Open Wide

   Said Terry Gross, "I don't usually gasp while preparing my interviews, but I gasped several times while looking at the illustrations in the books by my guest Richard Barnett."  Terry Gross is the host of the show Fresh Air and she was talking about the new book by her guest, Richard Barnett, a book on the history of dentistry titled The Smile Stealers.  There are perhaps few sounds that are so faint and yet can make each of us cringe almost in fear...a creaking door late at night perhaps, or a mosquito in a darkened room.  And then there's the drill of a dentist, that whirring hum followed by what one hopes will be little more than a bit of bone dust and the suction of water and saliva by the dentist's assistant...but we cringe with anticipation that somewhere along the way we just might feel that zing, that zap of pain when a nerve or something deep in our mouth will be touched; it's universal, the acceptance of possible further pain in order to reduce the ongoing pain our infected tooth or cracked molar is causing us, all of us suddenly identifying with the agony of Dustin Hoffman in Marathon Man.  Said the author: Well, I think dentistry of all the medical professions has always generated the most fear, certainly continues to generate the most fear.  I think very few of us go into a dentist's surgery with a light heart and a spring in our step.  So I wanted to think about the place of fear, the place of pain but also the place of attempts to mitigate that in the history of dentistry.  And I was very struck as I researched the history of dentistry that it's the story of technique.  And what a story --from threads and ropes to bridge teeth to replacing missing teeth with those taken from corpses, or just sitting in the street and tilting your head back to have your tooth just yanked out with what basically was a pair of pliers (ouch)-- but a captivating interview nonetheless.

   Some of this came to light the other night when I was eating dinner (a salad, of all things) and I felt something hard in my mouth, as if a pebble had somehow made it through the washed lettuce (all of our teeth are sensitive, able to feel grit as fine as 1/10,000 of an inch) but this was different.  I rolled it around with my tongue, popped out the offender and stared at a shiny piece of gold.  My cap (not quite a crown but basically half a crown) had popped off.  A quick trip to my dentist the next day and it was glued back on (it had been put on 22 years earlier, he told me).  Somewhere along the line we've all encountered something similar, that cavity or broken tooth, or an X-ray (modern dentists are now using ultrasound instead of X-rays) that shows deeper infection and the possible need for a root canal (see my earlier post on such a discovery).  In one instance some years ago, a simple bite on a soft piece of cooked zucchini caused a chunk of my molar to break away, as if a glacier ready to lose a bit of itself.  Such is the genetic history of my family, my teeth for whatever reason now filled with fracturing and cracks (or so my dentist has told me) that caps and crowns and fillings now occupy nearly half of my mouth...and yet all of my teeth are still with me.

   That agony of a toothache or an exposed nerve (say from a fall or a chip from biting something) is a harsh reminder of how pain can be generated in such a small area.  Cold and hot and biting down are now out, our chewing heading to only one side of our mouths.  In the wild, a lion kicked in the mouth by a zebra will likely perish, it ability to heal or chew or tear now removed, an event often captured over and over by documentary filmmakers.  But imagine being in the same spot, your one-sided chewing now leading to an abscess or to something happening on the opposite side of your mouth; now eating or even drinking something becomes quite limited, perhaps causing you to take smaller amounts of food or to swallow your food in bigger unchewed chunks.  Thought of in that manner, we forget how easily most of us have the option to have the problem taken care of, a call to the dentist or the rush to the orthodontist.  It's as easy as having an emergency ...only for many it isn't.

