Thursday, January 31, 2008

Teeth, Part Four (And Last, Finally)

Time to wrap this puppy up. Here's the first three parts, if you want 'em: 1 - 2 - 3.

I now had some swell front teeth, but there was a long way to go before my dentist's could sleep. For instance, they had to make me look like this...

That's me three days after the actual implantation of the titanium rods in my upper jawbone. I was healing then. It was a bit worse the day before, more black around the eyes.

Before I got that look, though, there was a whole 'nother round of molds taken of my mouth, multiple extractions of molars, fitting of a second set of prosthetic teeth (still attached to the incisors, but this time extending a couple of tooth-spaces beyond them, covering where the molars had been) and then the repair of that set when it snapped in half while I was eating pizza.

Yup. Pizza broke my teeth.

I love The Pleasant Cafe, so I want it known that the story I'm about to tell you shouldn't reflect badly on them in any way. They make the best pizza in Boston. The waitresses are wonderful. The atmosphere wouldn't be everybody's cup of tea, but it suits me just fine.

Anyway, MY WIFE and I are sitting there eating some pasta and pizza. I had just recently completed another round of extractions, and had been fitted with the second prosthesis. I was happy as a clam. All the work seemed to be going well. I had no discomfort. I was eating good food in one of my favorite dives. I picked up a slice of pizza and bit into it.


Since my mouth was mostly closed around the pizza, the sound resonated in my head. It apparently made no noise outside of my head; MY WIFE told me later that she didn't hear a thing. Well, I knew it had to be something bad because you don't hear a big old *CRACK* inside your noggin unless something serious has happened.

I felt around inside my mouth with my tongue and immediately found the damage. The new prosthesis had snapped almost in half. It was no longer firmly anchored to my incisors, either. The two halves were still attached, but barely, and if I opened my mouth, the whole works might have plopped out into my dish of spaghetti.

MY WIFE looked up from eating and saw what must have been a look of some terror on my face. She immediately said, "What's wrong? Are you OK?"

By clenching my teeth together, the prosthesis stayed more-or-less in place where it should have been. I had to be careful speaking because I could have cut my tongue on the sharp edge where it had broken. I said, through the clenched teeth, "My... plate... broke."

She looked down at my spaghetti.

"No... the... plate... in... my... mouf."

It took a moment for that to register. Once it did, she knew I couldn't eat anything else. She said she'd get the waitress to come and pack up our food so we could go home.

While she looked for the waitress, I sat there with my jaw clenched, embarrassed. I was sure that everybody else in the restaurant knew I was a guy sitting there with a broken plate in his mouf.

On the ride home, MY WIFE told me about her conversation with the waitress.

"My husband just broke his plate, so could you please pack up our spaghetti and pizza to take home?"

"Broke his plate? We can get him a new one. You don't have to leave."

"No, he broke his plate."

"Really, it's no problem! I'll be glad to get him a new plate of spaghetti."

My mouth had become an Abbott & Costello routine.

When I went to sleep that night, I took the broken plate out of my mouth, of course. I laid it on the bureau. I could now feel where I had no teeth, but I still never looked at the empty spaces.

(The next morning, Dr. D'Amico repaired it rather easily, with superglue or something similar. He explained that I'd never have this problem with the permanent prosthesis. It was just that this one was anchored in only two places, rather than the four places that were planned for the final, so there was more stress on it where it had snapped. There were no further problems with it after the repair.)


I'm going to tell you about the actual placing of the implants now. This was what resulted in the puffy face and two bruised eyes in the photo above.

First, I'll tell you that it wasn't as painful as my face looks.

(That didn't quite come out right, but you know what I mean.)

OK, here's what happened. Save for two molars and the incisors, all the rest of my uppers were removed. I was getting four implants. The two molars - the furthest back on each side - were left in to provide extra chewing surface. The plan was to possibly add two more implants, where these molars were, at a later date.

(Thus far, I haven't had this done, as the prosthesis I have now is plenty good enough. I've actually had one of the two molars since removed. Know why? Another toothache. Yup. Anyway...)

I wore the second temporary prosthesis - the one that broke on the pizza - while the extraction sites healed. Once the healing was complete, I was ready for the implant procedure. In other words, once my gums healed, it was time to slice them open again.

Sorry. I know that sounds nasty. It is what happened, though. Dr. Strauss opened my gums down to the bone, and then he drilled into that bone, in four different places, for the placement of the titanium screw rods. This is what the rods look like.

I got that picture from a site called Your Dentistry Guide. Here's a really good explanation of the actual procedure, from the same site.

After the initial pilot hole has been drilled into the appropriate jaw site, it is slowly widened to allow for placement of the implant screw. Following this placement, a protective cover screw is placed on top to allow the implant site to heal and the dental implant to anchor (osseointegration). After several months, the protective cover is removed and a temporary crown is placed on top of the dental implant... The process is completed when the temporary crown is replaced with a permanent crown.

In my case, replace the word "crown" with "full prosthesis", since it was to replace 12 teeth, not just one.

The holes were drilled, and screws placed, with only novocaine for an anesthetic. I was awake throughout. It wasn't fun, that's for sure, but it truly wasn't as bad as it sounds. By this time, I had become pretty used to invasive procedures. I wasn't freaking like I did when my first teeth were extracted. And I got another scrip for a decent-sized bottle of percs, so that was a plus.

Now it was time for the bone to heal. In order for the process to be a success, the bone is supposed to grow around the screw. What's happening is that you're tricking the bone into thinking the screw is a tooth, really. If the bone doesn't heal properly around the screw, the implant will not take. In that case, rejection happens and the procedure needs to be repeated. Luckily, all of mine took - no rejections.

