The Premolar Attack

Part I - Triage

Two nights before I met Dr. Fuller and Dr. Zhao, the pain had come knocking softly, like a shy relative in the village sent to greet the visiting city cousins. Just a soft harmless pulsation. I waved it off. In a few minutes, the knock grew relentless, rising in intensity until I could no longer ignore it. I popped some ibuprofen and waited for the pain to subside.

"Whiskey Sea", by Maria Fabrizio - When no amount of "whiskey" (whatever you do for pain relief) numbs you enough against the icebergs of life's unbearable pain. Such is the pain of a premolar attack!

I hate pain, but more than that, I hate making big pharma rich and will not swallow a single pill unless I’m convinced my life might be on the line. This time, it seemed quite clear a toothache was here to torture me to death. A tooth! Never underestimate the power of a pesky little enemy in the shadows who slowly drills into your inner circle.

It was well past midnight, and I had swallowed a whole mess of ibuprofens. I couldn’t take the pain anymore. I’m not a whiner I’ll tell you that. But this was pain straight from Dante’s ninth circle of Hell, and the devil had a red-hot prong of his pitchfork boring mercilessly right through my premolar, causing a fiery throbbing rhythm that sent my head in and out of waves of torment. I would never ever wish this intensity of pain on the devil himself.

My husband was lost and tortured by my groaning.

“Kill me! Kill me!” I mourned. “I can’t take it anymore!” Whimp!

“Let me hold your head, the pain will go away.”

 “It’s too much! Take me to the hospital…” Really!

“It’s going to be better by morning, I promise.”

“It’s taken too long and nothing is working. Just end my misery!” The stupid things we say over a toothache.

“That’s it. Let’s go.” He got out of bed. “We’re going to the emergency room now.”

Suddenly I wasn’t too sure any more about an emergency room run at 2 o’clock in the night.

“What do you think they will do?” I asked, trying to tone down my groaning. I felt like an annoying student about to be punished with time-out at the emergency room corner.

“They will stick a light up your tooth and give you some painkillers, refer you to a dentist and send you back home.”

“Ok, then, let’s not go. I’ll be quiet.”

“You already threatened me with your death, talking all that kill-me kill-me. We’re going!”

We drove through the quiet streets to a near-empty emergency room at the Good Samaritan hospital. They did my paperwork and we settled in to a long wait. So much for emergency. Above my head was the sign “triage” hanging from the ceiling. I was under a code red premolar terror attack and there was no triage doctor running towards me with the soundtrack rising to a crescendo like I see on TV medical dramas. I settled my throbbing head on my husband’s shoulder and tried to sleep.

As the morning broke, the doctor saw me, stuck a light up my premolar, prescribed me some oxycodone, and wrote me a referral to the University of Baltimore School of Dentistry. I'd been told this is exactly what would happen, hadn't I.

Part II – The Mystery

The University of Baltimore School of Dentistry has its prestige secure as the oldest in the world-- yes, in the world, I didn’t write that wrong. If the first modern dentist in the entire world graduated from this place right here in the 1840s, I was confident I was going to receive superior treatment.

They also have a first-come-first-served program that allows you to pay subsidized rates for very expensive procedures, and people travel from all over to make a beeline in the wee hours of the morning just to get in and have the students attend to you.

Teeth business is exceedingly costly in the US, even with insurance. As if these dentine body parts are any more important that fingers or toes. No wonder George Washington settled for wooden teeth-- ok, so they say there’s no proof of that, but there’s proof he had some sorry teeth. You ever seen an image of him smiling? No, he dared not.

My turn came and I met my assigned dentist students, Dr. Fuller and Dr. Zhao. They were extremely thorough, went far beyond the normal practicing dentist that I’ve been to. Perhaps it’s what you get from being treated by students whose work counted towards their graduation. No room for mistakes. I started enjoying their company. The teacher in me jumped out of the bushes of receding pain.

“What brought you two to such a smelly pursuit?” I asked them. They laughed, and both said they enjoyed being dentists. I asked them how long it took to graduate.

“Four years for general dentistry. Ten years for oral surgery,” said Dr. Zhao.

“Nooo!” I protested.

“Yup.”

“Why?”

“Oral surgery is an extensive field.”

“I don’t know what’s so extensive about cutting into gums and drilling into jaw bones,” I said with intentional naivety. Either way, ten years in school over teeth? Nuh-uh. Before going in for oral surgery, we had a lengthy conversation about teeth and cultures. They volunteered stories about their families, how Asian and Western cultures handled teeth issues. I told them Africans used twigs from certain trees for a toothbrush and I think they worked better than colgate. There I was, wakandaring up Africans.

As we talked, I started getting the feeling there was something that fascinated them about me but I wasn’t sure what. The questions kept coming, I kept “teaching”.

“So, do you have family?” one of them asked me.

“Yes. Plenty of it.”

Pause.

“Married?” Asked young Dr. Fuller.

“Yes. And my husband has had enough of this tooth drama.”

“Oh!” he said. I wasn’t sure what that reaction meant. It seemed as if he had just heard something quite unexpected.

“He rushed me to the emergency room over the pain and he had no sleep, poor guy!”

