My Poor Teeth!

My Christmas basket of gifts from God at birth was a mixed blessing. It included some good things, some bad things, and many things that fell somewhere in the middle. It wasn’t a very bad deal, but it certainly wasn’t a full-house, or even three Jacks. More like two Jacks, maybe, or two aces and two eights. You don’t want to bet heavily on the Dead Man’s Hand.

My teeth, for instance, have always been a gift of dubious value.

The first problems arose when my adult teeth started to come in. What is that? Age six, or seven? There just wasn’t enough room for all of those full-sized teeth. I have what is called a “Celtic palate,” which is a poetic sounding description of a condition where the teeth are way too numerous and big for the available gum space. It seems that, evolutionarily speaking, our jaws are shrinking faster than our teeth, and this situation is most often observed in the Irish. My genetic background is predominantly Irish.

Both of my sons had the same condition, and both of them wore braces for many years. That’s the usual response these days. They received their treatment from a very talented pediatric orthodontist and they both had good outcomes. Back in the dim recesses of time, when I was a boy, parents and dentists resisted the idea of employing braces on young teeth. It was expensive and uncomfortable, and that particular dentist probably wouldn’t be getting the billing anyway, so why not just pull a few teeth to make room and see what happens? Our parents saved some money, and the dentist made some money. That’s what they did with me.

“What happened” in my case was that the teeth came in with a certain amount of twisting and overlapping, giving me the smile of a character actor. It also gave me a less than perfect bite. Can you place your upper and lower teeth together and press? I’ve never been able to do so. I’ve never been able to chew gum, either. Leverage, you know.

It also happened that all four of my wisdom teeth came in impacted, which is to say, below the gum line and invisible. Getting those pulled when the time came was a party. In fact, it was three parties! There was one for each of the tops and later on a big party for both of the bottoms. It was all quite an adventure. Everybody’s favorite thing! Adventures in oral surgery!

I would say that I have always been pretty good about tooth care and dental visits. I’ve always gone to the dentist regularly; I never waited until something hurt, anyway. It’s always been something, though. There have been an awful lot of cavities over the years, and they still come at a frightening rate. Many of the early fillings were large, and have required replacement as time wore on. There have been a few crowns. These have been good work, on balance, they seem to last very well. I am no stranger to dentistry though, and it’s never been an easy road.

I became a lawyer in my forties and there were several negative effects that the profession had on my health. The stress of it was a problem for me. One effect was tooth-grinding during the sleep period. It seems that grinding the enamel surfaces together causes the release of lactic acid in the mouth, which hurts the enamel and actually causes bone loss in the jaws. How amazing is that? It’s the kind of thing that goes on unnoticed for too long and is then only discovered after the damage is done. I was given a mouth-guard and the effect was halted, but not before I had lost a few molars to the grinding. Nothing that showed, being in the back, and nothing that required expensive replacements, but I know that they’re gone. I miss those teeth.

And now it appears that I will soon be missing several more.

The Current State of Affairs

For the past thirteen years I have been at the mercy of Thai dentistry, and my general opinion is that those mercies are tender. I have no pattern of complaints. Nothing is perfect anywhere, and my experiences with Asian dentistry have provided a bit of drama, but Thai dentists are well trained and qualified. They all speak English. Some speak it better than others, but all speak it well enough. The standard of care is high, and the standards for sterilization are as good as they are anywhere in the world. I’d recommend that my American friends consider getting big jobs done here. If you’d be out of pocket for a couple of crowns and a bridge in America, you could come over here, have a six week vacation, get the work done, and still save good money after the air-fare and the room-and-board. More people should try it.

I went to the Samitivej Hospital for my first five or six years in Thailand. I came over with the Peace Corps, and they send volunteers to Samitivej. After the Peace Corps, I stuck with them. They’re a bit pricey for Thailand, but still between twenty-five and forty percent of what you’d pay in America. The dentists that did the run-of-the-mill work had been trained at Thai universities, but the fellow who did my crown had done his DDS and post-graduate studies at NYU. He was an artist. (The dentist who did the root canal for that job had a DDS from the University of Virginia. That may have been the only root-canal in history that caused zero discomfort.) Samitivej was a considerable bit of traveling from my apartment, so I looked for a change.

I switched to the R. Hospital, which was a short walk from my apartment. It was also a bit cheaper than Samitivej. The dentist spoke terrific English, and her work seemed fine. It was, in fact, fine, as far as it went. I went to her for over five years. It was a lot of visits, many fillings, and many cleanings. As always, I tried to do what she said and return within six or eight months for checkups. Towards the end, something happened.

Sidebar: Here’s the deal in Thailand. There are a few hospitals that are certified by international medical boards. They are a cut above the rest, and you can trust them with your life. Samitivej is one of the top four; all of them are popular destinations for medical tourism. R. Hospital is a good place with high certifications. I decided to switch my business to them when I discovered that American insurance companies send their insured for heart procedures and joint replacements. American insurance companies are extremely risk-adverse. I figured that if they could trust R., I could trust them too.

But, something happened. I’ve always had “office hypertension,” aka “cuff-fever.” I blow higher BP numbers at the doctor’s office. This became especially true for dental visits. The numbers could be alarmingly high, whereas in normal doctor visits, or at home, the numbers were within the guidelines for “not an emergency.” I get check-ups every year or so as well, and it had never caused a doctor to even say the words, “BP medicine.” As the dentist office readings crept up, my dentist got strange.

On my last visit to R., I hit very high numbers. No one said anything about it, they just smiled as usual. The dentist filled a big cavity, and she did it without the customary shot of Lidocaine.  There was no explanation, even though it would have been well within her powers of English. It was a thirty minute ordeal and it left me shaking for another fifteen minutes. And then she just told me, “come back in six months,” without having done the customary cleaning. I thought that something must be wrong.

To make a long story . . . not short . . . but not so long, I finally figured out on my own that there are guidelines for BP that go along with that “international hospital” certification. If your BP is over a certain reading, no Lidocaine; over a higher number, no work at all. I really wish that someone had explained this to me. It took me an additional, painful procedure at X. Hospital to work it out for myself. After that, I went to a cardio at Samitivej, started on a combined angio blocker and calcium blocker, got my blood pressure down, and by now I’m getting the dental work done there.

I guess that’s the good news. The bad news is that I have huge bone loss problems and gums that are receding faster than coyotes disappearing over the hill when the plains are on fire. Samitivej took much better x-rays than the other two hospitals had, and the news was unambiguous and bad. I now have four teeth on death-watch. They are beyond saving by mere crowning, and probably beyond implants as well. The word “dentures” has appeared in our conversations.

As for news falling between good and bad, my crooked, annoying front teeth seem ready to stand strong and unattractive for another twenty years. Is that irony? I’ve never adequately understood irony.

All of this will be expensive, even in Thailand, and it will keep me on a schedule of frequent dentist visits for the immediate future. On the positive side, my teeth do not ache on a day-to-day basis, and the dentists are trustworthy. So the outcome should be good, and I should then have several years of reprieve from large dental bills. Also, my blood pressure is down to a very unthreatening range, 110s or 120s over 70s (twenty five points higher on top at dentist visits). As a side effect to the BP medication, I’ve had to cut my drinking way back, which can’t hurt my general health.

This is in the pattern of my life. The negative things that happen to me are usually only in the annoying range, and so far I have managed to avoid catastrophe.  The negative never overwhelms the positive; I have always been, and remain, a generally lucky man.

For that I am grateful.