Pull it out…

After qualifying at University College Hospital Dental School in early 1982, I practised dentistry for another thirty-five and a half years. I never owned my own practice but worked in those owned by other people. I worked in a total of five practices. With exception of one practice, where I worked for less than eight months, I enjoyed the conditions of the rest. None of my ‘bosses’ (i.e. the practice owners) appeared to mind how much or how little I earned for them and how much time I took off for travelling. I am grateful to them for their tolerant attitudes towards my laid-back approach to work.

My first boss, ‘J’, provided gave me a smooth introduction to the trials and tribulations of general dental practice. He was always ready to give me advice if I needed it, but gently encouraged me to take control of my decision making so that I became in charge of what I was doing.

During the first few months of being in practice, I often encountered difficulties when extracting teeth. Maybe, at that time I had insufficient experience to know when an extraction was likely to be too difficult for me to perform. Maybe, some teeth are just very hard to extract. This is the case.

If I got stuck midway through an extraction, I would ask my dental nurse to summon J. When J, who was very skilled at extracting teeth, arrived, he would work on the tooth up to a certain point. Then he would say to me that I should finish the job. He could have easily completed the extraction himself, but he wanted me to do it so that my patient would not lose confidence in me. I feel that this was extremely kind of him and will always be grateful for his sensitive approach. Later in the day, when there were no patients about, he used to take me aside and explain what he had done to loosen the tooth. Thus, I learned how to improve my technique.

As the years passed, my ability to perform extractions, even difficult ones, increased. Often, I would extract teeth that my colleagues would have referred to specialists. Although some of my other dental skills improved over the years, It is sad to relate that what I became best at was removing teeth rather than saving them!

PS: dentists never PULL out teeth; they use various techniques to widen the tooth socket and to split the collagen fibres that hold the tooth in the socket.

Picture source: “Der Zahnarzt in der Karikatur” by E Heinrich (1963)

Keep your hair on

Mr T was a regular attender at my dental surgery. Bald, he had a high pitched voice. For some years he made appointments on Saturday mornings because he commuted during the weekdays. He retired and then began coming to see me on weekdays.

One Thursday just before Mr T was due to enter my surgery, our receptionist rushed in and said : “Don’t be surprised when you see Mr T.”

A few moments later, a woman in fairly dowdy, quite unfashionable clothes walked in and sat in my dental chair. When this person with a good crop of hair greeted me, I recognised Mr T’s voice and his familiar face was framed by his unfamiliar hair. I looked at my dental nurse, and she looked back at me, astonished.

As I always did, I asked the patient whether he/she had any medical problems lately, or had to see the doctor lately. The transformed Mr T said “not at all.”

Puzzled, I performed the dental check up, and discovered that there was a tooth that required extracting. T consented to this and we arranged for him to return a week later. He/she left the room.

In those days, early in my career, whenever I performed a tooth removal I asked the nurse to support the patient’s head gently during the procedure.

As soon as T left the room, my nurse said to me: “Don’t expect me to support his head next week. What if his wig were to come off in my hand?”

A week later, dressed as before in dowdy women’s clothing and with a full head if hair, the previously bald and previously male-attired T turned up for his extraction.

Before commencing, T asked me in his high-pitched voice which was now in complete harmony with his female appearance: “Will this take long?”

I said: “Only a few minutes. Are you in a hurry?”

“Slightly,” T replied, “I am going shopping with my wife in a quarter of an hour.”

I suspect that throughout his working life, T had yearned to appear female, but only in retirement was he able to make his fantasy into reality. His wife must have been a very understanding woman.

Ouch! Pull it out!

dent 1

When I qualified as a dentist back in 1982, there was no vocational training period during which the newly qualified dental surgeon worked under the guidance of an experienced practitioner. Like others who graduated at that time, I was plunged into the ‘deep end’. I was fortunate that the owner of the first practice where I worked was understanding and helpful. He provided me with much valuable advice.

However, nothing can prepare you for the unexpected.

One day, a new patient sat in my dental chair. He spoke English with an eastern European accent. He may have been Ukranian. He said to me: “It is my philosophy that when I am having pain from a tooth, I remove it from my mouth.” Having just spent five and a half years training to save troublesome teeth, I asked him whether he was certain that he did not want an attempt to be made to save the tooth. He was adamant: he wanted the tooth out.

When he pointed at one of his upper incisors, a tooth that was visible when he spoke, I asked him again whether he would not prefer to save such a prominently visible tooth. Once again, he explained his philosophy.

With some reluctance, I administered the local anaesthetic to render the proposed extraction painless. While his jaw was going numb, I asked him once again whether he was sure that he wanted to lose the tooth. He did not change his mind.

It is usual to check for numbness the area around a tooth that is to be removed. This is done by prodding the area with a sharp-pointed probe. As I began to do this, the patient pushed my hand away sharply. Before I could ask him why he did this, he grabbed the offending tooth with his thumb and forefinger, twisted sharply, and cleanly extracted the whole incisor with its root intact. My assistant and I stared at the man, totally surprised.

He said: “All I needed was the injection. The rest I can do myself”. Needless to say, I did not offer him a discount.

 

dent 2

 

Pictures from “Der Zahnarzt in der Karikatur” by E Heinrich, publ. 1963