My Last Baby Tooth – The Conclusion

Click here for Part 1
Click here for Part 2
Click here for Part 3

At long last, the series of dental procedures to replace my baby tooth have completed.  Last Wednesday, I went in for the final appointment where the dentist set the crown (the artificial tooth) onto the implant. 

About 3 weeks before, I went in to get fitted for the crown.  Unexpectedly, this turned out to be one of the more unpleasant parts of the process.  The main part of this process was taking wax impressions of my teeth that a lab would then be able to manufacture a properly fitting crown.  To do this, they stuck a fairly large wad of the wax impression material into my mouth, had me bite down, and then I had to keep it in place for about 10 minutes or so until it set.

They started off by taking the impression of my upper teeth (the implant is on the bottom).  This was kind of uncomfortable, but not too exceptionally bad.  The worst part was that the wax had a very slight, strangely spicy flavor to it and I found that it kind of burned my lip a bit while it was in place.  While waiting for the impression to set, the staff left me alone in the room and went off to gather supplies and/or tend to other patients.  For some reason, I kind of felt oddly self-conscious during that time.

After the upper impression was completed, they next took a couple X-rays to verify the exact angle and positioning of the implant.  I thought it was interesting, and encouraging, that while reviewing the X-ray, the dentist spontaneously exclaimed that the oral surgeon is “a master”.  Apparently, the implant was very precisely and cleanly positioned, creating a pretty ideal situation for the placement of the crown.

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My Last Baby Tooth – Part 3

Click here for Part 1
Click here for Part 2

I am way past due in getting around to writing the next part of this story.  As you might recall from the first 2 parts, I had one baby tooth that I had never lost as a child due to the permanent tooth never coming in.  Back in April, the tooth started bothering me and the dentist informed me that it was going to have to come out.  I had it extracted in early-May.

On August 22, I had oral surgery to put in a dental implant, the first part of the process of replacing the lost tooth with an artificial one.  This was the most invasive, and only surgical, part of the procedure.  The surgery involved the insertion of a titanium artificial root into the jawbone through an incision at the gap where the extracted tooth used to be.  Once the surgery has fully healed and the oral surgeon confirms that the bone has fused appropriately with the implant, my regular dentist will be able to affix a crown to the root, completing the process of replacing the lost tooth.

After I had the tooth extracted in late May, I had to wait a minimum of 6 or 7 weeks to allow it to fully heal before proceeding with the implant.  That timing pretty much ran right into a vacation that we had planned for the end of June as well as the July 4th holiday, so I ended up deciding to just put up with the gap in my teeth for a bit longer.  I finally contacted the oral surgeon’s office and set up an appointment for a consultation at the end of May.

The oral surgeon that I went to specializes in implant procedures.  I think that might be the only thing he does, although I’m not entirely certain.  Dental implants are expensive and generally considered by insurance companies to be an "elective" procedure (more on that later), so there actually was kind of a salesmanship element to the consultation.  I even felt a bit like I had been to a luxury dental office, with such amenities as bottled water offered while waiting for the dentist and even sunglasses provided during the exam to shade by eyes from the examination light.

After the examination, the oral surgeon told me that I was a good candidate for the procedure and spent a little time going over the procedure in more detail.  One key topic that he brought up in this discussion was the available options for anesthesia for the surgery.  He indicated that general anesthesia wasn’t usually needed for this (I’m not entirely sure, but I don’t think he even offers that as an option), but he did pretty strongly recommend the use of an oral sedative during the surgery in order to help me to relax and also to help to avoid movement during the procedure.

I then met briefly with a member of the office staff who went over some of the financial details of the procedure with me.  She indicated a cost of a little over $2000 for the implant.  Many dental insurance plans apparently do not cover implants, considering them to be fully optional, cosmetic procedures, even though they are now widely considered to keep the gums/jawbone much stronger and are also longer lasting than dental bridges.  Fortunately, my insurance does cover about 50% of the cost, although apparently it is 50% of what the insurance company thinks the cost should be rather than 50% of what the oral surgeon actually charges (and the patient has to make up the difference).  There are also annual maximums that come into play.  As of the time that I’m writing this, my insurance company still hasn’t finished processing the claim and I don’t yet know how much they will cover.

After the financial discussion, we then scheduled the appointment for the procedure.  I decided that I wanted to have it done on a Friday, which would then give me a couple days to recover without having to take more than one day off from work.  We initially scheduled an appointment for the next Friday after the consultation, but they called the next day and let me know that the office staff had incorrectly recorded the itinerary for an upcoming vacation the oral surgeon was taking and would have to push it back a couple weeks.  The August 22 appointment was the next available Friday.  I wasn’t entirely thrilled that the only time available was 7:30am, but I still took the appointment since the only alternatives were to either switch to another day of the week or put the procedure off for almost another month.

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My Last Baby Tooth – Part 2

Click here for part 1

The tooth is gone now. Rather than simply pulling it, as I had expected, the dentist ended up essentially pulverizing it last Wednesday afternoon. Apparently, it wasn’t as easy a tooth to remove as had been hoped or expected.

As a bit of a preface, this ended up being my family’s week for unpleasant dental procedures. My wife had learned a couple months ago that she needed to have her wisdom teeth removed and, coincidentally, that was scheduled for last Saturday, just 4 days before the extraction of my baby tooth. Since she only had two wisdom teeth that needed to come in (the lower ones never came in), she decided to have the procedure done with just local anesthetic instead of being put to sleep for it. When she got there, the oral surgeon immediately asked her if she wanted to re-consider that, which obviously wasn’t a good sign. She decided to go through with it, though, and when she came out she immediately told me it was one of the most miserably painful experiences she remembered.