This last was somewhat surprising to Dr. Strauss. He knew I smoked, and he knew I was a catcher on the ballfield. He would have preferred I did neither of those things. Smoking is supposed to bring on a much higher rate of rejection in these procedures, but it didn't affect mine - Thank God. And if I had taken a fastball in the mush, who knows what would have happened?

(One thing I didn't have to deal with, but which some patients undergoing the procedure do, was a bone graft. If there isn't enough healthy bone tissue in the site where the implant is to be made, an extra piece of bone must be taken from somewhere else in the body and grafted on, giving the implant a stronger anchor. This is, as you might imagine, not a pleasant thing. However, if it's needed, what else can you do?)

Finally, after the initial implants had healed, it was time for the placing of the permanent prosthesis. I had another mold done by Dr. D'Amico. Then, while the prosthesis was being manufactured, I returned to Dr. Strauss for him to open my gums again, for placement of the final pieces to which the prosthesis would be attached. Once those sites had once again healed, and both doctors were sure that everything was hunky-dory, I had my incisors extracted. Then, finally, the permanent prosthesis was attached.


And that's finally that. I have had no problems with it since I got it. It is permanently in my mouth, just like real teeth. It is far stronger than my rotten original teeth were. I can do just about anything I could previously do. The only exceptions are, say, chomping into an apple or eating corn on the cob. I could probably do both of those things if I was careful, but it's just as easy to cut up the apple or eat corn off the cob. It's not worth another $8,000 for me to find out if I could do them, in any case.

There has been a decided drop-off in the number of colds, sore throats, earaches, and other minor maladies that were no doubt exasperated by the toxins I harbored in my bad teeth. In addition, I lost the possible toxicity of some 9 or 10 amalgam fillings - although whether or not those cause health problems later in life is still somewhat unconfirmed.

And here I am, very happy with my lovely new smile, a month or so after everything was completed.

And you know what? It's six years later and I'm still smiling.


Buck said...

MOST interesting series of posts, Jim. And very, very helpful, as well, for someone who's in the very front-end of this game.


Anonymous said...

I still think it was a nice tie you were wearing.

Jeni said...

Very interesting story, there. Most definitely, bad teeth contribute to all kinds of ailments which makes me wonder why the medical/insurance professions DON'T offer better assistance to people to have these things corrected.
I have to tell you too - my ex-husband was in an auto accident back in early 1971 I believe. IN that accident, he was thrown through the windshield of the car. Six weeks later, (drunk -of course) he was riding a motorcycle and wrecked which ripped open all the places that had been sutured 6 weeks earlier. Between the two accidents, he ended up losing his four front teeth. Since he was in the military then, they did the dental repair and he had the four front teeth implanted. Since then, he has always joked that if it looked like a barroom fight was about to break out, instead of trying to protect his "jewels" first, he would reach up to cover his mouth instead! At least he realized that much that he didn't have the means to get those teeth replaced! Just figured you could appreciate that little story.

Suldog said...

Buck - No problem. Good luck with your own procedure.

Uncle Jim - Yes, it IS a damn nice tie I was wearing in the picture yesterday. Not nearly as nice as the person wearing it, of course.

Suldog said...

Jeni - I very much know the feeling. In 2006, I had a line drive hit me in the jaw. The worst feeling I got was not from the pain, but from the realization that maybe my entire dental work had been destroyed. Luckily it hadn't been.

(If you want to read it, you can find that story in the "Things I'm Proud To Have Written" section, linked on the main page. It's called "Blood, Sweat, No Tears".)

Celebration of Life said...

Hello Suldog! Thanks for visiting my blog. Hope you come back and visit again sometime!

Doodle Bean said...

Thanks for your story. I'm healing from a bone graft to prep me for an implant later this year. So, it's helpful to hear about your experience.

Just one point:

I didn't have much bone, but they didn't take a graft from another bone -- they use a bone paste made from cadavers. Ghoulish, but effective.

Thanks again!

Suldog said...

Doodle Bean - Cadavers? Damn! Now I almost wish I did have to have it done. That would have made the story much more interesting. said...

I killed me to see those, I just pray I never have to do that.

You look good though...not that I'd date you or anything!

lime said...

that's a terrific smile you ended up with. i never thought about how the extraction of unhealthy teeth might have helped your general health as well in terms of fewer infections. that's quite a nice benefit too!

Craver Vii said...

Wow, that's quite an adventure! It looks good though.

Remember Billy Crystal's Fernando character? "Youuu lllook mmmarvelous!

Peter Porcupine said...

Suldog - GREAT blog!

If you're ever on Cape Cod, shoot me an email; I'd be happy to buy you a cup of coffee. Or a clam. Not both, but still, your choice!

Lyss said...

I empathize.


and I lost half a tooth to a burrito tonight.

Melinda said...

Wow - very interesting series Sully!
Not only were they great posts, but you've inspired me to brush my teeth at LEAST twice a day :)

ps. Haven't forgotten about the dill pickle chips - I'm still trying to figure out a good way to pack them so they don't break and go stale en-route. Hopefully they'll be on the way soon :)

Am'n2Deep said...

Wow, what an experience! I loved the Abbot and Costello bit--funny. Interesting about the fact that your health was better afterward.

And, I'm taking note of The Pleasant Cafe. My husband is being sent to Boston this summer for his new job. We don't have enough info yet to know if he can bring me along, but I'm there if it's ok. Boston is on my list of places I'd like to visit in the U.S.