The next step in my journey toward restoration of full oral health or at least maintenance of current levels of function has been a decidedly invasive one: removing the living artifacts of my abortive third dentition; or in other words, impacted and otherwise non-functional wisdom teeth.
I've sometimes had dreams that include losing teeth (which seems to be documented as a fairly common thing). In these, the process appears patterned after the life experience of losing the deciduous (baby) teeth: the root has melted away or otherwise partially decayed, the tooth wiggles around loosely and soon enough pops out despite any attempts at saving it.(i) But with these firmly rooted adult soldiers it's quite another story and a rather more violent one, if also more artful.
It had taken a while and a number of call attempts to get an appointment rescheduled - though truth be told, I wasn't being especially persistent about it myself - but when the clinic finally called back, they had openings right away so I went with it. I went in on Wednesday afternoon (August 14) with the plan of removing the two uppers and one lower. That turned out to be just about right, though not exactly for the reasons previously contemplated. The surgeon re-iterated that I really should get all four out; the lower left, while not lying horizontal like the lower right, is also considered impacted because of how it's partially stuck within the bone. The main risk he cited for leaving it is the possible development of a cyst, which would originate from cells around the crown which was meant to be exposed, causing a buildup of fluid which eats away internally at the bone of the mandible. To watch for that I'd need to get X-rays done three times a year, because that's how fast it could develop. At my request he showed an example of what it would look like on such an image. I insisted that I'd stick with three for today and see how it went, because it was new territory for me, and as he confirmed, the lower ones would be more difficult, time-consuming and with more damage to heal since they had to be cut out from under gums and bone.
We went over the basics and I asked about some points of concern from experience - treatment of lips, breathing, swallowing, and possible fainting during the procedure, and the jaw pain involved in holding it wide open for extended periods. He reassured me that only the lower one would require the wide opening, and otherwise that we'd be taking our time and I could just hold up a hand if I had any pain or needed a break. Around and during the procedure I found his "bedside manner" quite satisfactory, communicating the needed information at all the right times, reassuring that everything's going fine (truthfully I hope) and keeping to himself or saving for later any thoughts in the vein of "wow that's a lot of blood!!".
There was a waiver to sign to authorize the anesthetics and acknowledge various possible complications that could require further surgery: precisely what I wasn't interested in signing at age 18. On the other hand, the possible complications of inaction were just as present and without requiring anyone's permission.(ii)
I started off by drinking a liquid pain medicine - something in the ibuprofen family but stronger - and we proceeded shortly to injecting lidocaine at various key points. As promised he took it nice and easy; the only ones that really hurt enough to get a groan out of me, also as he advised they would, were up into the palette from the inside. I described my state as "woozy" and wondered how we'd translate that for the Spanish-only assistants, and had some difficulty describing more specifically what I was feeling. "Mareado" (seasick, queasy, dizzy, faint, tipsy) was suggested but didn't quite seem to hit the mark. There was some deconvergence of stereo vision, slowness of movement, thought and speech, though noticeably not of heart rate, which I'd say along with sweaty palms betrayed an inner tension despite my attempts to focus on slow, deep breathing and pleasant thoughts.
Somewhere amid the various machinery whirring and faces leaning over me it occurred to me that this right here - this was the reason for having money.(iii) The reason for all the years of toil, of unsexy penny-pinching, of shrewd investments among failed ones. It's not for the leather upholstery; it's not so that you can take the woman out anywhere in town and offer anything on the menu. No, this is what luxury means: it's that when you need needles and worse stuck in and body parts yanked out, you get the guy who considers himself to have all the time in the world, and not the one who considers himself working a shift and sees you as yet another plucked chicken carcass moving down a conveyor belt. Not that it was even all that much money, this time.
But I digress. The top teeth went pretty easy. There was a lot of pressure and a strong pulling, as announced. I hear that some have this done under general anesthesia, and I can see the appeal, but I'd be hesitant about it. How would it work, without the cooperation of the patient to resist the pulling? Do they have to immobilize your head? Mandible too, for the lower teeth? Are we quite sure that reflexes will rule out accidental inhalation of fluids pooling in the throat? So I was glad to be at least mostly present for the process, to contribute my real-time feedback, breath management and unforced movements.
During the pulling there were lots of cracking and crunching noises and sensations, also announced as to be expected. The most similar experiences I've come up with are crunching iced-over puddles underfoot when walking in winter, and cracking up the silicon of flash memory chips with pliers. Not exactly like a shattering of glass, more of a gradual propagation of internal fractures without resulting in complete breakup. K-k-k-k-krunch. Then the tooth was out, I tasted blood, and he proceeded to cleaning out the socket, with mechanical implements including some sort of drill and with water.
