Adventures in Dentistry

by Dave Schuler on November 28, 2012

The other day I went to the dentist. Not my dentist of many years but one of my clients in whom I have complete confidence and for whom I have considerable respect. That respect has been enhanced by my experience as a patient rather than as a consultant.

As it turns out my left mandibular first molar was cracked. Hard to tell if it was cracked clear through or just has multiple partial cracks. The imaging just wasn’t good enough. It actually stands to reason that tooth would have a problem. I had a cavity filled in that tooth ten years or so ago, the most recent one I’ve had. Prior to that I’d had a cavity filled perhaps 35 years ago. I don’t have a lot of fillings but as it works out two of them were in that tooth.

The conventional treatment for a cracked tooth is a cap and I’ve now got a temporary cap. The permanent cap will be the newish ytterbium-zirconium oxide kind. Much superior to the old porcelain caps with metal substrates. Or even the old-fashioned gold caps.

We’re keeping our fingers crossed about the pulp (nerve) of the tooth. So far, so good. The tooth feels odd and a bit uncomfortable but I experience no pain when chewing and it’s not sensitive to hot or cold. I have some degree of pain on that side but that may be because of the work that was done or, typical for me, pain memory. I’m still taking NSAIDs although I really dislike taking pain medication or any kind.

A couple of interesting things. When I received the dental anaesthetic my shoulders began to twitch. I suspect that was a result of the epinephrine. Today I have an ache behind my left shoulder blade that I suspect is related to the adrenal gland there. It’s my understanding that adrenergics stimulate the adrenal gland and my lethargic, old adrenals aren’t used to the work.

Also, since the procedure I’ve been sleeping through the night, something that’s been pretty rare for some time. That makes me wonder if late at night I hadn’t started grinding my teeth and, when I encountered severe pain, awakened.

This is the first major dental work I’ve ever had. Nothing more prior to that than a very few fillings and most of those were fifty years ago. It’s unknown territory for me.

I’m pleased to report that the other day was the best dental experience I’ve ever had including ordinary cleanings. I told the dentist so and he was visibly pleased.

{ 20 comments… read them below or add one }

James Joyner November 28, 2012 at 11:25 am

I had to get a cap four or five years ago for the same reason: an old filling had damaged the tooth and extracting the filling finished the job. I can’t say that the replacement process was pleasant, even though I’m sure the dentist is quite competent. Indeed, dentistry seems to me to be decades behind the rest of the medical profession, still using rather medieval seeming techniques for even basic processes such as cleaning.

Janis Gore November 28, 2012 at 11:32 am

My dentist is terrific. The crown he did for my left molar was nearly painless. Except for the $785.

michael reynolds November 28, 2012 at 1:04 pm

I have a mouth full of expensive dentistry, something like six crowns I think, plus some stuff related to hitting the pavement with my face at one point. (No, not drunk: ice.)

1) Dentists are businessmen and some will absolutely lie to sell unneeded procedures. Dentist A wanted me for about 10 grand. Dentist B diagnosed less than half that. Guess who I picked?

2) Go to specialists. The difference between root canal with a good endodontist and root canal with a lousy dentist can be the difference between “unpleasant” and “Abu Ghraib.”

Dave Schuler November 28, 2012 at 1:58 pm

Go to specialists

That’s one of the reasons I went where I did. It’s a group practice that includes an endodontist, a prosthodontist, an orthodontist, and a periodontist. Some of them I like personally, some not, but I’m confident, based on interviews with patients and staff, that they’re all highly competent. I also receive a staff discount which is nice.

Janis Gore November 28, 2012 at 2:01 pm

I like all the people in my dentist’s office. Now, the periodontist I once knew can go to hell, but he did take me to China.

Janis Gore November 28, 2012 at 2:58 pm
Jimbino November 28, 2012 at 3:52 pm

Thank Darwin for places like Mexico, Brazil and Hungary, where you don’t have to put up with the monopoly pricing of Amerikan dentists!

Andy November 28, 2012 at 4:46 pm

Last year two of my silver fillings came loose and caused a corner of one tooth to crack. I got those, along with all my other silver fillings, replaced with the newer epoxy ones.

