"Ouch", I thought as a sudden, intense, but familiar pain struck my tooth. A throbbing, rhythmic classic toothache was dancing with my favorite molar, the one on the lower left (later named as #18 by my dentist) that had a fracture and a root canal in 2008. The same favorite molar is the posterior anchor to my bridge which acts as a memorial to the adult tooth that was congenitally absent, becoming a "no-show" when the "baby tooth" graduated to a valuable spot under my childhood pillow and then to the tooth fairy, who always left some money.
A throbbing night with tooth pain, buffered by Aleve and acetaminophen, inspired me to call my dentist's office. Laura at "Dr. Mike's" office was caring and professional in getting me an appointment 4 hours later, during which the x-ray showed a radiolucency. Dr. M. examined the area and the x-ray before determining that I had an infection in precarious proximity to the aforementioned molar #18. He prescribed an antibiotic and recommended evaluation by an endodontist for potential tooth-saving surgery.
Three days and several aches later (sometimes treated with the addition of topical brandy which had a numbing effect late at night when it throbbed the most), Dr S, the endodontist whom I'd seen for a root canal 14 years ago, smiled as he greeted me enthusiastically. He had reviewed the history taken by his dental assistant and the x-ray she took. He proceeded to examine my mouth and the tooth with it's swollen gummy home. "Look at that, Jennifer!" he exclaimed, wishing to show her something horrific (so thinks the patient who definitely doesn't want to impress any dental professionals with his pathology). I started to have a grief reaction silently for my tooth.
He drew a picture to show why the tooth needed the grief reaction. Cracked Tooth Syndrome causes gum separation from the tooth allowing my saliva to percolate down where it causes infection leading to tooth extraction, which I needed soon. He applauded the quality of the root canal performed by Dr. Mike on the tooth in 2008, reassuring me that it was wonderfully intact and not related to the infection.
As I checked out, the receptionist volunteered to call Dr. Mike's office to find out who he used for extractions (the dentists are narrowing their scope of practice just like us physicians). I continued to thank my tooth for years of good service while driving to my office where I called Laura and asked what course of action Dr. Mike would recommend. I heard her enthusiasm for the oral surgeon in the office next door to them.
Laura knew that since I have the bridge, Dr Mike had to "section" (cut) the bridge just before the extraction. After calls to the favorite and next favorite oral surgeons whose schedules didn't match my need, I called Laura back and she made a personal contact with Dr. P's office and called me back. Can you come here at 11:45 to get the bridge sectioned and then go to Dr. P's office at 2 PM?
I had my schedule in my hand and already knew how we could shift patients to the nurse practitioner's schedule that was light today. "Yes", I said to Laura, and proceeded to see patients until 11:30. Then off to Dr. Mike's for sectioning the bridge. "It's Laura's birthday," the office staff at Dr. Mike's happily noted.
Dr P was in his office in the city 23 miles east (not the one next door to Dr. Mike), so GPS for guidance and Wendy's drive through for the 99 cent chili plus a 30 minute nap in my car got me into Dr. P's office at 2 PM. Dianne efficiently got me to fill in the forms and sign three pages about information transfer and payment, etc.and immediately a dental assistant called me back and into room 4 where I gave a brief history and listened to Christmas music on the overhead speaker.
Dr. P. entered, engaged me about the history and said, "Let's get that numb for the extraction." He injected me with 3 or 4 chunks of lidocaine and left for several minutes. I enjoyed "O Holy Night" and a couple other songs while he was gone.
On re-entry, he applied a device to the tooth and leaned. He heard a moan and noted that my body wasn't touching the dental chair and stated, "We're not here to hurt you. Let's inject that some more and wait a few minutes." I appreciated the heck out of that approach. Many physicians I've seen over the years tend to ignore patient "discomfort", but Dr. P. was not out to hurt people. God bless you, Dr. P.
Ten minutes later, after Dental Assistant Sidney reaffirmed that I understood the post op instructions about wound care, he was back. As he securely grabbed the tooth and started to rock back and forth to loosen it, I noticed that "Rockin' Around the Christmas Tree" was playing and I didn't re-experience the pain of the previous attempt. I got a prescription for Vicoden, an envelope full of gauze squares to press into the hole until the bleeding stopped. I paid my half of the fee and left.
Then to Wendy's drive through for a small frosty per Sidney's instructions and back to the office to see one patient who refused to see our nurse practitioner. I mumbled through the gauze as I took the history and examined the patient who didn't share my confidence in our nurse practitioner. I was still numbed by the extra lidocaine and didn't take the Vicoden until safely back home in my recliner.
Lessons learned or reaffirmed:
If you need to see three dentists in one day, you're going to get some pain and probably lose a tooth.
The primary dentist and his staff know the system and the players, they know how to get things done.
Receptionists make things happen, especially on their birthday.
Family Nurse Practitioners are flexible, valuable members of the health care team.
Teamwork and relationships are really important aspects of health care.
Get an oral surgeon who believes, as Dr P, "We're not here to hurt you." (And thank/honor them)
Don't forget to ask the dentist for your extracted tooth so you can put it under your pillow.
(If I could put it under my pillow, I'd give all money /coupons left by the tooth fairy to Laura, Dr. Mike's receptionist for good work on her birthday.)