Art and science

ART AND SCIENCE

 

From my childhood until I qualified as a dentist in 1982, aged 30, I drew and painted a great deal. Creating pictures was one of my favourite pastimes. In the late 1970s when I was already studying to become a dentist, I joined a weekly print-making class. It was held in the West Hampstead studio of my mother’s cousin, the etcher/engraver Dolf Rieser (1898-1983; see: https://dolfrieser.com/biography/ ). 

The image above is from an etching that I created in Dolf’s studio. It is a composition inspired by electron micography of intra-cellular structures. At the time I created it, I had just finished a PhD in a biological subject and was studying biology that was considered necessary to qualify as a dentist.  Interestingly, Dolf had also studied biology (genetics) in his youth, receiving a doctorate in the subject. He took to artistic pursuits after completing his studies in biology. Later in his life he wrote a book called “Art and Science” (published in 1972 by Studio Vista). Dolf was an inspiring teacher with a great understanding of compositional technique.

In 1982, I began practising as a dentist. It goes without saying that a dentist’s work involves a great deal of use of the hands and fingers. All day long, five days a week, I was doing the fiddly kind of things with my hands and fingers. Prior to qualification as a dentist, I had used my hands and fingers to create often complex images (drawings, paintings, etchings, and copper engravings). I found that my urge to create images diminished rapidly after I began practising dentistry. I suppose that the clinical activities satisfied my need to employ my manual dexterity in other ways. Sadly, now that I am retired I have not (yet) gone back to creating images. Now my fingers are kept busy at the keyboard, creating books and blog articles.

This won’t hurt a bit!

human fist

 

One of my dental colleagues, a very confident fellow and a competent operator, told me this true story many years ago.

One day, he had a nervous male patient, a well-built strong looking man. However, the patient was extremely anxious, as many dental patients often are. The patient needed to have root canal treatment and was convinced that he would experience much pain during the procedure. 

As my colleague prepared his local anaesthetic syringe, he said, trying to be reassuring:

“Don’t worry, sir, after I have given you this injection, the procedure won’t hurt a bit!”

The patient turned to my colleague brandishing his tightly clenched fist, and said:

“You’d better be right because this will certainly hurt you!”

 

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Stung on the tongue: a careless diagnosis

Big bee_640

I cannot remember the name of the person who taught us dental pathology back in 1981 at University College Hospital Dental School, but one thing he told us made a deep impression on me.  He said that it was unlikely that we would see oral cancers frequently in general dental practice, but when we did see one we would feel a certain ‘jizz’ (our teacher’s word), a feeling that we were looking at something unusual and worrying.

One day when I was in practice, a delightful late middle-aged woman visited my surgery as a new patient. She said there was something on her tongue that had been bothering her for several weeks and was making eating and speech difficult. She had been to her doctor (medical), who told her that she had had a bee sting on her tongue. She told me that she had been taking antibiotics prescribed for it for  quite a time and the condition was only getting worse.

I had never encountered anyone with a bee sting on their tongue. The lady’s story and her doctor’s diagnosis sounded strange. She showed me her tongue. As soon as I saw the huge ulcer on the side of it and its peculiar border, I felt that ‘jizz’, which our pathology teacher had mentioned. I knew that the poor lady had, almost without a doubt, a carcinoma on her tongue. I told her my suspicions, and she looked relieved, and was grateful. Clearly, she had not believed her doctor’s story. I phoned the local oral surgery department, and they admitted her promptly.

About a year later, the lady reappeared. During the surgical treatment of her cancer, she had lost several teeth and wanted a denture to replace them. Sadly, her mouth was by now so distorted that making a prosthesis was beyond my competence. I referred her to a prosthetic specialist. Unfortunately, she did not live long enough for his work to be completed.

Whether earlier intervention would have saved her life, or at least prolonged it, is a question than cannot be answered. 

In my 35 years in dental practice, I only ever saw two patients with obvious oral cancers. However, I did refer many patients to have unusual looking lesions seen by oral surgical specialists. None of these gave me that ‘jizz’ nor turned out to be cancerous.

Your smile in my hands

People are naturally quite exacting about the appearance of their front teeth. Apart from self-esteem, people judge others by the state of the teeth in their smiles and while speaking. As a dentist, I was often challenged by my patients’ desires to have a smile which looked good.

man person face portrait

On one occasion, a young girl in her teens came to me with a loose denture, which she wore to replace a missing upper incisor. I suggested to her that she could get rid of the cumbersome dental prosthesis if I replaced her missing tooth with a barely invasive adhesive bridge attached to a tooth neighbouring the gap. She agreed, and the bridge was prepared. I fitted the new replacement tooth, which looked very realistic to me. Repeatedly, I asked the young girl whether she wanted have a look in a mirror to see the new tooth in place . Repeatedly, she refused, saying:

I’ll look at it when I get home.”

I never heard from her again. So, I can only assume that either she loved the bridge or she was so disappointed that she visited another dentist. I have come across this behaviour several times since then especially with patients who have been supplied with a denture bearing a complete set of teeth. However, most patients prefer to see what they are getting.

