Dental science marches on!
On Wednesday, I finally lost the last remnant of my rear right lower bicuspid. In a few months, if all goes well, a fake tooth will replace it.
I've always had lousy teeth. Part of this was genetic/developmental luck of the draw, and part of it was indifferent hygiene when I was a kid (I brushed regularly, but never got the hang of flossing until much later). My dentist was a soft-spoken fellow who, I now realize, was also very technically old-school. I ended up with a lot of his fillings, which a later dentist described as "pre-Vietnam".
(I assume this is a term of art. I've also noticed that dentists all seem compelled to rag on the work of the previous dentist you had.)
When I was in grad school, the great big filling in this one tooth started to come loose, and I put off dealing with it for way too long, by which point I was hurting quite a bit and needed a root canal. My second dentist referred me to an oral surgeon, who ground off the whole top of the tooth, drilled out the pain-flavored filling in the center, and replaced the whole thing from below the gumline with this cunningly constructed porcelain-and-gold replica that even had slight discolorations in a couple of spots to make it look real. The whole operation was amazingly pain-free and sadly required no happy drugs, local anesthesia having advanced considerably since I was a kid. With a cyborg bicuspid that was more machine than tooth, I came away happy.
Later, I got another root canal and crown (plain gold) on one of my molars, from my current dentist, who predictably informs me that he would totally not have done the first one the way the other guy did. But the first one seemed OK until recently, when the crown abruptly came loose. The old root had been rotting away down there, and couldn't be saved. It was time to say goodbye to Mr. Tooth.
There are two things they can do in this situation. The classic solution is to put in a bridge, which involves decapitating the adjoining teeth and putting in artificial crowns that are attached to the new fake tooth, to support it. Since one of the adjoining teeth was pristine and the other one was mostly OK apart from a small filling, nobody really wanted to do that. It does have the advantage (from my perspective, not the dental industry's) of being the cheaper and faster option.
The more involved option they sold me on was to get an implant, which is a fake tooth supported by a post inserted into my jaw. When my dentist first explained this to me, I wasn't entirely clear on how that post could get support in my jawbone, given that the original tooth was in a socket shaped like a big, flattened cone.
The answer turns out to be awesome: They're going to fill the entire hole with bone first. I had the first part of the process done on Wednesday morning. A periodontist/oral surgeon pulled out the remaining nasty rotten tooth bits, cleaned out the socket with a drill, then filled it with a cream made from the ground-up, irradiated fragments of the bones of actual other human beings (deceased). Over this, he stitched a membrane that is some sort of pork by-product, to cover the hole, and lashed it down with sutures going all over the place, looped around the adjacent teeth.
What amazed me was how quick and painless even this surgical process was. The actual operation, from extraction to stitching-up, took all of thirty minutes. It seems as if local anesthesia has gotten even better, much more precisely targeted. They had to inject me in six or seven spots, but the result was zero pain (after the initial needling, at least) without even a great deal of numbness away from that side of my jaw. I remember when the whole side of your face would be dead from the Novocain required for a simple drill-and-fill.
The goal of all this blasphemy against Nature is to persuade my body to generate new solid bone that will fuse with the grafted bone. A few weeks from now, if all goes well, I go and get the stitches out (or at least the biggest ones that are non-dissolving). In January, when the regenerated bone is hard enough, they drill a new, smaller hole into my jaw and stick a sort of titanium bolt into it. Then, sometime a couple of months later when my bone has fused again around the bolt (and, I think, into some pores in the titanium), it's strong enough to be load-bearing and my dentist puts the new fake tooth on top.
The aftermath involves some soreness and swelling. I've been on a combination of giant Motrin pills, Tylenol, ice packs, and amoxicillin for the past couple of days. They gave me a prescription for Vicodin, but I haven't really needed it. The pain's way down now, but I'm going to have to take the amoxicillin for a while longer, which is a bummer because I think it's upsetting my gut, but at least I'm not allergic to the stuff like Sam is.
The oral surgeon claims the result will, unlike those root-canal jobs, be more durable than my regular teeth. I guess we'll see. I do greatly appreciate the people (and the pig) whose former parts are now incorporated into my lower jaw.
