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I've had a lot of dental work done, close to $15,000 worth so far. When I first started on my current course I was fearful of the dentist's office - it was part of the reason I had so much work to do, I hadn't been seeing a dentist regularly. Since that time I've become an old hand, I've had so many different procedures performed that there is little left to fear. What follows is my recollection of the different things people have done in my mouth.

A cleaning

This, surprisingly, can be as stressful or even more stressful than some of the major procedures. It all depends on what shape your mouth is in. Most of a scheduled cleaning involves scraping the plaque off of the teeth from around the gum line. If the gums are healthy and strong this will involve staring at the ceiling for 15-20 minutes, no real pain. If the gums are weak or soft there may be some bleeding and there will almost certainly be some pain.

The pain is not major but it can be startling, it can be hard to anticipate and so made a little worse for the surprise of it. On the up side it is the kind of pain that requires a stimulus. By the time you get out of the chair the pain is all gone.

If there are cavities in the teeth, especially around the gum line, they will be discovered during a cleaning. The pain of being poked in a cavity is far different from the pain of being poked in the gums. Getting the gums scratched is a familiar pain, akin to a scratch on the skin. Tooth pain is in a new league and like the gum pain can be made worse by the surprise of it. The pain felt when a cavity is poked is felt inside the tooth, in the nerve or pulp. Depending on the tooth that can be a large nerve. This pain is less sharp, less local than getting scratched on the gums, it is more diffuse and more akin to an ache.

X-rays

These are easy. Panorama x-rays involve standing for a few moments while a big machine swivels around your head, these aren't common. More common is the x-ray gun used to take a picture of a tooth or small section of teeth. In order to get a clear picture of just one row of teeth the x-rays have to be stopped before they pass through your mouth and the opposite row of teeth. This involves holding a lead stopper in your mouth. Now, I'm a pretty big guy with a pretty big mouth, that lead stopper doesn't really get in my way. sloebertje, who reminded me to include mention of these, implied it might not be that simple. Agreed, this stopper was probably designed to just about fill the average sized person's mouth - it may be awkward.

You will have to get x-rays when you first go to a new dentist and whenever something significant changes in your teeth. Whenever you complain of tooth pain there is a good chance you'll get a new x-ray of that tooth so they can see if there is an infection around the root. Whether they view film over a light or view the results on screen it looks about the same. Teeth show up white, an infection shows as a halo of dark around the tooth, fillings are black and gums are a swirly diffusion of both.

Shots

A local anesthetic is required for just about anything more serious than a cleaning. Most of the time this is going to be a shot on the 'outside' of the gums, high up on the gum line between the cheeks and gums. This shot doesn't hurt at all. Occasionally, briefly, you can feel some very mild pressure as the liquid is pushed in. Rarely, a shot will have to go 'inside', on the palette side of the mouth. These can hurt a little, the dentist will describe it as feeling like a pinch. It feels almost exactly like you expect it would, a needle. It doesn't hurt much and doesn't hurt once the needle is gone.

In either case, the local ends up removing all sensation from the area for a few hours. The lips will feel thick and there can be the sensation of a very mild ache as the local wears off. Other than that it is relatively simple thing and will not do nearly as much damage to your speech as Bill Cosby implies. Be very careful drinking from a glass right away, you may not create quite the seal between lips and rim as you believe. As well, and I know I shouldn't know this, smoking a cigarette can be mildly puzzling but is achievable.

I've been informed by more than one noder that my dentist is barbaric and behind the times for still giving me shots. This could be, though for the quality teeth I'm receiving and competence I sense around their office I have to assume it could also just be preference. I know that they offer nitrous and valium as well as knock-out drugs. I've just never asked for any of these, I like the shot. It leaves me awake and lucid so I can record all my impressions for here. ;)

Getting a filling

As with most of the rest of these procedures there is really nothing to 'feel' as you are numbed by shots already. Getting a filling or a cavity plastered over is pretty simple. First they scratch away or drill away any dead tooth or nastiness that shouldn't be there. You may hear more than you'd like but it isn't that terrible. Conceptually speaking a filling is akin to painting your nails or cutting your hair - no blood or pain-sensing nerves should come into the process.

Root canal

We get root canals when a tooth is too far gone to recover good health. The nerve is removed from the tooth, effectively 'killing' it. Depending upon the condition of the tooth it can then be filled or crowned.

The euphemism for 'bad time at the dentist' this, as well, isn't actually that bad. There should be no actual pain. Even without pain, the first root canal can be a pretty stressful event for all of the other sensations that go along with it.

During a root canal the dentist drills down into the top of the tooth, sucks the root out and then closes up the hole in the tooth. The drilling is uncomfortable the first time, not for any real pain, but for imagined sensation and especially for noise. As well, there is the possibility of bits of tooth flying off and landing elsewhere in the mouth. As the rest of the mouth is not numb these are felt and immediately understood for what they are. There will be a dental hygienist ready with a vacuum but bits of tooth are still disconcerting. The rest of the procedure is really only sensed as movement or action, nothing can be felt or heard.

