I’m not going to put any gross pictures in this post. Some people like to see stuff like that, and some people don’t. So in THIS post, the only pictures will be of the temporary-temporary tooth (which looks like a transparent impression of my teeth but with a tooth painted on) and of me modeling it. If you would like to see two head-and-shoulders pictures of me grimacing/smiling without one of my front teeth, and a closer picture of my bared teeth so you can see what the extraction site looks like two days after extraction (not gory, but it’s not what you’d call a beauty shot), I have posted them here: Pictures of Swistle’s Missing Tooth.
To review, my body had for reasons unknown decided that the root of one of my upper front teeth was An Intruder, and was steadily working on absorbing it. I found out about this situation five years ago when I had a routine dental x-ray. The dentist sent me to an endodontist to see if the tooth could be saved with a root canal, and the endodontist said definitely not. The dentist said there was no rush and we could keep an eye on it; every so often he took another x-ray and confirmed the steady but slow loss of the root.
In the last year or so I started having a periodic non-painful-but-not-pleasant-either tingling sensation around that tooth and decided to act sooner rather than later. (The danger in waiting is that the area can suddenly become painful or infected, and then it’s no longer as relaxed/uncomplicated a procedure; also, if some of the root is missing/soft, the tooth might not come out in one piece.) I had a consultation with the oral surgeon who took out Rob’s wisdom teeth, because I love her; she’s a small, intense, birdlike person in a lab coat and headlamp, and she’s quick with a dry joke, and she seems like she really LIKES her job. She confirmed that there was no hope of saving the tooth (“Well, that’s a darn shame,” she said, looking at the x-ray), and the only question was When; she agreed the earlier the easier, so we set a date.
I consulted with you guys about whether to have laughing gas or general anesthesia, and you were ALL OVER THE SPECTRUM and there was NO CONSENSUS AT ALL. (Part of the issue, it appeared, is that “general anesthesia” is not a specific term at all, and can mean many different medicines at many different risk levels.) I went with “There are so few opportunities in life to nope-out of unpleasant experiences, so I’m going to take this fine offer.” But I worried I’d wake up feeling terrible and barfy like I did when I had my wisdom teeth out.
Let’s see, I think that catches us up to the day of the extraction. My appointment was in the late morning, and I couldn’t have anything to eat or drink for six hours beforehand. I drank a fair amount of water the night before, as instructed. In the morning I kept getting big rushes of nervousness. I leaned heavily on my “In x hours this will be all over and I’ll be back home” Coping Thought.
I was supposed to arrive half an hour before the appointment. Shortly after I arrived, a nurse called me back and gave me a large dose of amoxicillin. Because I’d opted for general anesthesia, she also confirmed that I had someone in the waiting room who could drive me home and stay with me for the rest of the day, and she asked for a phone number where they could reach Paul later on to check on me. She also asked me what I was having done, probably to make sure we BOTH knew the score. Then I went back to the waiting room.
Nearer my appointment time, the nurse came to get me again. In the hallway, she had me put one of those blue shower-cap-like things over my hair, and she put little shoe-sized ones over my shoes. She brought me into the actual room after telling me not to touch anything in there that was blue; when we went in, I saw various surfaces covered with blue paper sheets and lots of medical instruments. At a sink there was a cup with what looked like four or five doses of mouthwash in it; she had me rinse and spit, rinse and spit, rinse and spit for just over a minute, to sterilize my mouth. She’d mentioned that it would taste bad, but I’m used to mouthwash (I don’t like to brag, but I can go the entire 30 seconds) and it basically tasted like a slightly more medicinal mouthwash, with less burning.
She had me sit in the exam chair, which was like a usual dentist’s chair. She adjusted the little head support to be comfy, and she took my glasses. Then we were joined by the person who handled the anesthesia (she was dressed like the other nurse, and I don’t know if you have to be an anesthesiologist to do any sort of anesthesia or if there are different job titles that can do different levels of anesthesia, but I will just call her the anesthesiologist). She tied a piece of elastic around my upper arm, had me make a fist a few times, and praised my veins. (I get a lot of praise from medical professionals about my veins. I’ve come to look forward to it.) She put in the IV. She put one of those little oxygen things in my nose and hooked the tubes over my ears. She put an oxygen monitor on my finger. She put three sticky circles on me, but I forget where (upper chest? arm? neck? non-upsetting places like that). The nurse covered me up to the waist with a big blue sheet. I was starting to feel Very Medical.