I've always had lousy teeth. Part of this was genetic/developmental luck of the draw, and part of it was indifferent hygiene when I was a kid (I brushed regularly, but never got the hang of flossing until much later). My dentist was a soft-spoken fellow who, I now realize, was also very technically old-school. I ended up with a lot of his fillings, which a later dentist described as "pre-Vietnam".
(I assume this is a term of art. I've also noticed that dentists all seem compelled to rag on the work of the previous dentist you had.)
When I was in grad school, the great big filling in this one tooth started to come loose, and I put off dealing with it for way too long, by which point I was hurting quite a bit and needed a root canal. My second dentist referred me to an oral surgeon, who ground off the whole top of the tooth, drilled out the pain-flavored filling in the center, and replaced the whole thing from below the gumline with this cunningly constructed porcelain-and-gold replica that even had slight discolorations in a couple of spots to make it look real. The whole operation was amazingly pain-free and sadly required no happy drugs, local anesthesia having advanced considerably since I was a kid. With a cyborg bicuspid that was more machine than tooth, I came away happy.
Later, I got another root canal and crown (plain gold) on one of my molars, from my current dentist, who predictably informs me that he would totally not have done the first one the way the other guy did. But the first one seemed OK until recently, when the crown abruptly came loose. The old root had been rotting away down there, and couldn't be saved. It was time to say goodbye to Mr. Tooth.
There are two things they can do in this situation. The classic solution is to put in a bridge, which involves decapitating the adjoining teeth and putting in artificial crowns that are attached to the new fake tooth, to support it. Since one of the adjoining teeth was pristine and the other one was mostly OK apart from a small filling, nobody really wanted to do that. It does have the advantage (from my perspective, not the dental industry's) of being the cheaper and faster option.
The more involved option they sold me on was to get an implant, which is a fake tooth supported by a post inserted into my jaw. When my dentist first explained this to me, I wasn't entirely clear on how that post could get support in my jawbone, given that the original tooth was in a socket shaped like a big, flattened cone.
The answer turns out to be awesome: They're going to fill the entire hole with bone first. I had the first part of the process done on Wednesday morning. A periodontist/oral surgeon pulled out the remaining nasty rotten tooth bits, cleaned out the socket with a drill, then filled it with a cream made from the ground-up, irradiated fragments of the bones of actual other human beings (deceased). Over this, he stitched a membrane that is some sort of pork by-product, to cover the hole, and lashed it down with sutures going all over the place, looped around the adjacent teeth.
What amazed me was how quick and painless even this surgical process was. The actual operation, from extraction to stitching-up, took all of thirty minutes. It seems as if local anesthesia has gotten even better, much more precisely targeted. They had to inject me in six or seven spots, but the result was zero pain (after the initial needling, at least) without even a great deal of numbness away from that side of my jaw. I remember when the whole side of your face would be dead from the Novocain required for a simple drill-and-fill.
The goal of all this blasphemy against Nature is to persuade my body to generate new solid bone that will fuse with the grafted bone. A few weeks from now, if all goes well, I go and get the stitches out (or at least the biggest ones that are non-dissolving). In January, when the regenerated bone is hard enough, they drill a new, smaller hole into my jaw and stick a sort of titanium bolt into it. Then, sometime a couple of months later when my bone has fused again around the bolt (and, I think, into some pores in the titanium), it's strong enough to be load-bearing and my dentist puts the new fake tooth on top.
The aftermath involves some soreness and swelling. I've been on a combination of giant Motrin pills, Tylenol, ice packs, and amoxicillin for the past couple of days. They gave me a prescription for Vicodin, but I haven't really needed it. The pain's way down now, but I'm going to have to take the amoxicillin for a while longer, which is a bummer because I think it's upsetting my gut, but at least I'm not allergic to the stuff like Sam is.
The oral surgeon claims the result will, unlike those root-canal jobs, be more durable than my regular teeth. I guess we'll see. I do greatly appreciate the people (and the pig) whose former parts are now incorporated into my lower jaw.