Hard sell

clean mouth teeth dentist

 

An engraving of the Tower of Babel by Dolf Rieser (see: More about Dolf Rieser) used to hang overlooking the first landing of the staircase in our family home in north-west London.

In my thirties I worked as a dentist and lived in north Kent. Almost every weekend, I used to drive to visit my widowed father in our family home. On one of these visits I noticed a box lying on the landing beneath the Tower of Babel engraving. It was an unopened, sealed box containing a dental water pik. This is a device that can be used to pulse tiny jets of water between neighbouring teeth in order to dislodge deposits of dental plaque (bacterial debris). It has proved to be a far less effective method of removing plague than dental floss, which itself is less eggective than the use of  tiny interdental brushes. I was a bit surprised that my father had bought a water pik as he is not a lover of gadgets.

For several weeks after I first noticed the unopened package, I kept returning to my family home and seeing the unopened package, which was gradually becoming covered with dust. Eventually, I asked my father about it.

He told me that each time he visited his dentist, ‘D’, he was asked to purchase one of these water piks. After a series of visits, he paid out almost £100 to buy one. I asked him why he had wasted his money on something he was not going to use. He said:

“D kept on pestering me to buy one. He was getting on my nerves, so to shut him up I bought one. I have no intention of using it.”

No doubt profit was not the only motive for D wanting my father to own a water pik, and he might have been surprised by my father’s reason for buying one, namely to put an end to his ‘hard sell’.

 

To see the Tower of Babel engraving, click: HERE

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Bad hair day

hair

When I began practising as a dentist, I worked in a small town in north Kent. My working week stated on Monday afternoons. So, Monday morning was available for me to do whatever I wanted. I used to have my regular haircuts on Monday mornings at a barber shop owned by Dave. He often cut my hair and always did a good job.

One Monday morning, I entered Dave’s establishment and as Dave was not around I had my hair trimmed by a young lady. She did a good job but handled my head roughly. She knocked my head around as if it were one of those balls that boxers use for training. I am exaggerating a bit, but there is no denying that having this lady cutting my hair was a stressful experience.

Some hours later, I rang Dave to tell him about my recent visit to his shop. I wanted him to know that if his assistant persisted in treating customers the way she did to me, he would lose business. Dave apologised, and then told me that his young lady had had a bd weekend, a row with her boyfriend. 

I suppose that Monday was what people call a ‘bad hair day’ for me.

 

Bad hair day: a bad day a day with many problems, annoyances, etc. (https://www.merriam-webster.com/dictionary/bad%20hair%20day)

A light bulb moment: sudden enlightenment

bulb

 

After I had completed my first (Bachelor’s) degree, I decided that I would like to apply to become a doctoral (PhD) student. In order to do this in the UK (and elsewhere) it is necessary to enlist a supervisor, an academic who guides you through the process of researching and writing a doctoral thesis.

I knew roughly in which field I wished to pursue my further studies. Someone in Cambridge was looking for a PhD student to work on something that sounded interesting to me. So, I visited the academic in Cambridge. First of all, I was not particularly keen on the man’s personality (albeit having only met him once) and also the project he was offering seemed far too difficult for me, way beyond my ability. 

After the Cambridge episode, I discovered that the Imperial Cancer research institute was offering amazingly generous scholarships for PhD stuents working in their laboratories. I applied, choosing two of the projects that seemed to be in harmony with my interests, and received an offer of interviews at the institute in Lincolns Inn Fields.

At the first interview, I was introduced to the eight or so members of the team i was applying to join. They sat around whilst the senior members of the team interviewed me. It did not take me long to feel uneasy about my future colleagues, and as the questioning continued I could not wait for it to end. Near the end of the session I was asked if I was interested in cancer. In an attempt to cut short the proceedings, I answered that I was uninterested in that subject. 

After an equally unpromising interview with another of the research groups that I had applied to join, I left the building and began walking across Lincolns Inn Fields, feeling relieved that the interviewing ordeal was over. It was then that an important tought entered my head.

A PhD takes about (or at least) three years to complete. During that time, I would have to work in a laboratory with the rest of a research team and in regular contact with my supervisor. I realised while walking in Lincolns Inn Fields that it would be important for me that I enjoyed the people with whom I would be working. A pleasant environment was more important for me than the precise nature of the research topic.

