Long time readers of my blog may remember my tooth problems of the past. (You can read about my tooth problems here: http://www.rubbertrampartist.com/2015/02/12/my-teeth/, here: http://www.rubbertrampartist.com/2015/03/04/princess-tooth-revisited/, here: http://www.rubbertrampartist.com/2015/03/06/another-day-in-the-saga-of-my-mouth/, here: http://www.rubbertrampartist.com/2015/03/25/murphys-law-of-the-mouth/, and here: http://www.rubbertrampartist.com/2015/03/31/good-bye-my-sweet-princess-tooth/.) In summary, in the last five years, I’ve had two lower molars extracted, and I’d prefer not to lose any more teeth.

In my home state, I go to a free dental clinic where students training to be dental hygienists practice on patients. The students are only weeks away from graduation and closely supervised at all times.

However, I haven’t found a similar clinic near where I work in California. Last year, I went to a dental care chain and had a terrible experience. Then I found a dentist I really liked.

The new patient fee at the new dentist’s office was only $59 for an exam, x-rays, and a cleaning. The dentist was a woman, as were all the workers in the office. Everyone was super nice. Between the x-rays and the cleaning, the dentist consulted with me in a little office  The dentist found a cavity and was able to fill it that day, which saved me the time and expense of driving down the mountain again. I also paid to join the discount program of the network this dental office belongs to. I was pleased with the entire experience.

(Well, ok, I wasn’t pleased with having a cavity or getting it filled. But the office was super fancy, and I was able to watch Pawn Stars while the professionals were working in my mouth.)

From the time I arrived in California this May, making a dental appointment was in the back of my mind. In August, I finally called and found out I was covered by the discount plan until early September. So I made an appointment. The woman who made the appointment for me was at a call center and didn’t know how much the visit would cost, so I called my dentist’s office later that day and spoke with the office manager. Since neither woman told me anything different, I expected I’d see the dentist I met last year.

I arrived at the office at the appointed time on the appointed day. No one was at the desk to greet me. I checked in with a computer. Then I sat down to wait. At some point the nice office manager returned to the desk and called me up to check in with her. I sat down to wait again. I waited for twenty minutes past the time of my appointment. No one apologized. No one offered any explanations.

Finally, a young woman brought me to a room and took x-rays. The process took about ten minutes. Then she brought me to an exam room at the end of a long hallway. The other exam rooms along the corridor were empty. The woman gave me the TV’s remote control, but the satellite signal wasn’t working properly. I’d get 40 seconds of Chopped Junior and two minutes of nothing. I sat alone in that room for another twenty minutes until a young man in blue scrubs walked in.

Oh good! I exclaimed. You haven’t forgotten about me!

I know I was being a sarcastic asshole, but I felt like a sarcastic asshole by that point. I was hungry. I’d been waiting for forty minutes without apology or explanation. And the one thing that may have distracted me was experiencing technical difficulties.

The young man in blue scrubs tried to turn my frustration into a big joke. His joking did not make me feel better.

Then the young man in the blue scrubs said, Hello! I’m Dr. Whoever. And you are?

Wait!! What?! This was the dentist? What had happened to the young woman dentist with the cute bow in her hair whom I’d seen last year? (I have a slow brain, or I would have asked the young man in the blue scrubs that very question.) Also, it was obvious to me that this guy didn’t even know my name when he walked through the door. Really? Shouldn’t a medical professional look at the patient’s chart and know her name before he walks through the door?

It became obvious he hadn’t looked at my chart either. Images of my mouth popped up on the screen where I’d earlier been trying to watch Chopped Junior, and he dentist started talking to me about my teeth.

The first thing he told me was that I had an “infection” on one of my wisdom teeth that’s still below the gum.

I said, I was told it was a cyst.

Probably ten years ago, the dentist at the poor people’s clinic I was visiting for checkups and cleanings every six months noticed what this dentist was referring to. The dentist at the clinic specifically referred to what she saw as a “cyst.” She sent my x-rays to a consulting oral surgeon who said it was no big deal, unless it started giving me trouble.

So the dentist in the blue scrubs said “infection,” I countered with “cyst,” and he said, Same thing.

