A day at the dentist. A whole day.

I had a nasal infection when I was a baby. From that time on I had never ever been able to breathe through my nose unless I was fully exerting myself, such as while running distances. An hour after the run was over my nose would slowly fill up with mucus again and I’d be congested.

So I was a mouth breather. Popular folklore (aided by the TV show Stranger Things) is that mouth breeders are dumb. In reality, mouth breathers don’t get enough oxygen because we can’t breathe through our noses. Maybe we never can get the right amount of oxygen to our brains, perhaps keeping our brains from functioning at peak. Also, it looks kind of dumb to walk around with your mouth open all the time. But there was nothing I could do about it.

There was the time I was doing homework at the table and my older sister snuck up behind me. She clapped a hand over my mouth tightly and said, “You can breathe through your nose if you want to.” It took me a minute to fight her off, after which I gasped for a while.

There were real problems caused by my inability to close my mouth. My mouth stayed open all night, providing a saliva free environment for bacteria to grow. My teeth began to decay at an early age. I had an abscess in my lower jaw when I was 5 years old. My father went a little nuts about that. He would attribute every medical problem that we kids had, to our failure to control ourselves. When my sister got an eye infection, for instance, he blamed her for wearing bangs. He was very angry at me for not brushing my teeth properly. But I was in kindergarten. What did I know?

My teeth steadily eroded. The dentist office was a familiar and scary experience for me from the age of about 6 onward. Also, while my lower jaw grew normally as I matured, my upper jaw did not. This gave me an underbite. I needed braces to lean the bottom teeth inward and push the upper teeth outward. After three years of having had braces cemented on, my teeth were somewhat aligned. But when the dental technician took off the cement that had held the braces on all that time, she also took off bits of enamel from several of the teeth. So there were holes on the surface of my teeth, which meant more problems coming down the pike.

Five years ago, at the age of 60, I decided to get implants. So I started going to the dental school at Columbia Presbyterian, for cheaper but the most up-to-date treatment, using the latest methods and equipment possible. By four years later, a lot of basic work had been done on my teeth.

But no implants yet. Two bases had been implanted, but there was bone loss. They had to be removed.

An MRI of my head indicated that my upper jaw had never grown to full size. This meant that not only did I not have normal sinuses, which probably was why my nose was permanently congested, but I was unable to bite properly since I was a kid. My lower jaw juts out a good quarter inch ahead of my upper jaw. This is called a class 3 situation. I’m a class 3 with bad teeth.
A great deal of preparation work had been done on my teeth and jaws over the last 4 years. The bases of two implants had been set, but there have been bone graft problems that delayed the eventual capping of these implant posts. Two implants on the left lower jaw had to be removed. New ones will be put in eventually.

Every 2 years I’ve been assigned a new dentist because the previous one had graduated. By autumn 2019 I began to get exasperated. Both my dentist and my prosthodontist had graduated from the dental program there. I had already been through three different dentists. Now they assigned me a fourth new dentist, and a new prosthodontist. I had been going for four and a half years but still no teeth. In an appointment with both of them I asked if it were possible for them to create a plan by which I get my implants before they both graduate in June of 2021?

Well, they said they could probably do it. Or at least get me most of them, before they graduated. They said they would create a plan in the next few weeks.

Then COVID forced a lockdown of the entire facility for about 5 months. During that interval, the health professionals of Columbia Presbyterian figured out procedures and protocols by which they could vouchsafe their own health and that of their patients.
In September I got a text: could I come in for an MRI? They made a three-dimensional image of my remaining teeth and both jaws. Later, another appointment with the prosthodontist. The MRI image was on her computer. My dentist came in from another floor. They both began to explain, point by point, what would be done and when. They said they believe that I can have my teeth by the middle of next year. They’re not completely confident that the whole process will be finished by that time, but they are sure that they can accomplish at least part of the goal. OH YEAH!

On October 21, the prosthodontist had me in for a full-day session from 9:00 until 3:00. I had looked forward to the day with hope and dread. She was to extract four of my upper teeth. This was going to be very painful. But I kept the goal in mind. I want those implants!

Now, the ways of both hospitals and colleges are traditional and arcane to their staff, and somewhat mysterious to outsiders. Once a procedure is instituted and accepted, only with great difficulty can they overcome the urge to keep it as it always has been. Because, after all, it always worked. Why change it?

