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.

Good Friday

Years ago, I knew a dentist, who owned his own practice. His residence was in the same building. His patients could ring him any time of the day or night. If there was an urgent out-of-hours problem, he would usually open the surgery and try to help the unfortunate patient. Most of his patients were considerate and did not ring him at inconvenient times. However, once someone rung him at three in the morning. The caller said that his toothache was so bad that he was unable to sleep. My friend, an intelligent man, said to him:

“You come and see me at eight in the morning. That way only one of us will have a sleepless night.”

 

boy

 

Occasionally, I had to be ‘on call’ for out-of-hours and weekend emergencies. When I worked in Kent before the widespread use of mobile ‘phones had begun, I had to carry a small radio receiver in my pocket during the hours I was ‘on-call’. If the gadget bleeped, I had to ring the telephone number of some remote call-handling centre. The centre would then provide me with the telephone number of the person in trouble. Usually, the ‘emergency’ turned out to be someone wanting to make or cancel a dental appointment in the middle of the night or on a Sunday or bank holiday. There was little I could do about these abuses of the emergency system.

One Easter weekend, I was contacted by a mother, whose son’s front tooth had snapped off and he was in pain. I asked the caller to bring her son to see me in the surgery, which I opened specially for her son. The boy arrived. The situation was not good. The child had managed to snap off a lateral incisor, leaving the root below gum-level. The tooth was un-saveable and needed to be removed. To extract it, I knew that I would have to perform some minor surgery, lifting the gum and then replacing it (using sutures). It was a job that would have been difficult to perform alone without an assistant. Fortunately, I had the ‘phone number of one of the practice nurses, who lived nearby. Luckily, she was able to come to assist. The operation was done without problem.

When I had finished treating the child, the mother neither thanked my assistant nor me.  She was typical of many National Health Service (‘NHS’) patients, who do not appreciate what is done for them because it is done free of charge. Many of the services provided by the NHS are free, and because of this a proportion of patients show no gratefulness. They take the system for granted, feeling that what is done for them is their birth right.

It was Good Friday morning when this emergency treatment was carried out. The boy’s mother said:

“What a shame that this happened today of all days, Good Friday.”

Silently, I agreed with her. I said:

“Well it’s been a bad Good Friday for your child.”

After a few moments, I added:

“It was also not an awfully good day for Jesus Christ.”

The mother gave me a dirty look, and then took her child home.

 

[Picture source: “Der Zahnarzt in der Karikatur” by E Henrich (1963)]

Through the tongue

During my three and a half decades working as a dentist, I have been assisted by numerous ladies varying in age from sixteen to over seventy years. ‘Carly’ was one of them. When she joined me in a practice west of London, it was the first time she had worked in a dental practice. She was a quick learner, but far from discreet.

CARLY

When we had a new patient, we recorded the person’s details on the outside of a record card. One day, a smart-looking woman sat down in my dental chair, a new patient, and I asked her for her personal details: name, date of birth, address, and so on. Carly entered the information on the record card. When we had finished, Carly asked the patient:

“Are you M.R.S. or M.I.S.S?”

The lady replied:

“Miss.”

Quick as a flash, Carly said:

“I can’t see why you ain’t married. You ain’t ugly or anythink.”

The lady took this quite well. She could see that Carly meant no harm.

One Monday morning, Carly arrived and said to me:

“Ere, look at this”

She stuck out her tongue, which had a shiny silver-coloured metal stud pierced through it. I was lost for words for a moment, and then asked her if it was uncomfortable.

“No, it ain’t,” she replied, “It makes eating spaghetti difficult, though. It gets caught up on it.”

All morning, whenever a patient sat in my dental chair, she would tap the patient’s shoulder, and then say: “Wht d’ya think?” before sticking her tongue out to display her stud to the person in the chair. Most of the patients were either politely complimentary of just smiled. By now, my regular patients had got used to Carly and her friendly but cheeky manners.

Another day, Carly arrived at work. Very excitedly, she told me:

“You’ll never guess how much I paid for a large pack of prawns at Tesco’s.”

“Four pounds?” I guessed.

“No, just a quid.”

“That’s a good bargain,” I said.

“What me and me boyfriend do,” Carly explained, “is we swap the labels on the packets in the chiller so that we get the special offer prices instead.”

“Be careful,” I advised.

On yet another occasion, Carly arrived at work looking distressed. I asked her what was wrong.