They look at each other, amused at something. There’s a private knowing, one I’m not a part of, and I’m now getting the feeling I’m the unknowing subject of their knowing. Like people gossiping about you in your presence, with you participating. I play along. It’s an interesting game.

“Kids?” Dr. Fuller went on.

“No.”

“Do you miss not having any?”

“Not at all. We don’t miss what we don’t have,” I said.

Then I noticed that he was holding my paperwork with all the details on me and he seemed to keep peering at it. It wasn’t until I was done with my oral surgery that the entire mystery became clear. 

At the lobby, Dr. Fuller had handed over my paperwork to the receptionist and said to her, “Please correct Ms. Hall’s gender right away.”

The dentist was angry with the receptionist for the careless mistake of ignoring the gender box and leaving it at the default “male”.

“Ok. I’ll print you a corrected form,” The receptionist said it without apology. For her, what she did with paperwork held no connection to medical decisions. Did she not know paperwork mistakes are a major cause of medical malpractice? Not that they would remove an ovary instead of a premolar. But this dentist was still a student, and he wanted no mistakes on his watch.

“Ms. Hall, I apologize for that mistake,” the dentist said. It was my turn to be amused. All along they thought I was male because the paperwork said so even if what they were seeing indicated I was female.

Part III – What Happened

Let’s back up to the part just before I went in for the oral surgery on my rogue premolar.

“What’s the prognosis?” I ask the dentists.

“Your tooth needs to go,” Dentist says.

“Can we not save it?”

“No. Sorry. The abscess is too deep.”

“But is there anything wrong with the tooth itself?”

“The tooth itself has no cavity but...”

“Then we must save it.” I insist.

I really wanted to save my tooth. That’s because my husband always says to me that his mother always said to him that whatever you do don’t ever let the dentist take a good tooth out of your mouth. So this is a battle that runs deep.

“Let me show you why we cannot save it.” The dentist is patient with me, and he proceeds to show me my x-rays and what they mean. “In fact,” he continues, “the lower premolar has to go too really soon.

I’m alert! I’m being robbed! Two premolars? What next? All my teeth? Are they fixing to set me up with dentures at my young and tender age? Am I their next guinea pig? After all this is a school. I proceed to put up a valiant fight. I'm keeping my tooth! I'm keeping my tooth!

“Ok then. I’ll go call the professor. She might give you a different opinion.”

I feel triumphant. I wait. Professor Schmidt was a grayed up senior dentist who wore a halo of experience around her elderly frame. She looked like she just popped out of an ancient dentistry journal. She proceeded to study my x-rays. I talked to her. I told her I’m keeping my tooth.

“I’m sorry, Ms. Hall, but here’s the reason it has to go...” I shut out her lengthy explanation, most of which I’ve already heard from the students. By this time I’m well-schooled in the human dental structure and all that it connects to. Nothing about the human body is simple, not a single thing. One could very well take ten years to study an eyelash and write volumes of books on it and still not know half the miracle of its existence.

My premolar had fought a good fight and it was time to part with it. I was taken in to the oral surgery room to have it taken care of.

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There’s an oral surgeon with gadgets in my mouth, and three students around her peering into my mouth. The surgeon is the teacher, I’m the blackboard, fully awake and numbed up where they are excavating my tooth. It’s all quite fascinating listening to her teach while I'm lying there. I close my eyes and let the conversation wash over me - the Premolar Cantata

“Take this and hold it down... ah... uh-oh... that’s ok... scrape deeper so it doesn’t cause her trouble later… Ok let’s start sewing it up...”

They are done in half an hour. Not a prick of pain. I almost want to start clapping for them. Until someone comes in with a piece of paper, a worried look all over her face. She was one of the students. What now? 

“Ms. Hall... I’m sorry but something happened during the surgery.”

What in dentist’s hell could have happened? I was wide awake. I heard it all. I was the blackboard for heaven’s sake, and I feel quite alright.

“I was working on your tooth and the scalpel slipped and cut through my glove and into my skin. Unfortunately it also had your blood on it. I’m requesting that you please sign off for an HIV test.” By this time she’s in sheer panic.

Pause. They all blink rapidly.

I laugh out loud. The look on her face! Was the terror in the room caused by the possibility of HIV infection from an African woman? Or was it the thought that I could choose to sue for careless medical procedure that I could argue also put me in danger? I laughed because in this moment of dread, I held the scalpel. Their lives could be determined by the decision I made.

“It’s ok if you don’t want to sign it but that will mean I have to take the test and wait for three months and be tested again...”

“That’s fine, I’ll get a test.” That broke the tension right away. The nurse drew my blood and told me I could wait a few minutes for the result. But I was starving and I had places to go and things to do and the sunshine outside waiting for me. I had no time to wait around.

“Please mail me the results,” I say. “But can I see what you took out of my mouth before I leave?”

“Sure, it’s right here.” The dentist lifted it between her thumb and index finger and leveled it with my eyes.

“There she is!” I said. “She’s a work of beauty that premolar, isn’t she. Lived in my mouth close to half a century. You served me well, you brave girl!”

Teeth Surreal - Dental anatomy art in ceramic by Heather Galler

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**Names have been changed to protect the privacy of individuals** 

Sere