The oral surgeon came in and chatted pleasantly for a minute. She listened to my lungs and heart. She said to the anesthesiologist, “Three fentanyl.” We talked another minute or so; she was just going over again what we’d be doing. Then she paused, looked at me evaluatingly, and said, “You should be starting to feel some effect of the medicine—like, a little blurry.” Almost immediately I DID feel a little funny, but not enough to rule out Power of Suggestion. What I remember saying is that I wasn’t sure if things were blurry because I was feeling the medicine or because I had my glasses off. I don’t know if I said anything else after that or not, but what felt like the exact same second I was wide-awake and feeling normal and fine, but I was also tipped way back and the doctor was working in my mouth. This was puzzling. I glanced over and saw the nurse, and she said, “The tooth’s out! It went great!” I could not see how she could be right about this, and wondered if I had misunderstood. It didn’t FEEL as if the tooth were out, or as if enough time had passed for that to have happened, or as if I’d even been unconscious yet, but I couldn’t get my tongue over there to investigate.
The doctor said, “Hi! How ya doing?” and I gave a thumbs up. I heard the anesthesiologist say, “Do you want more propofol?,” and the doctor said, “No, I think she’s good hanging out with us at this point, right?” and looked at me and I gave another thumbs-up. What she was doing in my mouth was a little uncomfortable, but I felt cheerful and chill and like I didn’t really care. I remember this from the last time I had fentanyl, which is when I was in labor with my firstborn. It did approximately zero for the quantity of pain, but it made me feel as if the pain were over there somewhere and kind of interesting to think about.
Anyway, the doctor was trying to get the implant in. She worked on it for quite some time, trying different things, but the implant couldn’t grip in: it just kept spinning like a stripped screw. This was a little uncomfortable. “Darn,” said the doctor, eventually. “Well, we tried.” So instead she did a bone graft. This part didn’t hurt: it was like the part of getting a cavity filled when they’re packing the filling-material into the tooth. Just a light pressing sensation.
Then she sewed it up. This hurt a little, but not much, and I didn’t really care and I wasn’t grossed out. I thought, “Huh! That kind of hurts a little!” and “Funny how it’s exactly like sewing cloth!” Just kind of la la la hanging out feeling interested and perky. The doctor was meanwhile explaining that although it was disappointing that we couldn’t do the implant the same day, in the long run the bone graft would make it a way stronger and longer-lasting implant: we’d trade three months of waiting-time for years or even decades of implant-life. She said she didn’t think I’d need/want to go under when I came back to have the implant put in, but that we could discuss it when I came back in a week for her to check the extraction site. She added that it was good I’d gone out for the tooth extraction, though, since it had proved to be “a bit tricky. I had to really TWIST it!” (My plan is to get the nitrous oxide for the implant: I’ve been meaning to try it, since it sounds as if the effects vary considerably from person to person, and I didn’t want to try it for the first time for something like an extraction. An implant seems like the right low-stakes moment.)
The doctor left. The nurse gave me gauze to bite on. People started removing things: the IV came out, the oxygen came out, the oxygen monitor came off, the sticky things came off, the blue sheet came off, the shower cap and shoe caps came off. The nurse and anesthesiologist were standing by in case I had trouble standing up, but I didn’t: I felt totally normal and okay and non-queasy and non-groggy. I walked to a chair in a station in the hallway where another nurse was waiting. She changed my gauze, asked how I was feeling. She went and fetched Paul, and then she gave him all the instructions; they were the same sheet of instructions they’d given me ahead of time, so everything was familiar. The only thing that was new was that they told me how much over-the-counter painkiller to take (I was a little disappointed not to get any of The Good Stuff, but I have to admit I didn’t need it). I was very, very, very annoyed with Paul afterward, because I SPECIFICALLY TOLD HIM ahead of time to please take notes during the instruction session because I might not be with-it enough to hear/remember everything, and he did not take any notes, and so then afterward I remembered they’d said I should take three extra-strength ibuprofen every six hours, and Paul said he was absolutely certain they never mentioned ibuprofen but then couldn’t say what medicine they HAD mentioned, though he did remember they’d mentioned SOMETHING—just definitely not whatever it was I remembered. Really, I’m still annoyed about this. He had ONE JOB. Well, two, counting driving me home. AND I reminded him ahead of time. What do I need to do, hold his hand around the pen?
