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.

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.

 

Photo by Pixabay on Pexels.com

 

 

 

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)]

Turn it off!

When I first qualified as a dentist and went into practice in 1982, nobody possessed mobile telephones (cell-phones). By the time I retired in 2017, practically all of my patients, even some of the children, carried and used these ‘phones. Believe it or not, my patients often tried using their ‘phones during my appointments.

phon

It was very annoying and ruinous for concentration when a patient stopped me in the midst of performing a delicate operation in his or her mouth in order to answer the ‘phone. Some patients even attempted speaking on their mobiles when their mouths were full of impression materials.

 

One day, I met my next patient at the reception desk. He had arrived punctually, but had his ‘phone up to his ear. He smiled at me, and then said:

“Give me a minute, I am in the middle of a telephone interview for a job.”

“Ok,” I replied, “come into my surgery when you are finished.”

Ten minutes of his half an hour appointment passed, then fifteen, and then twenty…

At the end of half an hour, I returned to the reception desk. My patient laid down his ‘phone, smiled, and said:

“I’m ready now. My interview is over.”

I replied:

“So is your dental appointment. You had better book another one another day.”

Even more annoying were those who insisted on asking me a question and then, instead of listening to my reply, began sending SMS messages. I recall one lady, who had very complex dental problems, which required much explanation of treatment options before I could proceed any further with helping her. Did she listen to me? Oh, no she did not. For half an hour, she sent a series of SMS messages whilst I spoke. At the end of her appointment, she asked me to repeat what I had been telling her because she had had to send a series of “very important” messages. After that experience, I put up a notice in my surgery, forbidding the use of mobile ‘phones. It was a successful move. Patients would reach for their ‘phones, and then my assistant or I would point at the notice. The patient would then apologise, and turn off the ‘phone.

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)

Switch it off, please

Over the airwaves,

messages of faith are heard,

evangelising

 

radio

 

‘Mark’, the owner of the first dental practice where I worked after qualifying, told me that it is important to have a good relationship with the dental nurse with whom you work. He pointed out that on working days, the dentist often spends more of his or her waking hours with the nurse than with his or her spouse. During the 35 years I practised as a dentist, I encountered very few dental nurses with whom I could not get on amicably. Let me tell you about ‘Maria’, who was kind, resourceful, and remarkable.

Maria fled to the UK after having had what sounded like a horrendous childhood and adolescence in a troubled part of the world. She worked with me for several years. Sometimes, when needed, she worked as a dental receptionist in our practice. When, as they often did, patients came storming up to the desk, impolitely demanding an appointment without even saying “please”, Maria would calmly reply: “Good morning, Mr X. How are you? And how is your family?” Her polite questioning in a soothing voice quickly ‘civilised’ the patient’s approach.

Once, I was running very late, and the patient I had kept waiting had only 15 minutes left out of the 60 minute appointment I had planned for him. I said to this patient: “I have run so late that I really don’t have enough time to do what we planned.” Before the patient could answer, Maria said to me: “Don’t be silly, Mr Yamey, you can do it in time. I know it.” And she was right. I could not have done a decent job so fast if Maria had not been my assistant. When it came to the time to prepare the dental impression (mould) for the crown (cap) I was preparing, she mixed the two elements – the firm base and the low-viscosity material that picks up fine detail – simultaneously. Ambidextrously, she mixed one constituent with one hand and the other with her other hand. We finished the job to my clinical satisfaction in a quarter of the time I usually needed. “See, you can do it,” she said, “I have faith in you.”

You might wonder why I did not speed up after that when working with Maria. During that curtailed appointment, fortunately everything went smoothly without hitches. I preferred longer appointments so that I would have sufficient time to deal with unexpected problems and to relax the often-anxious patients.

Maria was very practical. In the practice where we worked, equipment often broke down. When this happened, a repair man, ‘H’, would be called to do just enough to get the heavily-used, well-worn piece of equipment to work again. On one occasion, an essential piece of kit stopped working. I told Maria to ring H. She said: “He’s not needed.” I asked her why. “I watched what H did last time the drill broke down. Let me try.” Maria fiddled with the equipment for a few minutes, and successfully repaired it.

Maria was a devout Christian.  She kept a small volume of the New Testament in a drawer in the surgery. Some of the words in it were printed in red. I asked her why, and she explained that the words that Jesus spoke were printed in red. Every now and then, she used to say to me: “All you need to do, Mr Yamey, is to accept Jesus in your heart, and your soul will be saved.”  Out of politeness, not wishing to offend her by questioning her great faith, I would say: “I need more time to think about it.”

We had a radio playing continuously in the surgery. Maria had tuned it to a non-stop evangelical Christian station. Various people speaking with strong North American accents spent hours describing how they had discovered Jesus. Like quite a few of my patients at that practice, many of the speakers on the radio had been locked up in prison. During their long incarceration, the radio personalities had had time to contemplate life, and during this contemplation they had discovered Our Lord and taken Him into their hearts. I found this radio station quite fascinating and listened to it avidly in gaps between appointments. Maria seemed less interested in the broadcasts. She wandered in and out of the surgery when she was not needed to help with a patient’s treatment.

Mr ‘C’ was a regular attender. He had a barely discernible North American accent. On one occasion, just as I was about to begin treating his teeth, he raised a hand, and said: “There are two things I can’t stand. One is coming to the dentist. The other is having religion stuffed down my throat. Maria, please switch off the radio.”

Maria turned it off without argument – she never argued. From that moment onwards, Maria never ever tuned the radio to that evangelical station. She was not only a wonderful assistant, but also sensitive and thoughtful.

Ouch! Pull it out!

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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