“I’ve worked in the private sector. They expect results.” — Dr. Ray Stantz, Ghostbusters

Columbia Presbyterian’s walk-in patient admissions procedure has always been—for the past five years, anyway–to have the patient present an ID card to the security people at the desk. They take the card and look at it. They don’t scan it, record it or write anything down. They just look at it for a second, then they hand it back.
Then they ask, “What floor you going to?”
As you answer, the guard picks up a 6” by 6” card paper map from a stack of maps, and scribbles a big number of your floor on it with a pen. You’re handed the map, and you go. You can’t leave the security desk without that map in hand. You’re supposed to carry it with you until you get to your destination. Then what? No one checks it, so why do you have it? You sit in the waiting room, put the map on the seat next to you, are called by your doctor and go for your treatment. The next person to come in leans over, swats the map onto the floor and sits.

This ‘system’ allows anyone: thieves, molesters, crazy people, ANYONE to come in, go through security and go upstairs. They would know that ID cards are unrecorded and they won’t be photographed. They are anonymous and there’s no record of their coming or going. Why?

In the early morning there’s often a long line of people, many of whom have been there many times before. They are each asked for their ID, then handed a map every time they come in. That’s about two patients per minute, a huge waste of their time. Returnees know where they’re going yet they’re always given the map. Why?

The hospital buys tons of copies of this map to be stacked at security desks at every entrance. But nobody upstairs checks them. Why?

I’d been coming here for five years. I haven’t needed a map for at least four of them. Yet I am not allowed to go upstairs without one. I’ve attempted to sneak by but they give you holy hell if you do so.
Why?

So I’ve created a strategy over these years: dress well, wear a tie and hang my license on a lanyard. Walk nonchalantly but quickly past the security desk while looking at my phone and holding up the lanyard for them to see my ID in its plastic card holder. It has saved me a lot of time over the years.

But not this year. This is 2020, the year of the Covid-19 pandemic. The walk-in process was changed by adding a step after security: A nurse checks walk-in patients’ temperatures, then orders the patient to remove their blue gloves, sanitize their hands and go around the hospital barehanded.

After I put my blue gloves in the trash, I had to pick up the map! You can’t go upstairs without it! Every patient walking into the hospital, now gloveless, is required to hold an UNSANITIZED card in their bare hands. Why?

Why why why?

Columbia Presbyterian should institute an ID card system for returnee patients. All the doctors and students have them, so why not patients? The hospital would save everyone’s time and its own money while getting rid of a germ vector. Win win win.

I sighed, picked up the unclean paper map with my clean hand and went on my way.

Dr P, my prosthodontist, sat me down in the patient chair. She introduced me to another prosthodontist who assisted. I asked Dr P to give me a few seconds between anesthesia injections so I could handle the pain.

She started anesthetizing me. First a few injections between the gum and cheek after applying a topical. I’ve had many of these over the years. I tensed up and took the pain of each one, separated by the pauses I’d asked for.
Then she started injections in the roof of my mouth. These REALLY hurt, from the moment the needle touched the gum until several seconds after it was withdrawn. And I got three to four injections for each of my four teeth. The only saving grace in my pain management were her pauses between shots.

Several times I’ve had teeth removed, always by men. They put the calipers on the tooth and bend it forward or backward, reversing every couple seconds. I try to keep my head still by flexing my neck muscles. There are loud cracking sounds that only I can hear. Then the tooth comes out.

The method of Dr P. is to put the calipers on, then twist the tooth slowly one way and then the other until it loosens and comes out. Her colleague exclaimed, “You are the expert!” There was still a little cracking, but stress to my neck muscles is much less with this method. There’s no need to pull my head back as (a male dentist) pulls forward and vice versa.

At the beginning of the procedures for the third tooth the colleague asked, “Is this the massage chair?” The hospital had bought a few massage chairs but most of them were regular dentist chairs.
Turned out that this was the massage chair. Would I like the massager turned on? Sure. The massager came on and it felt wonderful!

Here is a neat thing about the human mind: the massage chair kept massaging my back through the entire second half of the day. The injections hurt much less! My mind was distracted by the massage. It really helped!

Every dentist chair should have a massage function. Come to think of it, every dental office ceiling should have posters or a video screen attached to it, and every patient should have stress balls to squeeze. The more distraction, the less pain.

After each tooth came out, a base for each implant went in. Four in one day was an intense experience, though made much more bearable by the massage chair. I thanked the doctors and went home with a swag bag full of ibuprofen, gauze and a couple of instant ice packs. The pain will subside but the goal is in mind. I will have teeth by summer!

#dentist #dentistry #pain #painful #prosthodontist #tooth #teeth #extraction #extracted #lidocaine #novocaine #anesthetic #Columbia #Presbyterian #Hospital #university #college #dental #patient #patients #toothless #older #olderpeople #student #students #implant #implants #bonegraft #sanitized #unsanitized #covid #security #sterilize #Columbia Presbyterian Hospital

A day at the dentist. A whole day.

