Category Archives: Dental

This morning P is phoning one of the patients that needs work done in the OR.  A child answers the phone.  A very young child, maybe kindergarten or grade one.  She should actually be in school by this time of the day but here she is answering the phone.  She is the patient who needs to go to the OR for the dental work.  A little young to sign her own consent however. 

I listened a bit to the one side of the conversation.  Bits were filled in for me by P.  

“May I speak to your mother or father?”, P says.  

There was some hollering in the background – you know “Mom! It’s the dentist’s office.” 

The little voice comes back on the phone.  

Mom is sleeping and will not get up.  This does not bode well for a potential OR case that has to be at the hospital by 7 am next Friday.  

Dad is in the bathroom the little voice states and can’t come to talk on the phone.  

P says she will call back in ten minutes to talk to dad.

“Couldn’t you just stay on the phone and talk to me?” the little voice asks.

Our office is computerized – well the front office anyway.  We haven’t gone whole hog and gotten computers in every operatory and we don’t chart directly onto a screen.  We use paper. 

And are we ever glad that we do right now.  The computer that acts as our server developed a defect on the hard drive.  There was some corruption of data in the backup too.  We have printout’s of everything – pretty-much anyway but the last back-up that works was the year end one. 

And our software company is not being much help.  We are seriously thinking of changing our software because of the poor support in spite of all the work involved in data conversion to another program. 

Our front office staff is trying to keep up with what we are used to doing on the computer by hand on  paper.  This weekend we are installing two new computers and they will be busy re-entering data on a more up to date operating system.  But this is going to be a lot of work.

Some patients push me to the limits of my patience.  Bad attitudes seem to be the thing that gets to me most.  When they do I tend to whip out my collection of sarcastic remarks.

So for Lent I said I would deliberately choose to serve someone rather than myself.  I don’t know that I chose this guy but he was sort of stuck in my face – someone I had to treat with more respect than I would like.  Someone I actually don’t have a lot of respect for because of his attitude. 

He came in.  Well, this is not the first visit.  And to each visit he has brought the attitude that whatever he wants he should get.  Trouble is that what he wants and what is possible don’t jive.  He wants us to restore health that has long been lost.  And I think he feels that we should do this with little effort on his part.  Sorry – Mr. but that is not how the deal goes! 

So here we are trying to convince the guy that his options at this point are really limited.  His teeth are beyond the point of being savable.  But he wants to keep on ignoring this fact.  He wants us to fix it.  He does not seem to get the fact that we are telling him the truth.  It is not what he wants to hear.

I am afraid that the attitude he displays is not just about his teeth.  I fear that he approaches life in the same way.  Being a chief, this is scary to me.  Does he expect the impossible to happen just because he insists it should, no effort required on his part, no long term commitments made?  It is an old attitude – the chief should possess the power to demand what he wants.  His people do not need a leader that lives in this kind of a fantasy. 

What a difference from what God the creator of all taught us.  If you want to be a leader – become a servant.

I couldn’t believe it – today a patient came in and wanted me to fill out forms for his short term disability at work.  He is one of those guys that goes in to a northern mine one week, comes out the next week.  He also lives way up north. 

He had a toothache so decided to finally get the offending tooth extracted.    You know – a few days of really bad pain, I could understand.  That could maybe disable you.  Getting a tooth knocked out – maybe that would disable you.  But the time you should expect to be off work – well maybe that same day.  Maybe you could stretch it out to two days.  But applying for disability insurance????  I asked him how long it had been bothering him. “Oh, off and on for about three years.”  I wrote that down. 

Well weird things get approved sometimes.

Today was one of those long tiring days when I wonder what on earth I am doing working more than 40 hours a week at my age.  One of those days when it felt a bit like running in one of those hamster wheels. 

Sometimes sedating children feels like I am really helping them.  The dental work gets done in a relatively efficient way and I know they will not remember a bad experience.  Most of this mornings cases were pretty good this way.  But for two of the five kids – it was not fun at all.  I know they will not remember because of the drugs.  It is good to focus on that fact at times. 

One child just happened to have a bit of a chest cold.  We ask but that doesn’t mean the mother has to tell us.  So in we go to do a couple of fairly involved fillings.  She was really mellow and that was good;  just how we like them to be.  Then as we began to fill her mouth with things – like a rubber bite block and a dental dam as well as fingers from two hands – she started to have a bit of trouble handling the phlegm in the back of her throat.  Suction – work.  Suction – work.  Not everything that we wanted to do got done.  But she was fine.  It will be about four to six months till we can get her in for more work. We are too booked up.  Which means there are too many kids needing dental work at the ages where sedation is the only option besides a general anesthetic.

