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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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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Burger buns in Baldock: two for one

Shop

 

If, say, your dentist were to offer to take out two of your teeth for the price of one, and you  needed to have only one tooth extracted, would you be excited by this special offer? I bet you would not.

Supermarkets are always making offers such as buy one, get one free. Once, we needed four burger buns. We entered a branch of Tesco’s in Baldock (Hertfordshire, UK) and found that burger buns were sold in packets containing twelve buns. Reluctantly, as there were no smaller packs, we took one pack of twelve. As we were heading towards the check-out desks, a lady who worked for Tesco’s chased after us. She was carrying another pack of a dozen burger buns. She said:

You didn’t take these.”

We only want one pack,” I told her.

But you must take a second pack. There’s a special offer. Two for the price of one.”

I told her that we really did not need 24 burger buns; we only wanted four. As it was obvious that she was not going to take ‘no’ for an answer, we took the second pack of buns without any idea of what we were going to do with them. As far as I could see, we had simply helped Tesco empty their shelves of a perishable product, which if not sold would have had to be thrown away.

Another supermarket chain, tries to encourage purchases by offering the customer a free cup of coffee after paying for the goods. And if you have bought enough, a free newspaper is also on offer. These are nice gestures, but do they compensate for the higher than average prices of many of the goods on offer in their stores?

Parking in shopping centres can be costly. Some supermarkets have large car parks associated with them. They are often close to other shopping outlets, and charge a fee for parking. However, car owners who make a purchase in the supermarket are given a voucher that allows them to avoid paying for the parking.

Special offers are, of course, designed to attract sales. And, we as customers are often happy to take advantage of them. However, I still refuse to believe that many would go for a two for one offer on tooth extractions. But … maybe … I could tempt you to accept three extractions for the price of one!

 

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.

A precocious child

Sometimes it pays to keep your mouth shut at the dental surgery.

In the 1950s and early ’60s, our family dentist was a kindly German Jewish refugee called Dr Samuels. In those days, I learned later while I was studying dentistry, sugar used to be an ingredient of toothpaste made for use by children. I doubt that my mother provided us with children’s toothpaste, which she would have regarded as being gimmicky.

Dr Samuels had a very upmarket practice in London’s St John’s Wood. His waiting room floor was covered with thick pile oriental carpets and the reading matter was glossy journals such as Country Life.

The surgery, where Dr Samuels performed his dentistry, was old-fashioned. Instruments were kept on display in glass fronted metal cabinets. His x-ray machine looked antiquated even to my young, inexperienced eyes. So, did most of his other equipment, much of it made by the German Siemens company. One of my uncles, also a patient of Dr Samuels, once asked him if a museum might be interested in displaying this historic looking dental equipment. Samuels answer was that it was not quite old enough for a museum.

Dr Samuels drilled teeth with a cord driven dental handpiece. He told us that he had an air driven high speed dental drill, but he did not like it because it cut too fast in his opinion. So, having fillings in his surgery was quite a noisy and bumpy experience.

Dr Samuels was a gentle, kindly man, like a benevolent grandfather. He never frightened me.

At the end of an appointment, he used to reward me with a boiled sweet. I looked forward to receiving these. However, one day when I was about 8 or 9 years old and he offered me the sweet, I said to Dr Samuels: “No thank you. Sweets are filled with sugar and bad for my teeth.”

The price I paid for my precociousness was that he never again offered me a sweet at the end of my appointments with him. I should have kept my mouth shut and graciously accepted his kind but unhealthy gift.

A bit too far

Drill a bit,  not too far.

In the tooth is a nerve:

do not disturb it

 

DRILL 1

 

It would not have been fair to my patients if I had written what follows before I had retired from practising dentistry. If I had been one of my patients, I might have lost confidence in my dentist after reading this.

Before dental students are allowed to drill teeth on living patients, much training is required. A great deal of this is done using plastic teeth mounted in the jaws of the heads of a mannequin, known as a ‘phantom head’. The plastic teeth are held in the artificial jaws with metal screws. The screws fit into holes on the undersides of the teeth so that the crowns of the teeth appear intact. As a dental student, I spent many hours each week practicing cutting standardised cavities. The cavities had to be cut to very precise dimensions, which were neither to be exceeded nor the opposite. I recall that certain parts of the plastic teeth had to be cut to exactly two millimetres deep and much the same width. At first, I found this extremely difficult. Not only was I not yet used to using dental drills, but also the plastic cuts in an awkward way.

Eventually, the time arrived for a practical test. Unsupervised, we were required to cut one of the several cavities that we had been learning to prepare. Disaster struck. Within a few seconds of starting my tooth, I had cut too deep. The metal of the screw retaining the plastic tooth in the phantom head was staring me in the face. I called over the examiners. They studied the tooth carefully, and then one of them said to me:

“I think you have exposed the nerve, Mr Yamey.”

“We might be looking at a root treatment, here, don’t you think?” asked the other examiner.

I could not believe what I was hearing.

“I think we’re looking at a failure here,” I replied.

They agreed.

I spent another few weeks in the phantom head room, and retook the exam, which I passed with flying colours, you will be relieved to learn. Now, I was deemed ready to treat dental cavities on real teeth in real patients – under supervision, of course.

The first tooth that I had to work on had only a little decay. Nevertheless, after the intense training, which emphasised cutting teeth should be done as conservatively as possible, cutting only as little of healthy tooth tissue as was strictly necessary to retain the restoration (‘filling’), I approached my first ‘real’ tooth with much trepidation. After boring down to the two-millimetre depth that was ingrained in my mind, I could see nothing but healthy tooth – no sign of decay. I summoned the clinical teacher (the ‘demonstrator’). He looked at the tiny hole I had created with great care and laughed.

“You have not yet cut through the enamel. Keep going,” he said.

The enamel, for those who are uncertain about dental anatomy, is the outer covering of the part of the tooth that is visible in the mouth. Beneath it, is the dentine, and below that the dental pulp chamber, which contains nerves and blood vessels. Decay spreads much more rapidly through dentine than through enamel.

I looked at the demonstrator, and said:

“But in the phantom head room we were told never to go deeper than two millimetres.”

“Those were just plastic teeth,” the demonstrator replied, “forget all that.”

 

[Picture from “Der Zahnarzt in der Karikatur” by E Henrich]

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)

If he were a dog…

dog

‘D’ had terrible teeth. Not only were they broken, but they were also worn down in such a way that they looked like an aged rodent’s teeth.

He had worked for many years in a place where there were high levels of atomic radiation. Naturally, he was concerned about how much radiation he had been exposed to over the years.  On one of his many visits, he asked me somewhat irritably: “How many more x-ray pictures do you need to take?”

I replied: “I have enough pictures to take out your bad teeth, but not enough to save them.”

D seemed reasonably satisfied with my answer. At least, he never raised the subject again.

Some weeks later, D’s wife, who was also one of my patients, asked me why her husband had to make such an enormous number of visits to my surgery. I explained that the repair work was extensive and complicated, each tooth requiring several appointments. She replied quickly:

“If he were a dog with so many problems, I’d have had him put down ages ago.”