurt, applesauce, mashed potatoes, cottage cheese, Italian shaved ices, and lots and lots of ice water. Cold gin would probably not hurt me much either and would also have a disinfectant quality to it. You’d have thought I’d have lost weight on this, but apparently not.

So, the moral, as stated at the very beginning, kiddies, is floss. Floss every day, twice if possible. Buy Listerine (or the generic version of your choice) and use it every day. Brush morning, noon, and night. Take good care of your teeth – and your gums.

Or else, folks, they’re going to kill you.


A & D said...

I should've worn my retainer like I was supposed to. My bottom teef' suck. My top ones have surprisingly remained fairly straight.

The Critic said...


.the champagne tomato. said...

happy birthday, you don juan of dentistry!

happy birthday!


Alley Cat said...

You need to put together a film about your surgery that can be shown to high school students. Kind of a scared straight type of deal, like what MADD produces.

the dental tomato said...

i hadn't actually read your entry til now, when i got my gumption up. good christ, that sounded unpleasant. when the time comes for me to have the same, i'm going to have all my teeth extracted and replaced with stainless steel spikes...good for nipping at republicans and actually inflicting some real damage.

why the doc didn't give you sufficient pain killers is interesting. it's a common thing. sometimes i think they're either (a) christians who think suffering is good and so why do anything to reduce it, or (b) docs who secretly wish they were vice cops and play out the fading dreams by making sure no one uses something like retreating gums as an oh so clever ploy to get prescribed vicodin--a commong strategy to be sure.

anyway, sheesh, man. i'm glad you survived.

now, any further thoughts on where the skin grafts came from?

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