Tag Archives: teeth

A benevolent dentist

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BEING A RETIRED dentist, I could not resist viewing a special exhibition held at the Museum of Freemasonry in Freemasons Hall in London’s Queen Street near Covent Garden. As a curious Londoner, visiting an exhibition in this imposing building had an additional attraction: a chance to see inside an edifice I have walked past many times, always wondering about it without ever entering it. I was alerted to the special exhibition by a message from a friend in Bombay, who keeps a close eye on current cultural events both in Bombay and London. She thought that this show would interest me because it is about the activities of a dentist, Bartolomeo (also known as ‘Bartholomew’) Ruspini (1728-1813).

Born near Bergamo in northern Italy, son of a minor member of the aristocracy, Ruspini was recognised as a surgeon by The College of Physical Sciences in Bergamo in 1758. He decided to specialise in dentistry and to further his skills, he travelled to Paris, which was then recognised for its training in this field. In those days, dentistry was not a recognised profession as it is nowadays. Most people who had dental problems, sought the assistance of hairdressers, blacksmiths, and others without any professional training. To distinguish himself from these untrained people, he called himself a ‘surgeon dentist’(https://en.wikipedia.org/wiki/Bartholomew_Ruspini). Today, the people, whom you might call ‘dentists’ are in fact ‘dental surgeons’.  I was qualified to practise dentistry, and one of my dental degrees was ‘Batchelor in Dental Surgery’.

Ruspini arrived in England by May 1752. He married his first wife, Elizabeth Stiles, in 1757, five years before he was accepted as a member of The Burning Bush Lodge of the Freemasons in Bristol. Later, Ruspini went on to establish several new Freemasons lodges (https://rmsghistoryextra.wordpress.com/tag/elizabeth-orde/).  By 1766, he was practising in London under the patronage of the mother of King George III. He had already treated royalty, so great was his reputation as a healer of dental problems.  His acceptance into high society was no doubt facilitated by his renunciation of Roman Catholicism and his second marriage, in 1767, by which time his first wife had died, to Elizabeth Orde. The couple were to produce nine children, five of whom survived infancy. Two of his sons became surgeon dentists.

In an England, which was then not particularly friendly to foreigners, Ruspini was accepted well because of his good nature, excellent clinical skills, and great ability to get on well with people and to ‘network’ in high society. He was highly regarded as a Freemason. His skills on the dance floor, delight in display, and flamboyant character made him a wonderful masonic master of ceremonies. In keeping with the ideals of Freemasonry, Ruspini exhibited much benevolence: hospitality, generosity, kindness, and charity. An example of the latter was his important involvement in the founding of the Royal Masonic School for Girls (in 1788).

Ruspini had his main residence at 32 Pall Mall in London, but also visited Bath frequently. He was famed for his patented styptic, a substance that stemmed haemorrhage. He also created a dentifrice as well as an elixir for easing toothache.

In 1768, Ruspini published the first edition of his “Treatise on Teeth”. I found a copy of its eighth edition whilst searching online. The book is well-written and easy to read and, in many places, not too out of date. It would do first-year dental students no harm to read this informative book, well at least as far as the sections on “The Disorders of the Teeth”.  This section has become somewhat dated, but not altogether so. For example, the author advises that disorders might arise from:

“… any particles of food that stick between the teeth and putrify … the excessive use of smoking and chewing tobacco … sugar, when used immoderately, is another enemy of the Teeth … All mineral exhalations are also very pernicious, as we see by daily experience in all those persons who work in any of the quicksilver, lead, or copper mines etc…”

Of the causes of caries (tooth decay), Ruspini gives several, but does not mention sugar in connection with this common problem, despite what he wrote in the quote above. However, he did consider that sugar was important in another disorder:

“Children who eat too much sugar, or sweetmeats, generally have their gums corroded; confectioners and chemists are subject to this disorder …”

Although much can be criticised as being out of date in his book, Ruspini did a wonderful job of describing concisely and clearly what was known about dental anatomy and pathology in his time. Part of the book is dedicated to clinical case studies. One of these concerned:

“…Captain Nelson, of the Royal Navy, whom I accidentally met at Portsmouth…”

Ruspini cured him of a painful fleshy growth in his mouth, which other surgeons had wrongly diagnosed as syphilitic.

The book ends with adverts promoting Ruspini’s styptic balsam, elixir, and dentifrice powder. A copy of this book and another about his styptic are on display at the special exhibition in the beautiful library at Freemasons Hall. Other exhibits included documents, drawings, cartoons, and a few other objects. For me the great thing about the exhibition was not its contents but introducing to me a truly remarkable member of my profession.

Members of the public visiting Freemasons Hall in Queen Street are encouraged to see the magnificent collection of items and documents relating to freemasonry before seeing the exhibition dedicated to Ruspini. The museum contains a rich variety of exhibits, many of them displaying the Freemasons’ passion for the use of symbols, and most of them objects of great beauty. Not knowing anything about Freemasonry, this first visit to the museum was for me more a dazzling visual experience than a learning opportunity. On a subsequent visit, I hope to spend much more time examining the artefacts and their informative labels.

