Ouch!

After reading over this entry, I have to warn potential readers that it's a little gross. Proceed with caution. -M

I have bad teeth. I've pretty much always had bad teeth. I've also been without decent dental insurance for a large part of my adult life. Combined, these two facts have made for some rough situations, one of which came to pass in the last 24 hours or so.

About two and a half years ago I was operating in 'correcting past oversights' mode and having a lot of dental work done. Included were a couple of root canals and extractions of teeth that were already past hope. One of the teeth I lost was the first molar on the bottom of the right side of my mouth. The tooth right behind it had also had problems and ended up being a root canal. The dentist and I had talked about getting a bridge to take care of both teeth, but to fix the immediate problem he filled in that second molar on a temporary basis.

Unfortunately, two things happened at about this time. First, I reached the annual maximum that my insurance company was willing to pay for dental work. Second, the ex initiated divorce proceedings, and since the insurance was through her job (I was going to school at the time), that made the whole issue of the annual maximum moot anyway. So I had the dentist do the minimum necessary to wrap things up, and spent the next two years or so paying off my part of the balance.

Fast forward to last night. I had come home from school, stopping at the grocery store to pick up a few things, including one of those cheap bake-it-yourself pizzas for lunch/dinner. As I was eating, I began to notice a gritty texture I don't normally associate with pizza. To my dismay, I discovered that the molar in question had cracked. I took a quick look in the bathroom mirror and discovered that it had cracked pretty much down the middle, splitting into inner and outer sections.

This was just before 5:00, so I called the dentist's office hoping to talk to someone. Alas, they were already closed for the day. So I left a message describing in some detail the problem I had and asking to come in as soon as possible. Then I made my way carefully through the rest of the evening with softer foods, careful chewing, lots of liquids, and a few ibuprofen tablets.

I awoke this morning knowing that I needed to get to the dentist today without fail. So I called in to the school and arranged to have someone cover my classes for the day. Then I waited for the dentist's office to call. That anticipated/feared call came in just after 9:30. The helpful receptionist said they had an open appointment on Wednesday at 10:00, or the possibility of a cancellation today at 11:30. She asked which I wanted. I said both. So we set a firm appointment for Wednesday morning and she put me on the waiting list for today.

I really wasn't thrilled about waiting another day on this thing, so I got cleaned up and made my way into the office at 11:15. I introduced myself and said I was there in case that 11:30 appointment cancelled. I figured that if I was actually there, I had a better chance of getting in whether there was a cancellation or not. And it worked. One of the dental assistants called me back just before noon and got me into a dental chair—not normally my favorite place to be, but in this case I was thrilled to be there. I had a digital X-ray taken, and I got to show Dr. Coleman my tooth, which was now in three distinct pieces after a brushing mishap. He gave me a lidocaine shot and sent me back to the waiting room until he could clear a slot for me.

That happened at about 12:20, and I was under the drill. There was some question initially as to whether he'd be able to save the tooth or just have to pull it, but after a closer examination he determined that there was enough sound material there to put a crown on it. So the deconstruction process started. He had to trim away a little of the gum (~3 millimeters) on the inside, which ended up not being as painful or as messy as I thought it was going to be. He used a laser to do it. That's right, I was operated on today with a laser. How cool is that? Anyway, he cleared away all the broken stuff and drilled out the existing filling. Then the reconstruction started.

He put in a couple of posts, one titanium and one fiber, to strengthen the roots and serve as anchors for the buildup he was about to do. Then he spent about ten minutes trying to get a band around the stub of the tooth to keep the material he was building up the tooth with in the proper place. It took him three tries, but he eventually was able to get it set. Then he injected the composite material inside the band and around the tooth. He got it filled in and let it cure for about three minutes, after which he started grinding down the excess and shaping it for the temporary crown.

At this point, all the painful stuff was done. He took a casting and made the temporary crown, all the while explaining the physics behind what he was doing. The foundation and the crown were both shaped to direct all the biting forces inward to the solid foundation of the natural tooth. I don't think he talks about such things with most patients, but he knows I have a science degree. Anyway, the temporary crown was soon finished and installed, and I was back to having a solid tooth again. It had only taken about 3½ hours and set me back around $400.

Now the decision is whether to go ahead with the bridge or just put a permanent crown on that tooth and maybe look at an implant somewhere down the line for the other. Given a choice, I think I'd prefer the bridge; so would Dr. Coleman. Unfortunately, the dental coverage we have doesn't kick in until December 1st, and even then there's a one year waiting period for major services like bridges and crowns. So either way, it's going to be an out-of-pocket expense. A crown is about $750. The bridge, which would take care of this tooth, the missing one in front of it, and anchor on the one in front of that, would be about three times that amount. So it looks like the crown is the way I'll be going.

And that's my day, pretty much. If you'll excuse me, I have to go take some more ibuprofen now.