Personally, I've never had a rough time with the recovery process. I always get my dental work done in the morning and save for one trip have always returned to work sans pain killers.

Crown

A crown is a fake tooth, a protective cover to go over either a dead tooth or a living one. If the tooth is dead it has received a root canal already.

The first step in getting a crown is to take a mold of the tooth as it currently sits in the mouth. This is done with a little tray full of quick drying plastic goop. Step two involves grinding the tooth down to a little nub. This will again involve a drill or grinder and even more bits of tooth flying around in the mouth. If a root canal preceded it then the stress should be less. If the tooth is alive then there will be a sensation of cold as the nerve is much less insulated. Step three is another mold to get the shape of the nub. These two molds will be combined to make the crown. The last step is to get a build-up, a temporary fake tooth that they make in the office during the visit.

The build-up will be more than sufficient for the two weeks or so you have to wear it but the day it is replaced by the crown is rather special. Build-ups are made of some sort of porous plaster-like material. It feels decidedly odd in the mouth. The crown on other other hand is covered, most likely, in porcelain and, to my mind at least, is rather nicer than real teeth. The crown comes a few weeks later and replacing the build-up with the crown is rather easy. Pop the build-up off, apply some good cement and pop the crown on. It is a 20 minute trip.

Crown popped off

So far this has been my second worst experience at the dentist's office. I had an infection under a dead tooth that was crowned. The infection refused to heal and so a special effort to clean the infection was made. This involved popping the crown off, opening up and draining the canals, getting a build up and taking antibiotics and steroids for a while.

The difficult part of the trip is popping the crown off. Crowns are cemented in place with a pretty damn strong adhesive. It is supposed to last forever. So, popping one off takes a rather special effort and more muscle than a dentist can easily bring to bear in so small a space. So how's it done? Pneumatics.

The device is shaped like a magic marker, tipped with a little piston and powered by what sounded like compressed air. The dentist carves out a little notch on the bottom of the tooth for the piston to get purchase and then begins trying to pop the tooth off. The piston hits hard, really hard. It is hitting the crown which is firmly attached to the tooth which is firmly attached to the jaw bone which is very much a part of the head. Each hit with the piston feels something like a punch to the face. The force this device projects is absorbed by the entire head. Hopefully it takes only a handful of pops before the crown comes free.

The last thing to note about this procedure is that when the crown comes free it lands in the mouth. As you are laying back at the time there is a great chance it will land in the back of the mouth, at the throat. Most likely this is no problem. I've found that I have no choice but to close my throat and breath through my nose while at the dentist. Accidentally swallowing something isn't really an option. Just be aware though.

Simple and surgical tooth extraction

Getting a tooth pulled, especially for the first time, can be a bit unnerving. As with all of the other procedures there should be no pain. As with most of the other procedures there are still some uncomfortable sensations.

A simple extraction is nearly exactly what it sounds like, the tooth is pulled simply. It takes only a few minutes work with some pliers. The pliers are relatively large and the angle the tooth comes out at can be odd so the mouth is wide open here. There is a sound as the tooth comes out, it is almost cartoonish in how appropriate it seems in retrospect. First is a squeek similar to the ones you hear when washing plastic dishes by hand. This is followed by the faintest of pops that is probably more imagined sensation than actual sound. Even though numb it seems as if I always feel a reduction in pressure when a tooth comes out.

A surgical extraction is what they call it when simple pliers won't do. This is generally for bigger teeth with bigger root systems. In a surgical extraction the dentist will have to work around the outside of the tooth with a spatula, loosening the tooth a bit. There is also the potential for the tooth to be taken out in sections if loosening it in the socket does not help.

Following the extraction there is a hole in the gums where the tooth used to be. This can't be filled by anything immediately, it must be protected while it heals. If there was any cutting or if the hole is large enough then sutures or dental super-glue may be applied to close the wound.

There will be pain but it won't begin for a few hours, until the local wears off. Go directly to the pharmacy and get that pain pill prescription filled. Go home, take one and try to go to sleep. This isn't going to be terrible but it will by no means be easy, either. The first two days or so there is an ache with occasional pain, there will likely be some bleeding for the first day. Diet is restricted and the restrictions are not difficult to follow. Difficult food doesn't even appear appetizing. Follow the after-care instructions very carefully, especially the part about 'no straws'. If the socket does not heal properly then you will be back in the dentist's chair for a very uncomfortable procedure.

Getting a socket packed

Dry socket is hard to mistake. When the socket does not heal properly it hurts something fierce. Each intake of breath is like icy fire pouring over the wound. To remedy this they pack the socket with a string coated with a 'pain-relieving' anesthetic. Hah.