Anyway. The nurse checked the gauze and said I didn’t need to do any more gauze, so that means the bleeding had stopped enough. I could taste a little blood in my mouth, and my upper lip was a little numb and there was a wearing-off feeling like when I have novocaine, but not as much as usual: like, as if I’d had one small shot of novocaine instead of four big ones, or whatever. We drove home, and I made some scrambled eggs for lunch so that I could take some ibuprofen, and then I took ibuprofen. I’d thought I would be kind of out of it for awhile like Rob was after his wisdom-tooth removal, but I felt normal and did normal things. I did take a nap in the afternoon, but I think that was more because I’d had a little trouble sleeping the night before.
I was supposed to put on an ice pack for twenty minutes out of each hour to prevent/reduce swelling, and I had two bags of frozen peas ready to be called into service; later I wished I’d gotten corn instead, because I could smell the peas. I was supposed to sleep with my head elevated, and I don’t like sleeping on extra pillows so instead I’ve been sleeping in a recliner; I like to sleep there sometimes anyway. I have had hardly any swelling; whether because of peas/recliner or because of the particular tooth/situation, I don’t know. I think I had big chipmunk cheeks when I had my wisdom teeth out, but that was four impacted teeth not one emerged tooth, and I didn’t use ice packs or sleep in a recliner.
The extraction site doesn’t hurt much. I’ve taken ibuprofen a few times, but just two of them per dose, and I haven’t been counting the hours until I can take more; it’s more like I think, “Hey, that’s starting to ache,” and then realize it’s been ten hours since I took anything. The worst part is that there is a tiny piece of stiff surgical thread sticking out, and the feeling of it grosses me out so much; and every time I eat, food brushes against it. This morning I finally used my tiny pocket-knife scissors to carefully, carefully snip off some of the extra, and that was some relief, but there is still some left (I didn’t want to cut it too close to the knot and then have to explain to the doctor why I thought any of this was a good idea), and I really hate it, and also I found two more pieces back where I can’t see them or get to them. My tongue keeps going over to see if they’re still there, but any touching/wiggling of the threads makes me queasy, so I and my tongue are at odds in our wishes.
I’m also very aware of the feeling of the two extraction-flanking teeth against the inside of my lips. I should ALWAYS have been feeling those teeth since THEY haven’t moved, but I suppose now I’m feeling their exposed corners or something. It feels distressing, like I have new fangs or a fresh overbite or something.
One of the biggest problems was that I’d planned a bunch of soft foods without realizing that if I had the bone graft I wouldn’t be able to have dairy for four days. Or rather, I DID realize it, but the paperwork said “no uncooked dairy” and I thought that meant, like, no unpasteurized/raw dairy. But when the nurse was going over the after-care instructions and said no uncooked dairy, Paul said, just confirming it, “Like, no unpasteurized/raw dairy?,” and she said, “No: no uncooked dairy. You can have pasteurized dairy, but only if you heat it very hot first. Like, you can have cream in your coffee, but microwave the cream separately first.” Which was confusing, because that’s what I thought pasteurization already did: heated it very hot. And so what I’d planned on was cottage cheese, and meal-replacement shakes made with cream, and ice cream, and pudding, and smoothies, none of which seemed like they could be heated nice and hot, or at least not without making me feel a little nauseated thinking about it.