After the upper two, I needed a quick break, then we proceeded to the lower, which was the most involved and took the longest, maybe 20-30 minutes. Since it was partially buried in the bone, the tooth had to be cut up, ultimately into four pieces. This involved what I imagined to be a tiny circular saw which made all sorts of grinding and screeching noises and vibrations; probably not objectively all that loud, but transmitted right through the bone with the ear just centimeters away. I suppose there were a few iterations of this, rinsing, and pulling, followed by cleaning of the socket and then a number of sutures to close up the wound. I'm told they're of a self-dissolving material so no followup visit needed.
Finally there was a bunch of gauze to bite down on and hold for a while post-op, though I was able to mumble through this enough to clear up all the recovery instructions. Since it's not really possible to bandage in there, keeping pressure on the gauze is crucial until the coagulation gets well underway. Thereafter you have to basically maintain normal oral hygiene, including getting whatever bits of food off the wounds, while being gentle not to restart the bleeding.
A revelation was that there had been an unnoticed infection around that buried tooth. The doc told me after the procedure that "a few milliliters" of pus or other fluids had come out after cutting open the gum. So between that and the other advice, I'm quite inclined to get the last buried one out too, though at that point I was quite exhausted and glad not to be doing them both at once.
He showed me the extracted teeth with all their parts accounted for, though I wasn't allowed to keep them due to rules around disposal of the infected one, and I didn't care that much to press the point.
There's a special periodontal mouthwash (chlorhexidine + cetylpyridinium chloride), a seven-day combination antibiotic course (amoxicillin + clavulanic acid), and daily pills for the pain (Davintex aka etoricoxib) and swelling (Deretual aka deflazacort), adding all told around 12% out of pocket to the costs.
Back home, a first bother was that the bleeding, which seemed okay after the scheduled removal of the first gauze, picked up again; so I bit down on some more and changed it out a good three or four times over a few hours before it seemed controlled enough that I'd venture to eat anything. I'll tell you, by that point, that ice cream by the tiny spoonful was about the best thing I'd ever tasted. By that point the pain was really setting in, as I hadn't prioritized starting on the pills. I'd describe it as a good seven or eight out of ten soreness. But the pill works pretty quick, and it lasts almost the scheduled 24 hours. If it gets worse I can also pick up Tylex to supplement (seemingly just yet another useless marketing synonym for the good old paracetamol, acetaminophen, Tylenol).
A bit more disconcerting, which I noticed after the numbness was mostly down, was that there was at least a small hole opened up in the upper right socket into my right maxillary sinus. With lips and glottis closed and moving my tongue around so as to create suction, I could feel air leak in from my nose. I called the surgeon as soon as I noticed this; he was unsurprised and said not to worry, it's because of the deep root on that tooth and it should close up in three days or so.(iv)
The next day once the blood was all out of the way and I could poke around more, I discovered another concern: what looked like damage to the gum tissue around the neighboring teeth on the right side, especially the two lower molars; the point that goes up between them looked pale and partially detached and was without feeling, despite remaining attached. I didn't know if this was to be expected or might need prompt action and exacerbating the situation, the surgeon didn't respond to my calls to his cell number; I tried several times from afternoon into evening, even left a voice mail early on and had a friend try WhatsApp later. By that point it was too late to call the clinic staff, but their after-hours recording gave an emergency number - on which again nobody responded.
So, not seeing any further options, I chilled for the night, and called again first thing in the morning. I first reached the normal dentist at the office, who told me that while he didn't know exactly what the other guy did, what I described sounded normal and would fully heal although it may take a month, but I could come in later for him to have a look if I wanted. Later, the surgeon got back to me, and said much the same thing. His unavailability had been due to being in an operating room the whole time - 10+ hours if I understand right!
A few days later, the bit of "dead gum" began to loosen and after some more poking, both intentional and otherwise, I was surprised, relieved and a little embarrassed to discover that it had not been any part of me at all, but merely a knotted-up end of the string of the stitches, which were otherwise mostly farther back and hard to see.
Since then, there have been a few other oddities; it seems like something different almost every other day. But as of today I'm off the meds and doing alright so far, pain wise.
- My most memorable loose tooth loss IRL came on some moderately hurried school morning. I hadn't even noticed it come out until spotting the contaminant in my breakfast cereal; "what's this lumpy white thing doing in my crunchy corn bran ?!" Said cereal product consisted of these pleasantly toasty smelling hollow square pellets, that would remain crunchy for about 500 milliseconds after immersion. By the logic of the instant, it totally could have been some foul object that had snuck inside one. [^]
- How did it go, "you may not be interested in war, but war is interested in you." [^]
- Plus of course all the other in-game assets: power, knowledge, experience, relationships and such, but at the time the thought just expressed itself in money terms. [^]
- By now, almost a week in, this seems to have happened, at least the air isn't leaking as noticeably though there still seems to be some exchange of fluids going on, and if anything more on the left side. [^]