I returned to University College, having made the decision to ask Professor Robert Harkness, whom I liked and whose research interests attracted me, whether he would take me on as a PhD student. To my great delight, he accepted me. As one of his doctoral students, I spent a very happy three and a bit years working in his laboratory with his other researchers, all of whom were friendly and helpful.

Since that day in Lincolns Inn Fields and my ‘light bulb moment’, which happened there, I have attended other interviews (for positions in various dental practices). At each occasion, I have asked myself: would I feel happy working five days a week with the person(s) interviewing me? If I have not felt the right ‘vibes’ at the interview, I have always turned down the job however attractive it seemed. On only one occasion, I have been mistaken with that approach, which I was fortunate to have been able to take when looking for work.

Healing hand

hand

 

In the UK, dentists cannot refuse to treat patients who admit to having serious illnesses such as AIDS (HIV). Dentists are supposed to have taken precautions to protect their patients, their nursing staff, and themselves against the risks of spreading disease by cross-infection. However, human nature being as it is, some dentists fear catching diseaes from their patients despite adhering to the appropriate requisites to prevent cross-infection. Irrationally, they try to ‘palm off ‘ patients whose medical conditions they fear by referring them to dental hospitals and specialist clinics. This is unfair to the patients who are forced to wait for long periods to be seen at these referral places for ‘specialist’ treatment that they do not actually need. I was not one of these over cautious fear-filled dentists. I treated everyone whatever their medical status.

I have treated many patients who have been infected with AIDS and other worrying illnesses such as Hepatitis B and C. I followed cross-infection guidelines and treated them no differently than I did for other patients. 

Many, but by no means all, of my patients were grateful for whatever I had done to deal with thier dental problems. Some of them, but not all of them, used to shake my hand and the end of an appointment or of a course of treatment. I appreciated that. What I noticed over the years was that the patients most likely to shake my hand were those who had been diagnosed with AIDS. I had the feeling that they were really grateful that I was prepared to touch their mouths without making a fuss about, or showing any fear of about their undoubtedly serious medical condition. The AIDS patients seemed to appreciate that I did not treat them as pariahs.

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.

Head to toes

It's raining again_240

 

This patient of mine was a local school teacher. An educated person, you would imagine.

One rainy afternoon he sat on my dental chair. Then, I reclined it so that he was lying almost horizontal: his head and mouth at one end of the chair and his feet at least five and a half feet from his mouth. I administered the local anaesthetic, waited for anaesthesia to become established, and then repaired the teacher’s decayed molar tooth with a silver amalgam ‘filling’. When the procedure was over, the teacher left my surgery apparently quite content.

An hour or so later, the teacher returned to our practice and asked the receptionist to allow him to speak to me. He entered my surgery and pointed to a mark on one of his brown suede shoes.

“I believe that you must have dropped some of your chemicals on my shoe while you were treating me,” he said.

I looked at the mark and quickly realised that this fellow was hoping to be compensated, possibly for a sufficient to buy a new pair of shoes.

“Unlikely,” I replied, “while I was treating you, you were lying horizontally. Your mouth was a long way from your feet. If I had dropped something, it would not have fallen anywhere near your feet.”

“Mmmmh,” he replied.

“Furthermore,” I added, “it’s been raining heavily all afternoon. Maybe, you picked up that mark while walking along the wet streets.”

The teacher left, and I heard no more about the problem with his footwear. I was left thinking what an unintelligent man he was, and that somebody had qualified as being capable of teaching young people.

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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St John’s finger

finger

It might have been in the Bargello, or more likely in the Museo dell’Opera del Duomo, both in Florence (Italy), that there was (and probably still is) an exhibit that captured my imagination when I was a young child. Amongst a collection of holy relics housed in elaborately crafted silver and glass containers, there was one holy relic that looked a bit like the stub of a discoloured cigar. It was, so the museum label stated, a bone from the index finger of St John the Baptist. Whether it was or was not, this item fascinated me, and even haunted me.

Many years later when I was looking into the story of St Appolonia, the patron saint of dentists, I read that one of the miraculous properties of the body parts of dead saints is their ability to reproduce themselves – a feature that must have been useful for those who used to sell such things. I am glad that I had not known this when I used to stare fascinated at St John’s finger, which I then believed to be exactly what it claimed. That would have spoilt my amazement, which I always felt when I saw that piece of bone in its ornate container.

 

Photo from flickr

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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