Paul's Internet Landfill/ 2012/ Going to the Dentist

Going to the Dentist

I have been meaning to write about my adventures in dentistry for a while now. Given that I am currently recovering from having two fillings done, today is as good a day as any if you are willing to forgive my muffled pronunciation.

For many of you an blog entry about dentistry will not only be boring, but mundane -- you go to the dentist regularly and have been doing so since childhood. I had not seen a dentist in over twenty years when I made my first appointment in November 2009. I may have seen a dentist when I was very young, but I don't remember any such experiences.

I started going to the dentist for two reasons: I became terrified of losing my teeth, and I had a job with good dental benefits. My teeth had become increasingly sensitive to the point where I could not drink cold water without pain, and I spent several sleepless nights worrying that my teeth were rotting abscesses that would leave me gumming food for the rest of my life. I knew that dental care was a big issue -- all the food at our local soup kitchen has to be soft so that people with bad teeth could chew it. I did not want to use my dental benefits (I still do not understand how I can have expensive dental procedures with relatively small benefit contributions) but I am ashamed to admit that I was looking forward to freeloading dental care.

My dental hygiene at the time could have been worse. A few years before I had started brushing twice a day instead of once. I tried to floss my teeth from time to time, but I could not do so without the floss breaking. (The irony of writing a manifesto that began by warning of the dangers of a flossless life is not lost on me.) I could still chew food easily, and my dental sensitivity caused more discomfort than pain, but I knew I was not taking great care of my teeth.

I made the mistake of purchasing a dental mirror at KW Surplus and looking at my teeth. I saw that they were grey, and became convinced that this indicated rot.

I knew the dental-industrial complex would be unhappy that I had not been paying sufficient tithes over the years. I feared recriminations from the dentists. Normal people get lectured about not flossing regularly enough and not brushing well -- how would I be berated?

Suffice to say that I was anxious during that first visit. Unfortunately, the dental staff did not make me feel much calmer. They made me fill out surveys and they took my x-rays, which was fine. Then they started poking at my gums and muttered numbers with concerned looks on their faces: "5... 6... 5... 7..." I had no ideas what these numbers meant, and nobody told me, and I feared the worst.

It turns out that I got exceedingly lucky. Not only would I keep my teeth, but I only had a couple of cavities. I needed two sessions of heavy cleaning to get the plaque and tartar off my teeth, and apparently some parts of my bone were eaten away, but I kept my teeth. One of my coworkers expressed surprise (and dismay?) at how easily I had gotten off. It wasn't any virtue of mine. Apparently Indian people tend to have good teeth. I am also blessed with fairly good alignment of my teeth, so I never faced the horrendous expense and trouble of braces.

My teeth were not perfect. The mysterious numbers the dental staff rattled off indicated the depth of my pockets, and several of my pockets have remained deep. Certain teeth remain fairly sensitive. But the dental staff showed me how to floss properly and brush properly, and I have tried to follow their advice.

I also got off relatively easy on the lecture circuit. My dental hygienist had been impressed that my gums improved so much after the initial cleanings that I received lots of praise for my teeth for months afterwards. I was not doing anything special -- just brushing and flossing regularly. But she was very happy that my pockets were getting shallower and that my gums were staying healthy.

Unfortunately I have since gone out of favour with the dental staff. I have needed lots of fillings in recent months, even though I continue to floss and brush. (I suspect that large amounts of candy consumption are a factor -- as you may recall, I started eating candy to lose weight. In addition I was persuaded to take an injection of some new drug called Arrestin, which is supposed to promote gum growth and make your pockets shallower. That treatment did not do anything for me, which disappointed the hygienist.

The dentist feels like the most capitalist service I frequent. The staff are always pushing coupons and new products on me. They wanted me to take the Arrestin. They ordered me to use an oral fluoride rinse once a week. They keep telling me to use soft toothbrushes (which I dislike) and numbing toothpaste for my sensitive teeth (which misses the point -- I care about the health of my teeth much more than I care about discomfort). They recently installed an internet terminal in the waiting room, but to use it you have to sit through innumerable advertisements. When my dentist recommends a treatment, I never am sure how much I should trust that recommendation -- is it primarily because the staff have my oral health in mind, or is it primarily product placement?

However, the benefits of capitalism are also evident. There is lots of fancy equipment in the office -- chairs that massage my back and television screens to watch while the dentists poke around my mouth. There is plenty of staff, and they spend time on my teeth -- unlike a conventional doctor's office, the interactions do not feel rushed.

Canadians are often criticised for defending healthcare so strongly. We are told that we only like socialized healthcare because we do not see the alternatives. But dentistry (like optometry and several other subfields of medicine) is not covered by OHIP. The differences are evident. There are plenty of dentists and optometrists around. I am sure that the wait times for dental surgery is low. But dentistry has expensive upfront costs, and there are lots and lots of people who go through life with pain and bad teeth because they cannot afford dental care. I do not think that there is an easy answer to this problem.

So far I have spent $1687.99 at the dentist, which works out to about $425 per year. It feels very expensive, even though it isn't -- especially since my workplace insurance covers almost all of the cost. But I feel the financial impact of dentistry acutely -- my dental costs are not going to go down as I age, so I have to somehow budget that extra money or be willing to work for dental benefits. Dental benefits have played a larger role than I am willing to admit in keeping me tied to my job. Dentistry feels like an unpredictable expense, and as a miserly cheapskate I hate it. I also hate the fact that I am unwilling to pay for relatively cheap things like fancy toothbrushes or dental picks (which come out of my weekly grocery expenses) but seem perfectly content to write off hundreds of dollars of dental work (which apparently come out of some bank account in the sky).

I hate dentistry for a lot of reasons. My decaying teeth remind me of my mortality. Brushing and flossing is a drudgery that I put up with. My teeth are going to be sensitive for the rest of my life -- I will never be able to eat ice cream comfortably again. Ten years ago I did not have to worry about dental costs; if I live another ten years then there will be other new expenses to worry about. The expenses and drudgery involved in being alive have increased and will continue to increase, but there is little increase in joy or life satisfaction to offset it. If anything I feel less joy or life satisfaction these days, and I expect these qualities to decrease as I age, not increase. My dental adventures foreshadow the inevitable threshold when life goes from being tolerable to being no longer worth living.

I am also not thrilled with the story arc of my teeth. Getting new cavities every six months is frustrating and feels inevitable. I have nine fillings already and I don't want more. I remain convinced that increased dental sensitivity foreshadows future cavities, but my dentist do not take this concern seriously, and it seems there is nothing they can do to help prevent these future cavities from developing. At some point my fillings will degrade, and then I will face the expense of having them redone. In order to put fillings in the dentist has to grind away my existing dental surface, which no doubt causes additional damage to my teeth.

This is yet another entry to which I have no pithy conclusion. I am grateful to have teeth. I am grateful that my teeth are in relatively good condition after I neglected them for so long. I am grateful that I have access to good dental care. I do not deserve these things, and I feel genuinely sorry to those readers who are feeling resentful or sad because they have not gotten the blessings I have. I wish and hope that you all could have good teeth that will reliably chomp for many years to come, but failing that I hope that your teeth will serve you as well as can be hoped.