Many years later, I prepared two crowns (‘caps’) to restore a lady’s two upper central incisors, the most noticeable teeth in most people’s smiles. When the crowns arrived back from the laboratory, I removed the temporary crowns that had been protecting the prepared teeth. Then, without using cement (‘dental adhesive’) I placed the new crowns on the patient’s teeth so that she could say whether or not she approved of their shape and appearance. I noticed that the pocelain on the crowns had a pale greenish tinge. I looked up at my dental nurse. From her expression, I realised that she had also noticed the less than desirable dicolouration. I was fully prepared to sent the crowns back to the laboratory to have their colour improved when the patient exclaimed:

Oooh! These are lovely. They’re so beautiful. Oh, thank you, doctor!

Hearing this, and seeing the smile on her face, I felt that it would be foolish to have the crowns remade. So, I cemented them. She was a regular patient and never made any adverse comments about these crowns on subsequent visits to my surgery.

This only goes to show that there is no accounting for taste.

 

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No need to worry

 

 

adult ambulance care clinic

 

While I was studying to become a dentist, I took advantage of an optional fortnight shadowing anaesthetists. It was not a hands-on experience, but it was totally fascinating watching anaesthetists keeping patients healthy whilst they were deeply anaesthetised.

One day during a morning coffee break, I was sitting having refreshments with a senior anaesthetist and his team. Suddenly, I heard a shrill prolonged sound coming from a nearby room. I asked a technician what it was. He told me not to worry about it.

A few moments later, the senior anaesthetist asked me:

“What is that high pitched noise?”

“Oh, it’s nothing to worry about, ” I answered confidently.

“Really?” I was asked.

“Oh, yes. there’s absolutely no need to be concerned,” I advised the senior anaesthetist.

If it had been fashionable at that time, I might have told him to ‘chill’, but in those days chilling was reserved for cold weather and refrigeration.

“Hmmmm,” he replied.

After a few moments, he said to me:

“Well, actually that signal is the warning sound made by an oxygen cyinder that is about to become empty. I would really worry about it, young man.”

At that moment, I felt like a complete idiot and hoped that the ground would open up and swallow me.

 

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Fears of the dentist

Faces

Most people are very apprehensive about making a visit to the dentist. But, how many dentists are filled with apprehension at the prospect of seeing patients? Almost every day during my 35 years of practising dentistry, I walked into my surgery with a feeling of worry, concern about what might happen during the day.

The average non-dental person might not realise that treating patients is like walking on thin ice. With many patients in the UK just itching to sue the dentists, whom they fear, even the slightest thing might lead to a legal confrontation between the patient and the dentist. Clearly when a patient suspects that the dentist has made a clinical error, pulled the wrong tooth for example or made a filling that keeps failing, recourse to compensation is sometimes reasonable. However, something far less ‘life-threatening’ like a verbal misunderstanding can lead a litigious person to attempt to obtain remedial compensation. So, to avoid trouble and also to ensure that a patient leaves satisfied, the prudent dentist must treat each patient with tact, delicately, and clinical excellence. All that seems quite reasonable.

However, there are patients, whom the dentist dreads. The very sight of their name on the day’s appointment list can ruin the dentist’s day from the moment he spots it. These people, many of whom I wish I had been courageous enough to dismiss, often exploit the dentist’s desire to provide them with excellence. They ask for the impossible, or for things they know that they cannot possibly afford, and they are never satisfied. Worse still, they keep coming back to the surgery for minor matters, which are often unresolvable because of their sad personalities. I may sound a bit harsh, but many of the persistent complainers that I saw were unemployed, receiving their treatment free of charge (because of state subsidies), and had little else to do apart from sit in dentists’ waiting rooms.

Then, there are the dental obsessives. These patients are often quite charming until they reach the subject of their teeth. Even what you and I might hardly notice becomes a major problem for them, even a life crisis. They will keep asking the dentist to redo some small repair on a tooth because they, and only they, can perceive that there is some minute imperfection. And because of fear of complaints and litigation, I used to plough on with these people and long for retirement. Sometimes, I felt like telling them that in the grand scheme of life, a minor ‘defect’ in the teeth is nothing compared with having a major illness, or starving during a famine, or being injured in a traffic accident, but I ‘bit my tongue’.

Despite my continual anxiety about keeping the patients on my side, there was the odd occasion when a patient was genuinely grateful for something I had done. Those expressions of gratitude were worth more to me than whatever fee my treatment had attracted.

So, next time you have to visit the dentist and are filled with fear, spare a thought for the dentist, who might well be feeling the same as you, but cannot show it because it would wreck your confidence in him or her.

 

It has its uses

Psychedelic headscarf_240

 

In the UK, unlike some countries in Europe, we have a fairly liberal attitude towards Moslem women covering their heads and faces to a greater or lesser extent. In the last dental practice where I worked until I retired, our patients came from all over the world. A not insignicant number of our female patients were Moslems who wore some kind of head covering. A few of them insisted on being treated by female dentists, but most of them did not mind seeing one of the male dentists.

