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.

Head to toes

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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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Stung on the tongue: a careless diagnosis

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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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It has its uses

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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.

Breathless in Manhattan

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When I was a child, I was told that a good way to stop hiccups was by holding one’s breath. Being of a nervous disposition as a child, I worried that dire consequences might follow if one forgot to stop holding one’s breath. My parents assured me that this was impossible; the body did not allow someone to do this.

A few months before President Kennedy was shot in the USA in 1963, we were staying in a borrowed flat (appartment) in Manhattan, New York City.  I was playing a game with my young sister. It caused us great hilarity and much laughter. This led to me plagued by an attack of hiccups. So, as I had been taught, I held my breath. I was standing up.

The next thing I knew was that I was lying on the floor. My mother had taken very little notice at first because she thought my fall was part of our game. Actually, it was not. Contrary to what I had been told, I had held my breath long enough to black out! Very fortunately, when I fell I narrowly missed hitting my face on the shart corner of a metal table.

Does my tale have a message? Well, I suppose it does. Holding your breath can bring hiccups to an end sometimes. If you try this method, make sure that you are sitting down!

 

By the way, a hiccup (noun) is what you do when you are hiccoughing (verb).

Keeping fit

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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’.

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