“I crashed me boyfriend’s car.”

“But you haven’t got a license have you, Carly?”

“No, but I was drunk. I got in his car and drove it backwards into a lamppost.”

I am sure that the boyfriend was not pleased because throughout the day Carly was rung up by him on her mobile ‘phone. She would go out into the corridor, but because she was screaming at her chap so loudly, everyone could hear her.

During one appointment, I was beginning to scale (remove the dental tartar or calculus) a lady’s teeth. After a few minutes, while I changed instruments the lady, a well-dressed woman with airs and graces, asked me:

“Excuse me, Mr Yamey, but what exactly are you doing to my teeth?”

Before I could answer, Carly replied quickly:

“E’s cleaning the crap off yer teeth.”

The patient seemed quite happy with this simple summary.

Despite Carly’s occasional rather undignified comments, she was an excellent assistant. Patients appreciated her unpretentious, friendly, open approach and the fact that she was rarely silent. After a few months, when she had gained some experience, Carly left our practice to take up a better paid position in another dental practice. Some weeks after she had been working there, she dropped into our surgery to say ‘hallo’. I asked her how she was getting on in her new job. She replied:

“It’s ok, but they have told me not to open my mouth during the day.”

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

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)

I love you…

Teeth_500

In the second half of the 1990s, I worked in a dental practice in West London, not far from Ladbroke Grove. It was also not far from a home or shelter for mentally-compromised people. In those days,  patients with psychiatric problems mixed with the other people in the local community. Many of these people attended our practice as dental patients.

‘P’, one young man, a schizophrenic so he told me, was a regular patient of mine. Usually, treating him presented no problems other than those relating to the technical details of sorting out his dental problems.

One morning, P attended my surgery. He sat in the chair, which I then set to the reclining position. Lying down, he said to me, out of the blue and without any prompting:

“Mr Yamey, I have decided to become a homosexual.”

At a loss as to how to respond adequately, I said:

“That’s nice.”

Then in a strong voice, P exclaimed:

“Mr Yamey, I love you.”

“Thank you,” I responded lamely, adding: “Let’s get on with your treatment now”.

At that moment, my dental assistant, ‘Gemma’, walked into the surgery, ready to assist me with the treatment I was about to provide P. Within seconds, P began unzipping the fly on his trousers.

“Put that away immediately,” I ordered, “otherwise we will have to summon the Police.”

P followed my instruction and behaved perfectly normally throughout the rest of the treatment session.

When the appointment was over, P sat up from the reclining position, and placed a pile of low denomination coins on the armrest closest to me.

“That’s a tip for you, Mr Yamey.”

I thanked him, and then returned the coins, knowing that he could ill afford to waste money on me.

Gifts of the grateful

In the 1980s, I visited my friends in the former Yugoslavia frequently. Also, I visited Albania and what is now independent Kosovo. During my trips, I picked up a large vocabulary of Serbo-Croat, including quite a selection of outrageous swear words. Grammar has always been beyond me in foreign languages, and often in my own. My interest in Albania and my brief visits to Albanian-speaking parts of the Balkans resulted in me acquiring some vocabulary in Albanian, but far less than in Serbo-Croat. Until the 1990s, I believed that my fragmentary knowledge of these languages would be useless outside the Balkans.

gift 2

Prizren in Kosovo, pre-1990

During one trip to Belgrade, a friend arranged for me to be an observer in a clinic of a leading oral surgeon. I turned up at a large hospital and spent a couple of hours watching the surgeon reviewing a series of his patients. Although I was grateful to be allowed to watch the great man, I learned little that was relevant to practising dentistry. However, one aspect of this clinic interested me greatly. As each patient entered the consulting room, he or she presented the surgeon with a gift: a bottle, a large piece of cheese, a ham, etc.

The last patient to enter, a man in a somewhat shabby suit, entered and sat in the dental chair without having presented a gift. After his mouth had been examined, the surgeon took the patient and me out into a corridor. We walked through the hospital to a room with locked doors. My host unlocked it, we entered, and he locked the doors behind us. After a brief conversation, the patient handed the surgeon a small brown envelope, which he thrust into his jacket pocket. Then, after the doors were unlocked, the patient went one way, and we went another way. As we walked along the corridor, my host patted the pocket containing the envelope, and before bidding me farewell, said: “Pornographic photographs.”

gift 5 saraj

Poster of Marshal Tito in Sarajevo, Bosnia in the 1980s

My last visit to Yugoslavia was in May 1990.  Soon after that, wars broke out in the Balkans, and the former Yugoslavia disintegrated painfully to form smaller independent states. In the early to mid-1990s, there was terrible strife in Bosnia. Many people fled as refugees to places including the UK. In the late 1990s, Kosovo suffered badly from warfare between the Serbs and the ethnic Albanians. Many of the latter fled to the UK.