Kids dentistry has really come along way from when I was a kid. My kids were cursed with the deep grooves in the top of their teeth that I had – groves that are just about impossible to clean. For me I ended up with cavities in most of my molars. By contrast, my kids got a sealer in the crevices and they are doing pretty well.

Dave Schuler November 28, 2012 at 4:56 pm

I have, perhaps, a half dozen fillings all told. Fewer now that they’ve drilled that one tooth out. And down. Most of them are more than 50 years old. I guess that’s a testament to the technology.

Janis Gore November 28, 2012 at 5:14 pm

Nah, Dave. That’s a testament to hygiene. At 55 I had four, all found when I was 22.

Since then, none. Bu the old molar cracked around that semi-solid lemondrop.

Mama told you that candy would rot your teeth.

PD Shaw November 28, 2012 at 6:15 pm

Andy, your second paragraph precisely describes my experience. Offhand I can see ten fillings. It seems quite possible that my kids, thanks to dental sealants (and perhaps better dental genes from their mom), will have none.

PD Shaw November 28, 2012 at 6:23 pm

Its too bad Obamacare doesn’t apply to denistry, otherwise its wealthy supporters like Michael Reynolds would be joining Jimbino in the back alleys of Budapest to get their bridge work.

Janis Gore November 28, 2012 at 11:19 pm

I still want to know what the f**k’s wrong with Sunoco and Linebarger.

Janis Gore November 28, 2012 at 11:22 pm

Sunoco, Linebarger, Sis BOOM, BAH!

Jimbino November 29, 2012 at 10:30 am

PD Shaw,

Your “back alleys of Budapest” has to be a joke. You will get far better care for your money in Thailand, India, Hungary, Mexico and Brazil. You must be the kind of person who thinks something’s better because it costs 10 times as much.

PD Shaw November 29, 2012 at 11:16 am

I’m not being entirely serious (or unserious). My thinking is that Reynolds is likely paying more for procedures because he can’t differentiate a good dentist from a lousy dentist, so he’s paying for some extra credentialing that is not needed for the work. There might even be a placebo effect from paying more. I suspect this is due to Reynold’s mobility, which makes it difficult to accumulate local referrals.

Using specialists for non-specialist work is one of the most frequent complaints about the cost of U.S. healthcare. There are expensive state insurance mandates that require access, and almost all other OECD countries reduce access to specialist as a means of curbing healthcare costs. There is irony in people longing for sophisticated European policies while personally advocating actions those policies are against.

As to your foreign medical tourism; travel is expensive and recourse for extra-jurisdictional medical mistakes is hard. Sounds penny-wise, pound foolish to me.

michael reynolds November 29, 2012 at 12:11 pm


Correct as to the disadvantages of mobility. Incorrect on credentialing as I tend to live in affluent areas where all the professionals are well-credentialed. I’ve been here 16 months and I’m on my second dentist and my kids on their second orthodontist. Experience and skepticism do wonders.

PD Shaw November 29, 2012 at 1:50 pm

I think periodontists are good sources for referrals for dentists, they get to see a lot of different dental work product and interact with dentists on a regular basis. That may not protect you from referrals to buddies or someone giving kickbacks. Lawyers at least can be liable for “referral malpractice.”

For my part, I have dental insurance; I can see that my dentists is charging about 30% more than my insurer believes is standard in the community. I’m fine with that (and would have guessed as much), so I’m not the most price-oriented consumer either.

Jimbino November 29, 2012 at 6:14 pm

PD Shaw says,

“As to your foreign medical tourism; travel is expensive and recourse for extra-jurisdictional medical mistakes is hard. Sounds penny-wise, pound foolish to me.”

For us Texans, travel to Mexico is not expensive at all; your second point holds for eating, drinking or buying a bus, train or airline ticket in a foreign country. Recourse for fraud or food poisoning is hard. Enough to make a reasonable person stay home, watch TV and enjoy Obamacare.

Janis Gore November 29, 2012 at 6:47 pm

The dentist I use is a handsome, charming young man who is a good friend of the family. He grew up with my dear departed’s children.

His office is about six blocks from my home.

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