Ummmm, no they’re not the same thing.

A cyst is a sac of tissue that has either fluid or soft material inside it.

Cysts can form in a wide range of tissues including in the face and mouth (including the jaws). Some can form next to or around teeth, which are called dental cysts…

They can be sterile or become infected…

Abscesses are localised acute infections, which require immediate attention from your dentist. It is rare not to know you have an abscess – they are usually associated with acute pain (they hurt a lot!), swelling (eg of your gum or even face and cheek) and sometimes an unpleasant smell or taste in the mouth. Abscesses can form inside or near dental cysts, which is where the confusion can occur.

Dental cysts aren’t necessarily infected and can grow slowly for many months or even years without any or many symptoms.

Also, it occurred to me later, if I had an infection, why hadn’t the dentist given me a prescription for antibiotics?

So the dentist said he wanted me to speak to the surgeon about having the tooth extracted. I told him I’d speak to a surgeon in my home state about whether or not the tooth needs to be extracted. He looked at me blankly, and I had to explain yet again that I’m only in California five months of the year for work.

The dentist worked across the screen to the other side of my mouth and pointed out a tooth around which I have some bone loss.

What happened here? he asked. There’s bone loss.

My jaw was fractured, I told him.

What happened? Did you get in a fight? he asked as if my fractured jaw and bone loss were some big joke.

Yeah. You could say that, I answered flatly.

Well what happened? he demanded. Tell me the story.

I don’t want to talk about it, I told him.

Perhaps it’s the man’s professional responsibility to check on the welfare of people who show up in his office with bone loss due to jaw fracture. But I didn’t feel as if he were concerned about my welfare. I felt like he just wanted me to air my dirty laundry.

If the dentist were concerned about my welfare, these are some things he could have said to assess the amount of danger I was in or to offer assistance:

Are you still seeing the person who did this to you?

Here’s the number to the local/national/regional domestic violence hotline. (If anyone reading this needs it, the number to the National Domestic Violence Hotline is 1−800−799−7233.)

Would you like me to refer you to a counselor/social worker/therapist?

But no, he offered me no help or support.

When he realized I wasn’t going to tell [him] the story, he moved on to listing the special treatment he wanted me to have. He wanted the hygienist to do a special deep cleaning around the tooth, then shoot a laser around kill bacteria.

He didn’t explain things very well, but I think the bone loss has caused a pocket to form between the tooth and gum. I think it’s difficult to clean out the pocket, so bacteria grows there. Somehow a regular cleaning isn’t enough.

Before the hygienist  came into the exam room, the office manager showed up to have me sign off on the price of the procedures. The x-rays, exam, and cleaning were supposed to cost $80, and I planned to spend an extra $25 on a fluoride treatment. With the deep cleaning and the laser treatment, the bill shot up to $300. I didn’t really know what to do.

You can pay half today and half next month, the office manager offered me, but the issue wasn’t that I didn’t have the money in my bank account. The issue was that I didn’t know if I actually needed the procedures the dentist was recommending.

I approved the deep cleaning and the laser treatment, but decided to skip the fluoride.

The hygienist was the same women who’d cleaned my teeth last year. I asked her if the condition of the tooth with the surrounding bone loss was worse than it had been the year before. She said she didn’t know. She said in order to know, she’s have to pull up my x-rays from last year and compare. I realized no one–not the dentist, not the hygienist–had even compared this year’s x-rays to last year’s x-rays. I wish I’d asked the dentist if the condition of the tooth had gotten worse in order to see how he justified the special, more expensive treatment.

By that time I was discouraged and just wanted to be done and get out, so I didn’t insist the hygienist pull out the old x-rays and compare.

I’d already decided I’d never go back to that office, but as I wrote about what happened there, I realized the dentist never actually looked into my mouth. He looked at images of my teeth, but never looked at my actual teeth. This is the first time in my whole life where “going to the dentist” did not involve a dentist physically examining my mouth.

Images courtesy of https://www.pexels.com/photo/view-of-clinic-305568/ and https://www.pexels.com/photo/blur-bristle-brush-clean-298611/.