The Freemasons Hall is a ‘larger-than-life’, exuberant work of architecture and construction. It is the headquarters of the United Grand Lodge of England as well as the Supreme Grand Chapter of Royal Masons of England. The present building was designed by the architects Henry Victor Ashley (1872-1945) and Francis Winton Newman (1878-1953). It was built between 1927 and 1933 to commemorate the 3,225 Freemasons who died whilst on active service in WW1. Some say that the building is art-deco in style. This is the case, but there are also many elements in the design suggestive of a modern version of neo-classicism.

I am grateful to my friend in Bombay for introducing me to Ruspini and by doing so, giving me a reason to visit the remarkable London headquarters of the Freemasons.

Extracting the truth

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EXTRACTING TEETH IS still a significant part of the job of a dentist.

When I qualified as a dentist in 1982, I joined the practice in Rainham (Kent) run by Julian U. He was a generally competent dentist and very skilful when it came to extracting teeth. If, as it happened from time to time, I was having difficulty removing a tooth, he would come into my surgery to apply his skill and experience to the problem at hand. Whenever he did this, he would work on the offending tooth, but would stop when he knew I would be able to complete the operation.

Julian could have easily finished the job himself, but he left it to me to do this for a good reason. He knew that if I removed the tooth, the patient would believe that it was my skill that contributed to the successful conclusion of the operation and therefore would not lose confidence in me.

Later in the day, after the patient had left, Julian would explain to me why I  had had difficulties and how to avoid repeating the problem. He was a great mentor as I began my career in dentistry.

The NHS used to pay a standard fee for an extraction. If an extraction proved to be particularly difficult, involving bone removal for example, the practitioner could write to the NHS explaining why the operation was not simple and enclosing a radiograph (xray image) of the tooth in question. In these cases, the NHS used to pay a larger fee than the standard one.

On one occasion when I had not taken a radiograph prior to an extraction because I  had assumed it would be simple, the operation proved to be very difficult. After completing it, I  applied for the supplementary fee but did not receive it because I  had not submitted a preoperative radiograph.  I was furious not only because I had not been adequately remunerated for my effort but also because my word had been doubted.

Some months later,  a distressed couple brought their infant to my surgery. The child had chewed on a keyring and it had got stuck between two teeth. Carefully, I cut through the ring and thereby removed it from the kid’s teeth.

Still smarting from my failure to convince the NHS that my extraction of a few months earlier was truly difficult, I  wrote up my keyring removal and applied for a fee for this unusual procedure.  I explained that neither had I taken a radiograph (because it was unnecessary) nor was I  able to send them any evidence, such as the remains of the keyring because the parents had wanted to keep them. I waited patiently for the NHS to reply, which they did. To my great surprise,  they believed my story without me sending any evidence and paid me a decent fee. Nowadays, it would be unwise to perform any extraction without having taken a preoperative radiograph. This is not for the purposes of seeking enhanced remuneration but to protect the practitioner should the patient decide to make a complaint against the dentist. Sad to say, but by the time I retired, preventive dentistry acquired a new meaning. In addition to preventing dental disease in patients, it has also come to mean preventing the dentist from litigation and defending him or her when malpractice is alleged.

The saint and her teeth

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SAINT APOLLONIA WAS born in the 2nd century AD. She was one of a group of virgin martyrs who was killed in 249 AD during an uprising against the Christians in the Egyptian city of Alexandria. Prior to being murdered, she was tortured by having her teeth pulled out and damaged. Since then she has been regarded as the patron saint of dentistry and those suffering from toothache and other dental problems.

St Apollonia by M Landy

When I was a dental student back in the early 1980s, I did some research with a view to writing an article about Apollonia for the dental school’s journal. While carrying out my investigations, I came across an article (I cannot remember where) which described a sacred relic, one of Saint Apollonia’s teeth, which is held in a church somewhere in northern France. I cannot recall where this tooth resides, but I have not forgotten something that was written about relics in general in that article. That is, according to the writer, one of the miraculous properties of sacred relics is that they can self-replicate.

Since working on that unfinished article, I have hardly given Saint Apollonia a moment’s consideration until today when we visited an exhibition based around the works of the German artist Lucas Cranach the Elder (1472-1553). This wonderful exhibition is being held at Compton Verney, a fine old house built 1714 in Warwickshire and set in gardens very capably designed by Lancelot ‘Capability’ Brown (c1716-1783), until the 3rd of January 2021.

One of the rooms of the exhibition is devoted to works of art inspired by Lucas Cranach the Elder. Two such works by Pablo Picasso are on display alongside various other fabulous modern artworks by slightly less well-known artists. One of these pieces is a mechanised sculpture by Michael Landy (born 1963). This was inspired by the depiction of St Apollonia in a painting by Cranach which is held in London’s National Gallery. In Cranach’s work, Apollonia, dressed in a long, pleated dress coloured red, stands beside St Genevieve (martyred in what is now France), dressed in green.

