Saturday, May 24, 2008

Bad Wisdom

When I was twenty, under somewhat consciousness-altered circumstances, I became aware of what felt like pressure in my back teeth. A trip to the dentist confirmed that the sensation had been either real or a fortunate coincidence; I had impacted wisdom teeth, four of them.

I had them out over a Christmas break, while visiting my parents in Illinois. I think it was done in two operations, right side, then left side; I'm not positive of the memory of the whole thing because the first surgery is what sticks in my mind, for reasons that will soon become apparent.

I've never cared for the idea of general anesthesia, so all the dental work I've ever had has been under, at most, local novocain or nothing at all. This isn't as tough guy as it may sound, since I've been blessed with remarkably sturdy teeth. When I was twenty I had yet to have a single cavity, and the only traumatic dental work I'd ever had was the removal of my two bottom front baby teeth, when my adult ones came in behind them and failed to undercut the roots. Still, I have to admit that having two fully-rooted teeth yanked out when I was six feels a little painful, even at this distance.

As a complete aside from the main story, I'll recount that I also had an odd bit happen with the novocain when they were prepping me for the wisdom teeth extraction; they hit a vein with the needle. Novocain is a trade name for procaine, which is the anesthetic, but it's usually administered with adrenaline, which is the trade name for epinephrine. The epinephrine causes blood vessels to constrict and keeps the procaine in the local area longer, reducing the need for more injections. However, when, as it sometimes happens, the needle hits a vein, the epinephrine goes into the whole body. Epinephrine is the "fight or flight" hormone, and sometimes can cause panic reactions, especially if the patient is already anxious.

However, despite whatever trauma I had as a six-year-old, dentists are not a source of fear for me. Quite the opposite. No cavities. Great teeth. It's an ego thing. So, rather than having a panic reaction from the adrenaline, I had a different, although common reaction, which is a sense of "I feel like I ought to be afraid but I'm not." All the physical symptoms of fear are there, but none of the emotional involvement. It was an odd feeling of disconnect, which, it turns out, was about to get useful.

See, there's a downside to this "Look, Ma! No Cavities!" thing, and that is that it is a product of hard teeth, and hard teeth are brittle. Now let's see what I mean by "brittle."

"Impacted" in a tooth means that it is trying to grow towards another tooth. In my case the angle was fairly extreme; there simply wasn't enough room in my jaw for them to come up naturally. The standard procedure for impacted wisdom tooth extraction, at least when I had it done, was to file a couple of grooves in the teeth and hit the grooves with a hammered chisel, breaking the teeth into two or three easily extractable chunks. I've since been told that this is a pretty primitive procedure, and most such extractions are now done by sawing and such, but, 1970, central Illinois, who knew? I certainly didn't. Nor did anyone know what was about to happen when the hammer came down.

My oral surgeon hit the first blow onto the chisel and nothing happened. Then he hit it again, and said, "Oops."

Yes, dammit, I got my very own Bill Cosby "Oops." From my dentist. What had happened was that the tooth hadn't broken into two or three easily manageable chunks; it had shattered into more than a dozen pieces, shards, splinters.

So, the guy spent the next half hour trying to make small talk as he fished around in my open gums for little shards of tooth. He didn't get them all, either; bits of tooth were coming to the surface for months afterwards.

Then I got to go home and have my first experience with Demerol. Some people like the stuff; it makes me violently ill.

So, gums sewed up, still bleeding a bit (and one of the sutures had been sewn a little tight, so, what with the swelling, it cut into my gum and leaked blood for days), I got to vomit maybe two or three times before I figured out, don't take the Demerol!

And, of course, stomach acid is just the thing to sooth those raw and bleeding gums.

The second round of extraction went much easier, what with the no shattering teeth and no vomiting afterwards. I barely remember it, in fact.

Then, back at school, like I said before, months of having little tooth splinters come to the surface.

Ah, but it doesn't end there. It so happens that tooth extraction leaves a little halo of bone burrs around where the tooth used to be. Usually, these little spikes of bone get reabsorbed by the jawbone. Not mine. No, instead, sharp little bone spikes inside of gum plus chewing, moving the jaw, equals minor, ongoing gum lesions serving as infection sites.

After months of sore throats, persistent colds, coughs, etc., a dentist in Troy figured out the problem and took an X-ray, which confirmed it. The treatment was simple: open up the gum again and file down the spikes with a rasp.

Local anesthetic works well on pain, but it does nothing at all to keep you from hearing the sound of your jaw being filed down with a rasp, incidentally.

Finally, as a lasting little reminder of the whole thing, the months of infections caused a couple of drainage lymph nodes on the right side of my throat to permanently swell. My dentist told me to resist any attempts to biopsy or otherwise mess with them. This is now their "natural" state, and they'll probably be that way for the rest of my life.


black dog barking said...

The mouth is a wonderful piece of mechanical engineering combining brute force and delicate feedback mechanisms in a small, durable package. Pretty resilient too, able to recover from disasters like tooth shrapnel deposits that may not have been addressed in the design specs.

The whole "wisdom" tooth thing has an air of unplanned obsolescence about it that has to cause some discomfort for the Intelligent Design School.

James Killus said...

The whole "wisdom" tooth thing has an air of unplanned obsolescence about it that has to cause some discomfort for the Intelligent Design School.

I expect that there is less discomfort than we like to imagine. Rationalization is a high art and a low practice.

Marcila Dare said...

Four wisdom teeth, each of them impacted?! And the events after discovering them seemed like a zigzag of a dental story. But boy, it must have taken your more than just guts to fix all of those. From a set of wisdom teeth, it branched out to a few more problems. The dentist must have taken care of all those by now.

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