So that was a little discouraging, and I’ve been having trouble finding things I can eat. Applesauce. Scrambled eggs. Instant soup with those tiny noodles—but it can only be warm, not hot, per instructions. Coffee, too, can be warm but not hot. I’d thought that since it was a FRONT tooth, chewing wouldn’t be much of an issue, so I’m surprised to find it’s quite difficult to chew. I tried having a salad last night and eventually had to give up. I couldn’t seem to herd the leaves effectively.
All of these things pale in comparison to how I feel about the way I look. As with most things involving physical appearance, I am sure that my own feelings about the way I look dwarf the feelings OTHER people have about the way I look: like when someone else has a pimple and wants to stay in a dark room until it’s over, and I am like “You can barely even SEE it, stop drawing people’s attention to it by mentioning it!” But in our culture, missing teeth are fairly rare, particularly missing FRONT teeth. It IS a little shocking, it really IS, it’s not just me feeling self-conscious. It looks as if I blacked out a front tooth for a costume, and it’s approximately that weird to go out in public like that. I don’t think the photos I took really capture how shocking it looks in 3D. It seems as if it would startle/scare people about as much as a large bloody cheek wound.
Before I had the tooth pulled, I had an appointment at the dentist to make me a temporary-temporary tooth. I’ll have a longer-term temporary tooth (a “flipper”—like a tiny retainer that attaches to the two flanking teeth and holds a temporary fake tooth in place) at the end of next week, but this was to tide me over until then. (Normally they could have made the flipper ahead of time, but my dentist’s original plan was to attach my own removed tooth to the implant, which they couldn’t do until the tooth was extracted and they’d had time to modify it. I assume that plan is now off, since the implant couldn’t be installed after all—but maybe now they’ll make the flipper out of the extracted tooth? I don’t know.) They took molds of my teeth, and from those molds made a thin clear piece that covers all my top teeth. Have you ever had a custom whitening tray made, one that fits your particular teeth? That’s the same thing as this. Except that there is a fake tooth painted on to the inside of it:
When I wear this, it takes away the Startle Factor:
(My face is so red because I recently had a bag of frozen peas pressed to it. I did not sufficiently plan out this photo session.)
It’s pretty okay, especially in a small photo. But in real life, or closer up, it doesn’t look right. There’s a black gap where the painted-tooth doesn’t quite cover. And more importantly, the tray gets spit in it. And since it’s normal for spit to be blood-tinged for a few days after the extraction, what happened when I put the temporary-temporary tooth in was that the tray immediately filled with blood, masking all my front teeth, giving what I think I can safely call a far-worse effect than the missing tooth. If you need to schedule a tooth extraction, may I suggest scheduling nearer Halloween?
Also, the little tray is uncomfortable, and if I wear it too long the extraction site starts feeling kind of icky and achy. I can’t talk clearly with it in, which is tiring. If I smile naturally, my lip goes over the top of the tray and gets stuck there. I wore it to my first ceramics class (more on this another time) and I didn’t feel like myself at all: I hadn’t realized how often I smile until I couldn’t do it, and I was minimizing my words because I was hard to understand and self-conscious about the tray, and I was worried the tray was getting bloody without me realizing it, and by the time class was over I was exhausted from the effort of being Normal Human.
Last night I was moping and Paul said, “Is there anything I can do to make this better?,” and I said, with one hand covering my gappy mouth, “No. I can’t eat right, I can’t talk right, and no one can look at me. It’s just going to be miserable for awhile.” I can’t believe there’s more than a week until I get the temporary tooth, and even THAT is going to be on a little flipper I have to take out when I eat. But it should be more comfortable to talk and smile, and that will be a big relief.
Oh, one interesting thing is that I have a faint, dream-like, non-distressing memory of having felt a very intense but non-painful/non-scary feeling where my tooth was. Propofol affects memory as well as consciousness, so I’m interested to know how awake I was during the extraction. That is, to me it feels like I skipped it; but if I could go back and tune in at the time, would I be more aware than I REMEMBER I was?
Well. As mopey as I am, I am also very glad to have this first step over with: it was by far the most distressing part of the entire procedure to contemplate, and now it’s done.
Update on progress a little over a week later.