I moved from one dental practice outside London to another in London, an inner-city practice, in 2001. A significant number of my patients there had come from the former Yugoslavia as refugees. I was the only person in the practice who could greet them in Serbo-Croat or Albanian. Maybe, I was only one of a few dentists in London at that time who had this ability.

To the Albanian speakers my vocabulary was restricted to words such as ‘hello’ and ‘good-bye’, which brought smiles to their faces. Following a trip to Communist Albania in 1984, I recalled the Albanian words of political slogans such as “Long live Enver Hoxha”, “Enver’s party”, and “Long live the Peoples’ Party of Albania.” As many of my Albanian patients had come from Kosovo rather than Albania, these slogans meant little to most of them.

gift 3 travnik

Travnik, Bosnia, 1975

My limited Serbo-Croat was more extensive than my Albanian. I could entertain some of my Bosnian and Serbian patients with polite small-talk. Many of the ex-Yugoslav patients, like those I had seen long before in Belgrade, brought me gifts. Even those, with whom I felt I was not getting along with well, brought me, usually, bottles of home-made alcohol (e.g. rakia, slivovitz, and loza) that had been distilled by relatives who had stayed behind in the former Yugoslavia. These strong alcoholic drinks were delicious, smooth, and delicately flavoured. One fellow plied me with DVDs of the latest Hollywood and other films that he had ‘pirated’. One lovely lady from Bosnia presented me with a pair of earrings, which her uncle had made, to give to my wife. She wears these often, and she is very grateful.

gift 4

Many Middle-Eastern patients also felt that it was appropriate to bring me gifts. Thus, a lot of delicious baklava and other similar confections came my way. Delicious as these were, they were neither good for my teeth nor for my general health. A Hungarian family kept me supplied with large gifts of paprika powder, and there was a Romanian gentleman who brought me nice bottles of wine. Incidentally, the only words of Romanian I know are “thank you” and “railway timetable”. Once, we employed a Romanian dental nurse and I told her my Romanian party-piece “Mersul trenurilor.” She pondered for a moment and then replied “Ah, the programme of the trains.”

Once, my dental nurse, a friendly West Indian lady, and I were standing near a window facing the main road when a delivery van stopped nearby. A man was delivering trays of baklava to a nearby shop. I said to my nurse: “Why don’t you see if he’ll give us some to try?” She returned with a tray of baklava. Carelessly, because I was in a hurry to see my next patient, I put a large lump of baklava into my mouth, and then bit hard on it. As I was doing this, I heard a deafening bang in my head. The baklava was not too fresh. I had split a molar tooth into two parts, the smaller of which was loose in my gum.

gifts 1

Baklava

Unlike this disastrous piece of confectionary, the gifts kindly given to me by my patients did no harm. Furthermore, what I believed to be a useless tiny vocabulary of Balkan languages proved to be quite useful.  

Finally, you might still be wondering whether anybody ever took me aside to present me with an envelope containing pornographic photographs. To satisfy your curiosity, I can tell you that nobody did.

If the judge allows

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Photo by Pixabay on Pexels.com

I was a little intimidated by his appearance the first time he walked into my surgery. Tall, well-built, he clutched a half eaten sandwich in one hand and a bundle of papers in the other. When he had finished masticating the piece of sandwich in his mouth, he told me that the police had banned him from entering the area. Waving his collection of papers, he explained that his solicitor needed to get permission from the police when he needed to see a dentist at the practice.

P wanted a new set of dentures. Inwardly quaking, I took the primary impressions of his toothless gums, and then asked him to return a week later for the next stage of his treatment. By the end of the appointment, I felt that he was going to be a pleasant patient and that I need not fear him.

On the penultimate appointment, I tried the wax mock-up of his dentures to check that all was proceeding well. I let P look in the mirror. He was very pleased and wanted to take them away. I explained that the waxed version had to go back to the technician to be made into the final, usable plastic product. I told him that they would be ready in a week.