I've only had to have this procedure one time and I have to admit the dental assistant who provided it rather scared me. She measured off about a foot and a half of this gauze-like string that smelled and tasted of cloves. She began packing the string down into the socket. After about a foot of it I felt full. I kept expecting she'd snip off the remainder and pitch it. Nope. She somehow managed to fit it all in there. I had to wear it around for weeks while failing to follow the impossible instruction: don't tongue it. When it began to unravel a bit I snipped off a few inches on my own. A few days later I pulled the rest out on my own. That was probably a really bad idea but nothing terrible happened. I guess I wore the stuff long enough.

Follow the after care instructions when you get a tooth pulled. Having a socket packed is terrible.

Bone graft

My current dentist uses pig bone to fill in around teeth and human bone to fill sockets after a molar is pulled. I've had one bone graft and yes it was cadaver bone. The bone graft was put in during the same visit as the tooth was pulled. I didn't see the bone but I got the impression from them that it was tiny little bits floating in the most foul tasting antiseptic ever. Seriously, get over the idea that there is bits of a dead person in your mouth and put your fear where it really belongs - getting any of that antiseptic on the roof of your mouth. You can't sit up and rinse while they are putting this stuff in so if any of it leaks out into your mouth you have to gag and bear it.

The bone is not meant to become a part of you, it isn't like a skin graft. The bone is meant to act as a catalyst, to spur your body into growing new bone. For me it worked no problem, an x-ray a few weeks later showed the socket all filled up, it looked just like the rest of my jaw. The only weird bit is that it takes a while for the gum to completely heal over the wound so you can feel bone with your tongue for a while after. It is weird to think of parts normally always on the inside being on the outside.

Tools of the trade

Sometimes it is hard to know where to put your tongue. Relax on this score. Your dentist has done this a thousand times, knows how to work around you and knows which instructions you need. When working in the front of your mouth though, or when doing work they'd rather not chance messing up, they have a few little tools to isolate a single tooth. A frame with a thin sheet of rubber stretched over it is laid over your mouth. Then a smaller clamp is placed onto the rubber around the tooth they want to work on. Lastly they snip out the rubber inside that clamp. The effect is that this one tooth is exposed outside the rubber while the rest of your mouth is inside it. I find this relaxing as it reduces any anxiety I might have about getting my tongue in the way. It also prevents 'stuff' from falling into my mouth. I can safely swallow any saliva that collects in the back of my throat and not worry about there being any blood or antiseptic in it.

Another difficult issue that sometimes comes up is trouble keeping the mouth open long enough or wide enough. When this happens they have a little frame that they place in the front of your mouth between your teeth and gums. It holds your mouth open. Don't try to relax against it though, it is rather thin plastic and a sharp edge can dig painfully into your lips or gums. Even with the sharp edge I never seem to mind this. I guess I'd rather the dentist be comfortable with where they are working than I be comfortable with it. A few moments discomfort to make sure everything goes smoothly seems a rather easy trade.

If you ever have front teeth replaced they may take some pictures of you with a huge device in your mouth. You will bite down on this device to hold it in place while they make adjustments to the front of it, the big part that isn't in your mouth. They will line up the top part with your nose. These pictures, along with molds, are sent to the people who make the crowns. This assures that your new teeth are nice and straight. It is no big deal.

Some last words

For the most part going to the dentist involves getting a shot and then lying still while they work. Do try very hard to be still, moving a leg or arm causes the head to move as well. I didn't know that the first time. Getting a major procedure done involves a fair amount of stress - couple that with trying very hard to remain still and it should not be a surprise if you are rather tired after the work is done.

Different dentists may give you different instructions about the vacuum, or use it different ways. If the assistant is using the vacuum while work is going on then relax and let them do it. They can see when saliva pools and will get to it as soon as a hand is free. If no work is going on then you can save them some effort and simply close your mouth with the vacuum in it. It will pull your mouth shut and pull any liquid in your mouth up to it. It is easier and faster that way.

If you are having major work done on a tooth or teeth and it suddenly hurts - well, the dentist will probably see you jump and know why you did. Just in case though, feel free to gesture in some way when there is a break in the action. If you need more pain killer then by all means get it. Don't assume the pain is a part of the procedure, you should be numb.

Lastly, you should trust your dentist and be comfortable in the chair. Of course there are some nerves and stress with most of these procedures, especially for a first timer. However, if after a procedure you feel profoundly uneasy or feel it should have gone much better; if you feel like you never want to return to the dentist's office, start looking around for a new dentist. Maybe all you need is an outsider's opinion or reassurance that the work was done properly, you had a false expectation. Maybe though, you need a better dentist. Your dentist should never make you feel shame for the condition your mouth is in, nor should there be any serious pain or dramatic discomfort. We've been doing this a long time, there are very few mysteries about dental work. If you don't like what happened there is a decent chance they did it badly.

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