   Here in the U.S., getting dental care is not a given.  Emergency rooms at hospitals are not equipped for such procedures (you can receive pain medication, which may only compound the problem down the road).  And for many, paying for dental work, or even obtaining dental insurance (which often requires a co-pay which proves unpayable) causes millions of people to endure the pain or attempt to wait it out, and often with unpleasant results.  It's a far cry from the Hollywood movie version of putting a string on the offending tooth and yanking it out...with an infected tooth, the infection can spread quickly into your system.  Before long you could be seriously ill and possibly drawn into an actual life-threatening emergency.  The sad truth, said an article in The Washington Post: Nearly 1 in 5 Americans older than 65 do not have a single real tooth left...More than a third of American adults have no dental coverage, according to the ADA’s Health Policy Institute.  All of this in a time where Medicare provides no coverage and on the opposite end, wealthier folk are spending over $1 billion on shiny veneers and teeth whitening.  Said one of the patients waiting in line for 10 hours for a dental fix from the volunteer dental/medical charity Mission of Mercy: “We are not staying home, not sleeping and living off the government," (this as) She looked at some of the others who had come here, despite working for a living cutting down trees, building homes, minding a town library, running small businesses.  “I am trying to think that this is not demeaning,” she said as she cleared the chair for the next person in line. “But it is. It’s like a Third World country.”

   Often we forget about the simple things in life, the good times and the dinner parties that are so enjoyable and made so because we can sip a cold drink on a hot summer's day, or chomp down on a sandwich or chew something tasty.  But with something as simple as a crack or a lost filling, all of that comes to a grinding halt.  Our mouths suddenly become a complex and sometimes painful reminder of how intricate and complete a system our bodies can be.  At that point life isn't quite so cheery as we stop or at least reduce our eating and hope for the best.  For many of us, the dentist is indeed just a call away and the bill can and will be paid eventually...but for many, this is not an option.  In comments made after the article on charity dental work appeared, one retired dentist wrote: Take a page from the Scandinavians, who provide excellent preventive care to all young children, and great care to all residents, at very low cost.  The cost to society( government) for preventive care, and basic restorative and periodontal care is but a fraction of the cost of emergency care, or major treatment, and the results are so much better.  We shouldn't have to depend on the charity once a year to get people out of pain.  We have the mechanisms in place to rectify this disgraceful discrepancy in oral health, and can actually save money overall.   We just need leaders who are willing to put these into practice.  Another reader wrote something even more basic: Everyone in this country needs to start talking to the people around them, treating those people better and learning that we're all part of the same race.  "Those" people...they're us, they're neighbors, they're down the street...and who knows what tomorrow might bring; perhaps a lost job or a cut in coverage could soon make any of us one of "those" people.  Just as with repairing a broken molar or filling a cavity, we might need to just start there, to realize that there is no such thing as "those" people and that we are --for the most part-- quite fortunate.  

   William Falk, the editor of The Week wrote something similar in his comment about happenstance: One pivotal day 66 million years ago, a 6-mile-wide asteroid slammed into the earth off the Yucatan Peninsula in Mexico.  The explosion --as powerful as millions of nuclear bombs-- kicked up billions of tons of vaporized rock, filling the sky with a dark cloud that blotted out the sun for decades...In a new BBC documentary that aired this week, scientists who've drilled down into the asteroid's crater say that it hit "in the worst possible place" -- shallow coastal water where the underlying sediments were filled with gypsum; if the big rock had entered the atmosphere just 30 seconds earlier or later, it would have landed in the deep Atlantic or Pacific ocean and not created the catastrophic cloud of sulfur.  Most dinosaurs would have survived.  The human race might never have arisen...So much is the product of chance: how people meet their spouses, which of our parents' genes we inherit, why this person and not that one gets cancer or dies in a terrorist attack.  My genetic history apparently made me prone to teeth filled with fractures.  But I am lucky; my teeth don't hurt and when they do I can get them looked at...I am able to afford food with the proper vitamins and minerals that likely help my teeth somewhat; who knows?  All I know is that people are people, rich and poor, healthy and not-so healthy, fortunate and not, and sometimes we need to remember just how lucky we might be for something as simple as having teeth, or at least teeth that don't ache.   For many this is not the case...and whether we are or are not one of "those" people, we need to remind ourselves that things could change quickly, and in either direction.  As editor Falk ended: Flaming happenstance can fall out of a clear blue sky.  Ask any apatosaurus.