I had a nasal infection when I was a baby. From that time on I had never ever been able to breathe through my nose unless I was fully exerting myself, such as while running distances. An hour after the run was over my nose would slowly fill up with mucus again and I’d be congested.

So I was a mouth breather. Popular folklore (aided by the TV show Stranger Things) is that mouth breeders are dumb. In reality, mouth breathers don’t get enough oxygen because we can’t breathe through our noses. Maybe we never can get the right amount of oxygen to our brains, perhaps keeping our brains from functioning at peak. Also, it looks kind of dumb to walk around with your mouth open all the time. But there was nothing I could do about it.

There was the time I was doing homework at the table and my older sister snuck up behind me. She clapped a hand over my mouth tightly and said, “You can breathe through your nose if you want to.” It took me a minute to fight her off, after which I gasped for a while.

There were real problems caused by my inability to close my mouth. My mouth stayed open all night, providing a saliva free environment for bacteria to grow. My teeth began to decay at an early age. I had an abscess in my lower jaw when I was 5 years old. My father went a little nuts about that. He would attribute every medical problem that we kids had, to our failure to control ourselves. When my sister got an eye infection, for instance, he blamed her for wearing bangs. He was very angry at me for not brushing my teeth properly. But I was in kindergarten. What did I know?

My teeth steadily eroded. The dentist office was a familiar and scary experience for me from the age of about 6 onward. Also, while my lower jaw grew normally as I matured, my upper jaw did not. This gave me an underbite. I needed braces to lean the bottom teeth inward and push the upper teeth outward. After three years of having had braces cemented on, my teeth were somewhat aligned. But when the dental technician took off the cement that had held the braces on all that time, she also took off bits of enamel from several of the teeth. So there were holes on the surface of my teeth, which meant more problems coming down the pike.

Five years ago, at the age of 60, I decided to get implants. So I started going to the dental school at Columbia Presbyterian, for cheaper but the most up-to-date treatment, using the latest methods and equipment possible. By four years later, a lot of basic work had been done on my teeth.

But no implants yet. Two bases had been implanted, but there was bone loss. They had to be removed.

An MRI of my head indicated that my upper jaw had never grown to full size. This meant that not only did I not have normal sinuses, which probably was why my nose was permanently congested, but I was unable to bite properly since I was a kid. My lower jaw juts out a good quarter inch ahead of my upper jaw. This is called a class 3 situation. I’m a class 3 with bad teeth.
A great deal of preparation work had been done on my teeth and jaws over the last 4 years. The bases of two implants had been set, but there have been bone graft problems that delayed the eventual capping of these implant posts. Two implants on the left lower jaw had to be removed. New ones will be put in eventually.

Every 2 years I’ve been assigned a new dentist because the previous one had graduated. By autumn 2019 I began to get exasperated. Both my dentist and my prosthodontist had graduated from the dental program there. I had already been through three different dentists. Now they assigned me a fourth new dentist, and a new prosthodontist. I had been going for four and a half years but still no teeth. In an appointment with both of them I asked if it were possible for them to create a plan by which I get my implants before they both graduate in June of 2021?

Well, they said they could probably do it. Or at least get me most of them, before they graduated. They said they would create a plan in the next few weeks.

Then COVID forced a lockdown of the entire facility for about 5 months. During that interval, the health professionals of Columbia Presbyterian figured out procedures and protocols by which they could vouchsafe their own health and that of their patients.
In September I got a text: could I come in for an MRI? They made a three-dimensional image of my remaining teeth and both jaws. Later, another appointment with the prosthodontist. The MRI image was on her computer. My dentist came in from another floor. They both began to explain, point by point, what would be done and when. They said they believe that I can have my teeth by the middle of next year. They’re not completely confident that the whole process will be finished by that time, but they are sure that they can accomplish at least part of the goal. OH YEAH!

On October 21, the prosthodontist had me in for a full-day session from 9:00 until 3:00. I had looked forward to the day with hope and dread. She was to extract four of my upper teeth. This was going to be very painful. But I kept the goal in mind. I want those implants!

Now, the ways of both hospitals and colleges are traditional and arcane to their staff, and somewhat mysterious to outsiders. Once a procedure is instituted and accepted, only with great difficulty can they overcome the urge to keep it as it always has been. Because, after all, it always worked. Why change it?