Looking crestfallen, P said :”really ? That might be awkward?”

I asked why.

“I am seeing the judge next week. If he puts me behind bars, I won’t be able to collect the teeth.”

I asked him if he could let me know if he was unable to return.

“Sure, doc,” he said, “I can phone you from prison.”

I said to him: “I see now. That’s what people mean by a ‘Cell phone'”

P gave me a huge toothless grin.

P did return for his teeth a week later, but I was not at work. I’d had to cancel my clinic to attend our daughter’s birth.

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.

Magnetic moments

MRI 1

By nature, I am most apprehensive about having to undergo any medical intervention. Even having my hair cut at the barber gets me worried, not because I am concerned about the final hairstyle but because I fret about what might go wrong. Recently, I had to undergo an MRI (Magnetic resonance imaging) scan for reasons that need not concern you, dear reader.

I first heard of magnetic resonance whilst studying biological chemistry as part of my physiology degree course at University College London. Nuclear magnetic resonance spectroscopy is used to investigate the physical and chemical properties of molecules and is of particular usefulness to organic chemists. On the other hand, medical MRI scanning allows a non-invasive investigation of body parts (including soft tissues) without any dangers such as harmful radiation.

Many people who have experienced MRI scanning have told me how fearful an ordeal it is. Their main concern is having to lie still for a long period of time in a noisy, featureless, confined space in a narrow tube barely large enough to hold a body. When I learnt that I was going to have undergo an MRI scan, I was filled with anxiety. For someone like me, who dreads even haircuts and eye-tests, you can imagine that I was not looking forward to having my scan.

I arrived at the scan and felt like the peanut which stood on the railway track, whose heart was all a flutter (when ‘around the track the engine came… toot toot peanut butter’). 

Putting a brave face on it, I entered the scanning room through a reinforced metal door that looked like the entrance to an atomic bunker. I lay on a narrow bed, which turned out to be extremely comfortable. Before being given a set of headphones to protect my ears from the noise that would be produced during the scan, I was asked what music I would like to hear. I asked what was on offer. The choice was between Motown and classical. I opted for the latter.

The bed with me on it slid slowly into the circular tunnel in the centre of the Siemens ‘Magneton’. I continued entering it until only the crown of my head was outside it. When I looked up, all I could see was the grey funnel like rim of the entrance to the machine.

There was a sound like a fog horn, and then the sound of monotonous soporific classical piano music, rather tinny in tone. No decent composer would have had the gall to own up composing this pathetic attempt at ‘classical music’. Nevertheless, it was mildly distracting, and its lack of variety helped me to relax.

Then, the fun began. For reasons that the nurse could not explain the MRI machine produces a series of extraordinary noises, which must have been very loud because I could hear them quite clearly despite wearing the ear-protecting headphones. The first of these noises resembled someone hammering loudly at a building site. This was followed by bursts of sound (each lasting several minutes) that included ‘kerchunk, kerchunk, kerchunk,…’; ‘boop, boop, boop…’; ‘whooo, whooo, whooo,…’, ‘tak,tak, tak…’; and so on. All the time, the monotonous piano music droned on, barely competing with the miscellany of bursts of weird mechanical sounds coming from the magnets in whose womb I was confined. At several stages, the machine seemed to become over excited, not only emitting noises but also causing the bed on which I was lying to vibrate.

Far from hating the whole experience as I was sure that I would, I found it mildly entertaining. The 40 odd minutes of my scan shot by. Let me explain. First, I was extremely comfortable. Having to lie still on a comfortable bed was very restful and relaxing. It was far more comfortable than sitting for 40 minutes in an aeroplane or in some theatres. Secondly, the noises conjured up various images in my mind. During the vibrations described above, I felt as if I was on a reclining chair in Business Class on a long-distance flight. The odd combination of the repetitive classical music accompanied by the series of ever-changing mechanical noises being emitted by the scanner resembled the music of minimalist composers, notably the compositions Steve Reich. At times, I felt as if I was listening to a bad pianist giving a concert in a busy construction site. Many years ago, I attended a concert of Spanish Flamenco dancing. The endless racket produced by the dancers stamping their shoes on a hard floor was far less bearable than what I heard during my MRI.

At the end of the day, I realised that the horror stories that I had heard about MRI scans should possibly be discounted. I have written this to allay the fears of those who might one day need to undergo one of these investigations.