Landy has created a wooden sculpture, a three-dimensional version of what appears in Cranach’s painting. In the latter, Apollonia is depicted with her hands clasped together around the long handles of a pair of pliers whose beaks are wrapped around an extracted tooth. Landy’s three-dimensional version, which is about twelve feet high, looks remarkably similar to Cranach’s. A foot pedal is attached to the sculpture by a cable. When a viewer presses the pedal, Apollonia’s hands move the pliers towards her mouth and then fall back again. It appears as if she has just pulled out her tooth. I wonder what Cranach would have thought about this rather gory adaptation of his original image.

You have now been warned. If you are a dental phobic and happen to visit this marvellous exhibition, do not, I repeat, do not press that pedal beside Landy’s sculpture. Also, try not to miss visiting this superbly curated show.

What? No gloves!

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DENTISTS ARE FRONT-LINE workers, risking their lives for you. We put our fingers in people’s mouths and risk inhaling their expired breath and droplets of saliva and infected material. This has been the case ever since the start of human endeavours to resolve problems related to dental and oral pathology. I began hands-on dentistry in 1977 during the second year of my course in dental surgery undertaken at University College Hospital Dental School (‘UCHDS’). I qualified in early 1982 and worked in general practice until September 2017.

BLOG GLOVE Silvi_1024

At UCHDS we never wore gloves or masks while treating patients. The exception was for extractions that required minor oral surgery (cutting the gum etc.) when we were required to wear disposable latex gloves. For extraction that only needed forceps (‘dental pliers’) and elevators (wedge-like instruments), gloves were not required, but we did wash our hands between patients. When using the dental drill, we were required to wear safety googles over our eyes. What I have just described was what was considered correct practice at one of Britain’s leading dental schools. In those days, as in the future, any patient we treated was capable of harbouring nasty pathogens that could cause diseases such as tuberculosis, herpes, hepatitis B (and other forms of this virus), mycobacteria, fungi, and rarer diseases, all of which could have proved very detrimental to the clinician or his or her assistant.

The first practice I worked in was rightly considered to be one of the most ethical in the area. Once again, gloves and masks were not worn. Patients rinsed from a proper glass that was washed between appointments before being re-used. Instruments that had been used on a patient were placed in a bath of Savlon disinfectant for a while until they were needed again. All needles and local anaesthetic cartridges were single use only. At lunchtime and at the end of the day, all our metal instruments were sterilised in a hot air steriliser. It was not every practice that bothered to do this.  Horrified? Well, you might well be if you are old enough to have had dental treatment in the UK before the second half of the 1980s.

After I qualified, I subscribed to the New England Journal of Medicine with a vague idea of keeping up to date with medical science. Most of the articles were beyond my comprehension. However, in the mid-1980s, I began noticing many articles were being published about t-cells (a kind of white blood cell). What I only realised later was that these were being published because of the arrival and proliferation of a new threat to health: HIV (‘AIDS’). This epidemic prompted a dramatic change in how dentists operated. Almost overnight, we were required to wear gloves; advised to wear masks; commanded to sterilise instruments before re-using them; giving disposable single-use paper or plastic mugs for patients to use for rinsing.

What amazes me is that during the 35 years that I worked as a dentist, I never heard of or read about more than a handful of patients who were infected following dental procedures. There have been some newspaper reports of patients contracting HIV after seeing a dentist, but in some of these cases the mode of transmission was other than from clinical procedure. Over the years, I attended several lectures on the latest developments in cross-infection control. After each of these, I always asked the lecturer whether there was any scientific evidence that showed whether cross-infection controls in dentistry significantly affected patient mortality. Not one of these academic clinicians could provide an answer. One of them said to me:

“That would make a very good topic for a PhD.”

Whether they make a difference or not, modern cross-infection protocols make both the patient and the clinical team feel safer. I hope that everyone will feel sufficiently safe to be treated now that the atmosphere is infiltrated with particles of the Covid-19 virus. The nature of this highly contagious airborne pathogen justifies the many advances in cross-infection control that the profession has made since HIV appeared on the scene and will require further refinements especially in the field of air purification.

When I think back to my days of providing dental treatment with my bare hands and uncovered face, I am amazed that I and most of my colleagues never succumbed to anything much worse than fatigue and frustration caused by awkward patients.

 

 

Tooth powder

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tooth powder

 

When I was a child, I brushed my teeth with toothpaste. My parents did not use paste. Instead they used Calox Tooth Powder. A small amount of this was sprinkled into the palm of one hand and then mixed into a paste using the wettened bristles of a toothbrush. The resulting gritty paste was then used to brush the teeth. I have no idea why my parents used the powder, but made us use toothpaste.

Many decades later, this year, I visited the Indian city of Pondicherry, which was a colony of France until 1954. We stopped at a tea stall that in addition to providing tea also sold small packets of paan and chewing tobacco (not very good for oral health) and packets of ‘Gopal Toothpowder’. Seeing the latter reminded my of my parents and their use of Calox. I asked the vendor how the tooth powder is used. He opened his mouth and rubbed his finger along his teeth. In his opinion, no brush is required. I bought a couple of packets, but have not yet been adventurous enough to try to use their contents.

Head to toes

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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!

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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

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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

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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

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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.