“I’ve worked in the private sector. They expect results.” — Dr. Ray Stantz, Ghostbusters

Columbia Presbyterian’s walk-in patient admissions procedure has always been—for the past five years, anyway–to have the patient present an ID card to the security people at the desk. They take the card and look at it. They don’t scan it, record it or write anything down. They just look at it for a second, then they hand it back.
Then they ask, “What floor you going to?”
As you answer, the guard picks up a 6” by 6” card paper map from a stack of maps, and scribbles a big number of your floor on it with a pen. You’re handed the map, and you go. You can’t leave the security desk without that map in hand. You’re supposed to carry it with you until you get to your destination. Then what? No one checks it, so why do you have it? You sit in the waiting room, put the map on the seat next to you, are called by your doctor and go for your treatment. The next person to come in leans over, swats the map onto the floor and sits.

This ‘system’ allows anyone: thieves, molesters, crazy people, ANYONE to come in, go through security and go upstairs. They would know that ID cards are unrecorded and they won’t be photographed. They are anonymous and there’s no record of their coming or going. Why?

In the early morning there’s often a long line of people, many of whom have been there many times before. They are each asked for their ID, then handed a map every time they come in. That’s about two patients per minute, a huge waste of their time. Returnees know where they’re going yet they’re always given the map. Why?

The hospital buys tons of copies of this map to be stacked at security desks at every entrance. But nobody upstairs checks them. Why?

I’d been coming here for five years. I haven’t needed a map for at least four of them. Yet I am not allowed to go upstairs without one. I’ve attempted to sneak by but they give you holy hell if you do so.
Why?

So I’ve created a strategy over these years: dress well, wear a tie and hang my license on a lanyard. Walk nonchalantly but quickly past the security desk while looking at my phone and holding up the lanyard for them to see my ID in its plastic card holder. It has saved me a lot of time over the years.

But not this year. This is 2020, the year of the Covid-19 pandemic. The walk-in process was changed by adding a step after security: A nurse checks walk-in patients’ temperatures, then orders the patient to remove their blue gloves, sanitize their hands and go around the hospital barehanded.

After I put my blue gloves in the trash, I had to pick up the map! You can’t go upstairs without it! Every patient walking into the hospital, now gloveless, is required to hold an UNSANITIZED card in their bare hands. Why?

Why why why?

Columbia Presbyterian should institute an ID card system for returnee patients. All the doctors and students have them, so why not patients? The hospital would save everyone’s time and its own money while getting rid of a germ vector. Win win win.

I sighed, picked up the unclean paper map with my clean hand and went on my way.

Dr P, my prosthodontist, sat me down in the patient chair. She introduced me to another prosthodontist who assisted. I asked Dr P to give me a few seconds between anesthesia injections so I could handle the pain.

She started anesthetizing me. First a few injections between the gum and cheek after applying a topical. I’ve had many of these over the years. I tensed up and took the pain of each one, separated by the pauses I’d asked for.
Then she started injections in the roof of my mouth. These REALLY hurt, from the moment the needle touched the gum until several seconds after it was withdrawn. And I got three to four injections for each of my four teeth. The only saving grace in my pain management were her pauses between shots.

Several times I’ve had teeth removed, always by men. They put the calipers on the tooth and bend it forward or backward, reversing every couple seconds. I try to keep my head still by flexing my neck muscles. There are loud cracking sounds that only I can hear. Then the tooth comes out.

The method of Dr P. is to put the calipers on, then twist the tooth slowly one way and then the other until it loosens and comes out. Her colleague exclaimed, “You are the expert!” There was still a little cracking, but stress to my neck muscles is much less with this method. There’s no need to pull my head back as (a male dentist) pulls forward and vice versa.

At the beginning of the procedures for the third tooth the colleague asked, “Is this the massage chair?” The hospital had bought a few massage chairs but most of them were regular dentist chairs.
Turned out that this was the massage chair. Would I like the massager turned on? Sure. The massager came on and it felt wonderful!

Here is a neat thing about the human mind: the massage chair kept massaging my back through the entire second half of the day. The injections hurt much less! My mind was distracted by the massage. It really helped!

Every dentist chair should have a massage function. Come to think of it, every dental office ceiling should have posters or a video screen attached to it, and every patient should have stress balls to squeeze. The more distraction, the less pain.

After each tooth came out, a base for each implant went in. Four in one day was an intense experience, though made much more bearable by the massage chair. I thanked the doctors and went home with a swag bag full of ibuprofen, gauze and a couple of instant ice packs. The pain will subside but the goal is in mind. I will have teeth by summer!

#dentist #dentistry #pain #painful #prosthodontist #tooth #teeth #extraction #extracted #lidocaine #novocaine #anesthetic #Columbia #Presbyterian #Hospital #university #college #dental #patient #patients #toothless #older #olderpeople #student #students #implant #implants #bonegraft #sanitized #unsanitized #covid #security #sterilize #Columbia Presbyterian Hospital