What’s It Like To Pull Your Own Tooth Out?
Sometimes a patient just surrenders – and stops going to the dentist altogether. Usually they’re phobics who have an outsized fear of the dentist. Occasionally some patients suffer from uncontrolled gagging where even a simple procedure is impossible. Daily toothbrushing becomes challenging. These patients’ problems fester and multiply; in these cases, going to sleep may be the only solution.
“Is it safe?” they always ask.
A trained dental anesthesiologist partners in this endeavor, I explain. Just like the doctor in the operating room monitoring blood pressure and heart rate, doing the crossword puzzle in the back, this doctor would do the same, only in the office.
Then I say this: It is the only way.
“It’s expensive,” I add. “But people think it’s totally worth it.”
A few phobics can pinpoint the cause, a sadistic childhood dentist who said things like, “It’s only a baby tooth. You don’t need the sleepy juice for that.” And proceed to drill on the offending tooth. For most though, the fear is irrational. Yet phobias are real and these patients cannot undergo the simplest procedure without sedation. But their procedures are never simple. Sometimes taking years, a small cavity, easily ignored, will grow into pain that cannot be ignored. By then, either the tooth requires reconstruction or it has to be pulled.
“I don’t care what it cost,” the phobic or gagger often says. Like buying a car without air conditioning is unthinkable, dentistry without sedation is also impossible.
Henry was one such person. Hiding behind long facial hair, he never smiled or laughed. For our first two appointments, I sat several feet away, not wanting to scare him, trying to look at his forehead rather than his mouth.
“What brings you to the dentist after all these years?” I asked, knowing the answer: the pain had become intolerable.
“My whole mouth hurts. I can’t work; I can’t concentrate,” Henry said.
“I understand,” I said, although I didn’t. Joking that I must have been a rat in a previous life, I have an irrational aversion to cats. It doesn’t paralyze me, though, and I can even watch a cute kitten video on occasion. Gripping fears like Henry’s are plentiful enough to have their own vocabulary: arachnophobia, agoraphobia, commitment phobia. I can only sympathize; I can’t truly understand.
Henry continued. “I would put it off and put it off. If the pain got real bad, I’d get knocked out and have the tooth pulled. A few times I muscled through it until it didn’t hurt anymore. Once I reached in and pulled the tooth myself.”
On the third visit when Henry finally opened his mouth, I saw broken blackened stumps of teeth. Henry was 33 years old, yet his mouth looked ancient.
“I want you to pull out all my teeth and give me dentures,” Henry said. “I’m tired of not smiling.” He wanted to sing and laugh open mouthed with his children.
“Even the healthy ones?” I asked. His wishes went against everything I’d been trained to do. “I’m supposed to save your teeth.”
“Doc, if you won’t do this, I’ll go to someone who will.”
I debated with myself for days. Yes, Henry could easily find another dentist to pull out his teeth and make him dentures. But could he find one who would spend time talking to him? Had I been in the trenches for so long that I was evaluating Henry’s teeth rather than Henry the man? What if he got a life threatening infection from one of his decayed teeth? Or what if, like the majority of patients, he couldn’t tolerate his dentures? There’d be no turning back. It would be years before implants would be routinely used to anchor poor functioning dentures.
“Henry, you need your teeth!” I wanted to shout.
In the end I arranged for Henry to have his teeth extracted at the oral surgeon. After that, like altering loose clothing after weight loss, I relined Henry’s temporary dentures as his gums healed and shrank.
“My daughter said yesterday, ‘Daddy, you have grown-up teeth like me now,’” Henry confided. “Then she touched one of them.”
Henry had the usual denture wearer difficulties: eating nuts, chewing meat, and biting into apples. “It’s physics,” I said. “If you bite into pizza with your front teeth, the back of the denture will fall down, like a teeter totter.” Handing Henry a pamphlet, I suggested he cut his food into small pieces and chew evenly on both sides of his mouth.