One of my female Moslem patients came to the UK from a north African country. She always wore a loose-fitting headscarf, but did not cover up her face. One day, she needed to have a front (incisor) tooth removed. I explained to her that the situation was such that she would have be without any replacement for it for 24 hours – I cannot remember why. 

Will you be able to cope without that tooth for a day. The gap will show every time you speak or smile,” I said.

Picking up the end of the scarf she was wearing, she covered her mouth with it, and then said humorously:

This has its uses!

And with that comment, she allowed me to remove the troublesome tooth, and then left the surgery with her face covered. She looked like a typical Moslem woman wearing a face-covering. Nobody would have guessed that she was missing a front tooth.

Keeping fit

Evening jogger_240

 

While I was engaged to my wife, she suggested that I join her at her health club and try some of its facilities.

The first time I went, I decided to go swimming. After swimming two lengths very slowly, I managed to climb out of the pool, exhausted and breathless.

For the next visit, my wife-to-be suggested that I try a session in the sauna. She thought it would do me good and would  not be particularly exhausting. I removed most of my clothes and sat alone in the poorly-lit sauna room. After a few minutes I began feeling cold, and started shivering. Fed up with this miserable experience, I left the sauna, and got dressed. The sauna had not been switched on!

Undismayed by this, I decided to give the sauna another try a week later.  This time it was switched on, and steaming hot. Because my first visit had been so boring, I decided to take a magazine into the sauna to read to pass the time. I took my place on a bench alongside some very muscular men and opened my copy of a glossy BBC clasical music magazine. Within minutes, the glue holding my magazine together melted. Numerous pages covered with fascinating information about classical music floated gently downward on to the floor of the sauna, Sheepishly, I recovered some of them, and then hurried out of the sauna.

“Why not try the exercise cycles next time? ” my wife asked. “Good idea,” I replied reluctantly. So, a week later, I sat in the saddle of an exercise bike. My wife was seated on a neighbouring cycle pedalling away while reading a book resting on the handle bars. The third cycle in the room was being pedalled furiously by a man lstening to his Sony Walkman through a pair of headphones. Meanwhile, I was just trying to move my cycle’s pedal … completely unsucessfully. After a few minutes, I abandoned the cycle, and after that I have never bothered with health clubs again. 

“That’s a pity,” you might think.

But, maybe not, as I will explain.

When I was practising as a dentist, quite a few patients, often young men, used to limp when they walked into my surgery. Almost everyone of them had injured knees or tendons whilst playing football or running, or trying to keep ‘fit’. When I saw them, I thought how lucky I was that I did not become addicted to ‘keeping fit’.

What? No kitchen…

During my early years in dental practice, I came across two instances of people living in houses without  kitchens.

 

antique burn burning close up

 

The first instance concerned one of my fellow dentists. He bought a house from a lady, who only used a microwave oven. Her home had no kitchen. My colleague had to convert one of the rooms in his new home into a kitchen. 

The second example was also connected with dental practice. It was the home of one of my dental nurses, whom we shall call ‘S’. She was a delightful young lady, who worshipped the late Marilyn Monroe. Sadly, her eyesight was not quite adequate enough for working in a dental surgery. She and the senior dental surgeon in the practice decided that she should seek another type of employment, which she did.  On her last day of working with me in my surgery, I gave S a small bottle of Chanel No 5 perfume as a ‘thank you present’. S was thrilled. I could not have chosen a better present. S told me that Chanel No 5 was all that her heoine Marilyn Monroe wore in bed. Well, I had no idea about the filmstar’s habits, but I was pleased that inadvertantly I had chosen the right gift for my visually-challenged dental assistant.

If you are now thinking that I have strayed from my subject, you are wrong. While S was working in our practice, she revealed that her mother hated cooking, so much so that there was neither kitchen nor dining room in the house where S lived with her family. S told me that the family ate every meal, including breakfast, at restaurants and cafés near their home.

Maybe I am too conventional, but I was surprised to learn that people who are able to afford accomodation with a kichen or kitchenette choose not to have one. In complete contrast, my wife told me that some of her ancestors lived in homes (in India) with two widely separated kitchens: one for meat and one for vegetarian food.

 

 

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The whole tooth

I often wonder why dentists all over the world advertise their practices with a whole tooth, crown and roots.

Most people, apart from some with knowledge of anatomy, are aware of teeth being more than what can be seen in the mouth: the crowns of the teeth, which are covered with off-white enamel. Unless they have a tooth extracted, the majority of people never see the roots which help to keep the teeth on the mouth.

A more appropriate symbol for alerting people’s attention to a dental practice is a row of tooth crowns arranged as a smile.

Although the whole tooth might be the truth, a row of teeth as seen in the mouth should make more sense to someone seeking a dentist.

Photos taken in Hyderabad, India