Perhaps the emergency phone call I received last Saturday from a patient in crisis was a portent of the week to come. Alan was driving along in his car happily munching from a freshly opened bag of tortilla chips when he bit down on a wayward chip and felt a CRACK accompanied by a jolt of intense pain that forced him to pull over to the side of the road (and call me.) As my exam would later reveal, Alan’s tooth had split in half. Unfortunately, the only viable treatment course was to extract the fragmented tooth and to bone-graft the remaining socket to make it ready for an implant that I will place in three to four months.
When he was getting ready to leave the office (relieved of pain) Alan told me he was amazed (actually flabbergasted) that he cracked what was heretofore a perfectly healthy, unblemished tooth with nary a filling, on something as seemingly innocent as a corn chip. And while tooth enamel is the hardest substance in the human body, cracked teeth are an everyday occurrence and a frequent cause for dental emergencies.
Biting forces can exceed 500 pounds per square inch, so chomping down on an unanticipated obstacle such as an olive pit, an un-popped popcorn kernel, or even incompletely milled corn meal as was present in Alan’s tortilla chip can lead to dental disaster.
Little did I know that my encounter with Alan was a harbinger of things to come…
MY PLAN FOR THE WEEK
As I already indicated, Alan’s mishap occurred on a Saturday. Monday morning found me back in the office looking forward to the busy week ahead and the Memorial Day weekend to follow. The plan for that week was: Monday, Tuesday and half of Thursday – business as usual taking care of my patients, Wednesday – my teaching day at the Implant Program at NYU, Thursday afternoon – (usually spent caring for patients) the office was closed to all but my staff for a long-planned office meeting (just one of the ways we work together to maintain our happy family and to ensure that we remain at the top of our game). The meeting was to be followed by a photoshoot for our new website. And Friday…well, let’s just say I gave everyone, including myself, the day off.
In short, with only 2½ days available to care for patients before a holiday weekend, which is historically busy with last minute unplanned (aka emergency) visits to the dentist, we planned for and were ready for an invigorating week with little time to spare. Working lunches were part of the plan.
LIFE IS WHAT HAPPENS WHEN YOU’RE BUSY MAKING PLANS
So, I began the week seeing my first scheduled patients. I called Alan and he was doing fine. I was gulping down a quick cup of coffee while heading back to the hygiene room to examine a patient and that’s when I felt an earache coming on. Not terrible, but unexpected.
As the day wore on, I became aware of a diffuse distracting discomfort that was difficult to localize. It certainly felt like my ear, or possibly TMJ symptoms, but I suspected that a tooth was the culprit (that’s the dentist in me.) Besides, I am somewhat of a veteran as a dental patient and have personal experience with root canal treatments -five and counting. Oh how I loved going to the candy store as a child.
As I was saying, I was not in acute pain but I could not pinpoint the source of the problem and an x-ray was unremarkable. I had a full schedule ahead of me, so Advil to the rescue. At one point one of my dear and familiar patients, Faye, asked me if I was alright. She noticed that I didn’t seem to be my cheery self.
My staff, so I later discovered, also thought me out-of-sorts (code word: grouchy). More Advil. And the day passed without any more distractions from my tooth due in part to my preoccupation with my patient care and the wonders of modern pharmaceuticals.
I had no trouble eating, no pain from hot or cold to speak of. But I detected a vague tenderness to finger pressure along the base of my two lower molars. Wishing away a problem that one has no time to deal with is a human condition. Besides, non-dentists do not hold a monopoly on self-denial!
Through it all I was all too cognizant of the week’s commitments, slightly self-delusional I may be, but I’m no fool.
Doctor, Heal Thyself…Not A Chance
Before I left for the day I called my friend and dental colleague in the building, root canal specialist Dr. Howard Aaronson. I set up an appointment for the next afternoon, which was the only available time that both he and I were free.
The next morning started off absolutely fine. Brushed my teeth. Ate breakfast. Began seeing patients. All good…until I grabbed that first cup of coffee (you’d think I’d learn from the Java incident from the day before, right?) Mushrooming pain emanated from my left second molar and fanned across my lower jaw. I swiftly made my exit from the office after giving everyone the lowdown and appeared at Dr. Aaronson’s six hours early for my appointment.
And so, another root canal for me. Except, as treatment commenced, Dr. A discovered that my tooth was fractured and could not be saved. A cracked tooth, the second one of the week – first Alan’s and now mine.
I received first-aid and was promptly back in my office with slurred speech and a droopy lopsided smile. Back in the saddle (actually my chair), I continued my day’s purpose of practicing dentistry, all the while regaling my patients with stories of my dental misadventures. Laughter was the universal response to my embellished tale of woe. Patients and staff alike chuckled and chortled at me being on the receiving end of dental treatment – so I just had to ham it up. Hey, it is what it is!
Dr. Aronson’s exemplary care relieved my distress and enabled me to coast through the rest of the day. Dealing with my own dental emergency was a novel experience not without its moments of levity.
The next day was my teaching day. I arrived at the NYU Implant department with my diagnosis in hand and a treatment plan in mind. One of my mentors, colleagues, and friends, Dr. Ehab Shahid, had the surgical honors assisted by the very capable Dr. Donald Spitzer. My other mentor and dear friend Dr. John Como was also in attendance. (My buddies will like to see their names in print.)
So my tooth was extracted. A first for me. I even have all my wisdom teeth. The socket was bone-grafted and a dental implant will be placed in about four months.
Having the tooth removed was utterly painless. I mean it. Lots of local anesthetic and capable hands made the procedure seem like a non-event. In fact, I actually found myself laughing during the surgery. There I was, laying back in the dental chair with my three friends’ faces hovering within nine inches of mine. They looked like bobble heads as they kept nodding up and down. Maybe you had to be there, but it struck me as really funny.
My Friends, I’m Not Thrilled That I Lost A Tooth
It is weird to feel a hole in the back of your mouth. Not to mention how annoying it is that my tongue keeps playing with the space. And, I never appreciated how much concentration is required to restrict your chewing to only one side of your mouth. And forget eating crunchy foods like crackers or pretzels – it’s not worth the jolt when a rogue remnant rams into your raw gum.
My recent dental misadventure has heightened my awareness and appreciation of the many nuances associated with the experience of having a cracked tooth. Pain is subjective and an individual experience; what each of us feels and how we feel it is uniquely our own. Having the clinical knowledge of what was unfolding in my mouth and causing my physical distress enabled me to consciously observe and feel the patient experience without the angst and anxiety that often accompanies sudden pain of unknown origin.
I think my newly acquired insights will make me an even better doctor for my patients. I guess when it comes to a cracked tooth I can tell my patients that I do practice what I preach. Or I can boast that I elected to have my tooth extracted so as to expand my understanding of the patient experience and to enhance my empathy for my patients receiving care.
Thanks for reading,
Here’s more reading about what to do when your tooth cracks, and other related musings: