What My Teeth Have Taught Me

In bed with an ice pack, Thursday afternoon.

In my mother’s desk, she kept a small, round tin that had once held mints. Inside were all my baby teeth. I used to love to take it out and look inside at those tiny perfect teeth; I can remember the sound they made rattling against the side of the tin as I carefully placed them back in the drawer. Although her desk came to me after she died, it arrived empty. I found that tin inside a dresser when I was cleaning out my parents’ house last year. I looked inside once more, but didn’t keep it.

Little did I know that those shed teeth — which once lived inside my body — would be prophetic.

I grew up in a rural American town in the 50s and 60s, where there was a lot of poverty, not much higher education, and limited health care. My dentist was not the best, but he was a caring person who recommended to my parents that I get braces, because I had inherited a too-small mouth that gave rise to a lot of crowding, and crooked, overlapping teeth. My incoming first-year and second-year molars were also badly damaged by the high fever I had during measles. But my parents didn’t have much money in those days, and I of course didn’t want to get braces, which would have meant frequent trips to a distant city — and put me, who already hated wearing glasses, in a very small minority. I only knew of one child in my class of 125 who had had orthodonture. However, that is not a decision to be left to the child. In my case, the adults should have prevailed, found the money, and helped me cope, but… they didn’t. Several people in my family had lost their teeth and had dentures. It was common in our area to see people with missing teeth that were never replaced.

But that was not true in university, and in my subsequent life, first in university towns in New England, then in Montreal, and among our acquaintances in major cities. It is still the case in rural Quebec and many parts of America, as well as in many other countries with poorer populations and limited access to dentistry. But within a certain demographic, tooth loss carries stigma and judgement, and creates shame in the person who has it. Even when it is hidden, we don’t talk about it. In my case, I experience my lifelong dental saga as a chronic illness about which I rarely speak.

My dental problems started in my twenties. Ironically, I have few cavities and my teeth have always been strong. I’ve never even needed a root canal. The problems stemmed from the crowding, which gave rise to periodontal pockets. In spite of my diligent twice-daily brushing, flossing, water-picking, dental cleanings four times a year, and many gum surgeries — this eventually led to bone loss in my upper jaw, necessitating the incremental removal of most of my upper teeth and the placement of various restorations, from bridges to surgical implants. I’ve been going to periodontal specialists and oral surgeons as well as general dentists for 40 years, and although I’ve never totaled the money spent on my mouth, it has been huge.

The surgical suite of my periodontist in Westmount, QC

The latest and most extensive of these surgeries happened last Thursday, when I received three titanium implant posts in my upper left jaw. A loose bridge, and two old implants that had been placed too close together and had become compromised, were all removed six months ago, when I also received bone grafts to help support their replacements, which will hold a fixed bridge spanning the space of five teeth, including a front one.

Fortunately, dental science, techniques and technology have advanced tremendously during my lifetime. Since moving to this city, I’ve been able to receive state-of-the-art care, and, thankfully, to afford it. The spaceship suite where I had this most recent surgery is equipped with lasers, CT-scanners, enormous viewing screens, and all the latest equipment, but the primary differences are the highly-trained and continually-learning professionals who plan the treatments and perform them. I’m working with a team - my general dentist, my periodontist, and a prosthodontist who is responsible for the restoration work and who has made me temporary fixtures to wear this year during the various stages of treatment and healing.

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I decided to write about this because I am tired of minimizing it, and because I know that many people deal with similar issues but are, like me, reluctant to speak of them. Unlike some chronic conditions like, say, asthma, certain others carry stigma in our society — mental illness, obesity, and physical disabilities are prime examples — where the sufferer tends to be judged and blamed. I would put serious, ongoing dental problems in a similar category. The affected person can feel isolated and shamed, particularly when there is disfigurement, even if it is mostly hidden. I will never forget opening my room door in a European hotel some years ago to the insistent knock of a maid. It was early morning, and I hadn’t yet placed a temporary tooth in the front of my mouth — I was in the middle of one of these long multi-stage implant procedures. The young woman literally recoiled when I opened my mouth to answer her question, so unexpected was my appearance. And there are other effects: what and how one can eat is affected; the possibility of new problems is always in the back of your mind; travel creates disruptions in the maintenance routine, so that you’re always worried about a flare-up. I always travel with antibiotics and a special kit of tooth-care tools, and investigate where I could get emergency care in foreign countries if it became necessary. It’s also very, very costly to go the higher-end route of bridges and implants, rather than partial or full dentures.

Many friends don’t know what to say, while some are very empathetic. It doesn’t help that I tend to downplay what I’m going through; I’m stoic and want to live normally, and people tend to expect that of me. I actually received several phone calls while I was still being stitched up on Thursday, which I later discovered were from a friend who I’d told about the anticipated procedure the previous evening. In subsequent messages they never mentioned my situation at all, in spite of the fact that I explained why I hadn’t answered their calls. Other friends sent me supportive messages before and afterwards, and have kept in touch, which of course I greatly appreciate.

I think our increasing preoccupation with so many world calamities and personal anxieties has affected our ability to empathize with others. Social media has also changed all of our interactions, as well as heightening self-absorption and attention-seeking. People in my rural hometown are still far more accepting of a range of human frailties than most of the city-dwellers I see, though my cathedral community is a strong exception.

On the other hand, I’ve learned to live with it. My husband also has some chronic conditions, including some dental ones, and he has helped me see how to gracefully manage my own. I tend to heal quickly, and am grateful for the advances in care which minimize pain, swelling, and discomfort during the treatments, and allow me to function, for the most part, normally.

A former dental implant, now residing in my mother’s desk.

One result of my hundreds, if not thousands, of hours in dental chairs, is that I no longer feel fear. First of all, dentists do not want to hurt you, and modern dentistry shouldn’t hurt. My best advice is to communicate. If you are apprehensive, explain your feelings in detail to your dentist and they will do what they can to help. My American friends are surprised that we seldom have general anesthesia for major dental procedures here in Canada — maybe it’s a toughness legacy from all the teeth knocked out by flying hockey pucks! Some dental offices offer gas, but mine generally prescribe Ativan for those who are apprehensive. Local anesthesia injections, which can be the worst part of a treatment, are lessened by topical gels and acupressure applied by the dentist to the lips or gums - it’s over in a few seconds.

I always end up with good relationships with my practitioners, and that’s helped by my curiosity about what they’re doing and how they do it, and about who they are as people. This also lessens tension during the procedures, on both our parts. It’s good that we can laugh together, even if it’s sometimes black humor. Pain medications and steroids help a great deal afterwards, as well as knowing I can contact my practitioners easily.

Meditative techniques are the primary key I’ve found to surviving in the chair. Breathing deeply through your nose minimizes the chance of gagging, and helps to calm the entire body. I try to set up a rhythm and keep to it, breathing mindfully and taking my attention away from what is happening by focusing on something innocuous in my field of vision. Sometimes I “play” music in my head. If there is any hint of pain, I always ask for more anesthetic.

Over my life, I’ve also changed my relationship to time. Last Thursday’s surgery took three hours, using only local anesthetic, which was long, but exactly what I had expected. I’ve learned that time is something quite relative. The traffic light will eventually change, you’ll get to the end of a queue, the bus will arrive — there’s no point getting upset about waiting. As in music, time spent waiting proceeds linearly, from a beginning to an end — but there will always be an end. Knowing this, I’m better able to put up with a short-term ordeal to get to a new point where we can, in the words of one of my former dental surgeons, “let the healing begin.”