The second “difficult” child was young – just two, but a good sized chunk of a kid.  He was not mellow!  Not at all.  And by the time we froze his four upper front teeth(stubs) he was fairly irritated.  He began to cry – not a nice you’ve got to feel sorry for me cry.  A screaming bloody murder get me out of here now kind of cry.  And he kept it up for the whole two hours he was in the office.  Moreover he bit me – as hard as a two year old can with only sharp little lower incisors against my fingers holding the gauze against his bleeding empty upper incisor sockets. 

Some kids graduate to the Operating Room list from our sedation list after a morning like today. 

My last patient of the day was only seven.  I had seen him about 8 months ago, did an exam then and fixed a few of the many really rotten teeth this kid had.  Then he missed appointments and did not return.  Till today.  Today he came in – brought by his dad.  He has three badly infected teeth.  It seemed evident from the dad that the teeth were really hurting him.  So we froze one of the teeth – the worst one and got ready to take it out. 

The freezing part went just fine.  Then he started to cry.  He wanted out of there bad. 

He just seemed like such a miserable little kid.  I mean he looked fine on the outside but when he started to cry he was pitiful.  His life, according to him, sucks, his family sucks and he started talking about going home and committing suicide.  The reason was that no one in his family ever gave him good presents – or so he said.

A seven year old should not be talking about suicide.  The word should be foreign to him. 

Got a call about the middle of the afternoon that one of the kids I have been seeing regularly had been injured. Could I see her? 

Dental injuries are often very time sensitive.  The quicker a tooth is reimplanted after being knocked out, the better the chances for it to be successful.  And in case it ever happens to you – put the tooth right back into the socket if you can.  This young lady lives about half an hour out of town.  Mom had to get the vehicle going, go by the school and pick her up and get to our office.  She made it in just an hour.  And unfortunately, the tooth came inside a Ziplock bag.  One hour is the outside limit for re-implantation with a reasonable chance of success.  We popped the tooth into a special solution we have on hand and got ready to stabilize it. 

Having the facilities in our office to do braces sure makes that part of the job easier – just a few brackets and a wire.  Having a great assistant who is ready and willing to do her part – and in fact stays late to help is also wonderful, especially considering that she did not even work with me today.  Both she and my other assistant were exceptional today. 

So we got this beautiful young woman’s tooth (front one of course) reimplanted, the broken one next to it repaired and sent her off almost smiling.  And we sent her off with a mouthguard in hand.  And I bet she wears it.  At least for awhile – till the memory of today fades.

Lost a patient today.  Well they had hardly become patients really.  They were late for their appointment so 15 minutes after the appointed hour the reception staff called them to see if they had forgotten and would they like to rebook.  We must have touched a nerve!  They had been just leaving and if we wouldn’t see them they would just find another place to go.  Since the appointment time booked had been for 20 minutes and there was no way they would be at our office within the scheduled time we though we were being fairly courteous calling them as a gentle reminder that they had forgotten an appointment.  Instead we were berated for running on time!  Hard to figure some people out.

What really hurt – and at the same time was ridiculous – was the accusation of the mother that we were just being rude to new immigrants.  I assured her that actually we expected all of our patients to be on time for their appointments.  But I wonder if we missed some cultural clue here?  Different cultures do handle time in different ways. 

Today was not a good day in the dental sense – for me personally.  On the weekend I was eating something and felt an ominous crunch.  The tooth that crunched was the one that recently had a post and crown.  I knew exactly what had happened.  I hoped it hadn’t but, well, I was pretty sure.  A vertical fracture down the root.  No hope to salvage that one.

Today the diagnosis was confirmed.  As I sit here writing, the upper left side of my face is slowly awakening. 

Just a few complicating factors are putting off the inevitable – my huge sinuses surrounding about half the root and a partner who chose to do the prudent thing and let me see an oral surgeon to have it out.  So I am minus the crown and awaiting an appointment.  It can take a year to get in to that office. 

The gap feels pretty weird.

It’s always a bit disappointing when a patient that really needs dental care has an attitude problem that prevents them from accepting their role in the treatment of their problem.  We had a young girl – late teens – who came in with her mother a while ago.  She needed a lot of teeth restored and a root canal.  But her mouth was so dirty that the first day I refused to do anything for her.  There was really no point in trying.  The plaque was so thick – like fur on moldy bread. 

I called her mother in that first day and showed her the problem, explaining that there was no way that I could ask for approval from the funding agency for payment for a root canal under the conditions present in her mouth.  Sometimes mothers at this point get really upset with me.  This mother understood but I think there was not much she could do.  I think this girl has other issues that have more to do with defiance than with an inability to brush.  So she got a toothbrush and a new appointment. 

She came to the next appointment.  Her hygiene was not great but it was acceptable so the abscessed tooth was treated to what we call an open and drain – not the complete root canal but enough to get rid of the infection.  The pain normally goes away after this appointment.  Sometimes pain can be a good thing.  It drives us to get the treatment we need even if we do not want the accompanying discomfort of receiving the treatment. 

Today she did not come for the next appointment.  I guess we took away the only motivating factor.  That is always kind of sad.  Working towards health is always a better choice.