Since my baby tooth extraction was scheduled to be done only using a local, her experience obviously made me very nervous. I even called the dentist’s office on Monday and asked them to advise on what I should do. They still recommended sticking with the local and essentially said that this should be a much easier experience. When I had my own wisdom teeth out around 12 years ago, one of them was removed using only a local (it was something of an emergency as it had become infected) and the other two were removed while I used a combination of laughing gas and valium. I didn’t remember either procedure being overwhelmingly bad, so I decided to stick with the original plan this time as well.

The first thing that the dentist told me on Wednesday was that he was going to use a lot of the local anesthetic and that I shouldn’t really feel anything at all during the extraction. To his credit, this turned out to be pretty much accurate, even when the extraction did turn out to be a bit more difficult than expected. The amount of anesthetic used was by far the most I ever remember receiving for a dental procedure, with the dentist even having to stop to refill the dispenser at one point. He applied it at several different locations in my mouth and I was overall pretty thoroughly numb. My dentist has an excellent bedside manner and pretty regularly double checked during the procedure to make sure that I was ok and not feeling any pain.

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My Last Baby Tooth – Part 1

I’m labeling this post as "Part 1" as this is, unfortunately, a story that is going to have at least a couple more chapters over the next several weeks.

When I was a child, a routine dental exam revealed that one of my baby teeth did not show any signs of a permanent tooth growing beneath it.  The dentist explained that without a permanent tooth coming in, I would not lose the baby tooth in the normal manner and that the baby tooth would hopefully last for a pretty long time.  On the other hand, he did acknowledge that baby teeth obviously aren’t intended to last a lifetime and that, sooner-or-later, it would begin to break down and have to be removed.  This was back in the late 1970s.  Over the subsequent years, I’ve had two different fillings put in the tooth in order to help strengthen it but, otherwise, it has largely served as an odd conversation piece during visits to new dentists.

A few weeks ago, I started to notice that the area around that tooth was becoming sensitive.  Touching the jaw-line around the location of that tooth causes a jolt of pain, focused around the spot where the baby tooth meets the gum.  It hasn’t yet given me any kind of continuous pain and, usually, it hasn’t really been too much of a problem while eating. I was obviously concerned that the discomfort was an indication that the tooth was failing and put off a visit to the dentist for a few weeks on the faint hope that the problem would just go away.  Earlier this week, I finally decided that it wasn’t going to clear up (and it was also getting a bit worse), so Thursday I did go to see the dentist.

The dentist did confirm what I was afraid of.  The tooth is finally breaking down and now will need to come out.  His recommendation is to replace it with an implant, which is an artificial root that is put in by an oral surgeon and then can be used as the support for a crown.  The implant is a titanium rod that the oral surgeon basically screws into the jawbone through an incision made in the gum.  I hope that is more fun than it sounds but I somehow doubt that it will be.  On the positive side, the dentist assured me that the use of a crown with the implant is pretty much indistinguishable from a real tooth in look, feeling, and function.

At Thursday’s appointment, they took an X-ray and the dentist did a short exam to confirm the problem.  They then took a huge number of photos.  I find it interesting how much high-tech digital technology is now involved in dentistry.  They now have monitors at the dental chairs and all the photos and X-rays are immediately transferred to a computer (running Windows XP…) and displayed right away.  At the beginning of the appointment, the hygienist took several digital photos of the tooth in addition to the X-ray.  They have a tiny digital camera at the end of a wand (similar to the electric toothbrushes they use for cleanings) making it easy to take the close-up photos.  For some reason, I found it really funny that every time she took a photo, an old-fashioned camera shutter sound played loudly from the computer behind me.

After the diagnosis and determination that an implant was going to be needed, the dentist then took a whole bunch of photos of my teeth using a Nikon digital SLR camera.  The camera had a very large, presumably specialized lens that was also fitted with a number of lights, which I would imagine were needed to get anything recognizable in the photos.  Presumably this was intended to fully document my mouth to help with getting the right sizing and coloring of the implant and crown.  The whole thing felt rather weird, though.  I’m not an extraordinarily comfortable photographic subject under good conditions, so it felt really strange having someone snap all these close-ups of my mouth, often with a metal instrument (the doctor called it a "lip retractor") holding my mouth wide opened.

Finally, to better inform me on the implant, they showed me a short video about it.  This was obviously produced by the manufacturer and was hosted by a doctor who was apparently one of the designers of the procedure.  The whole thing was kind of cheesy and I was a bit amused how he kept explaining all the potential side effects or complications with statements to the effect of "we are ethically obligated to inform you of this, but it very rarely ever happens." Fortunately, it did sound like most of the risks were pretty minor and included the typical "risk of infection" that is there with any surgical procedure as well as potential impacts to bite, speech, appearance, etc. any of which could easily be corrected.

The video also went over the alternative treatments that were available.  Ever since I first learned about this tooth, I remember being told that eventually a "bridge" would be needed to replace the tooth.  Doing a little research online, I found that implants started becoming generally available in the early 1980s (not that long after I first found out about my tooth), but I suspect that they have probably become much more common and routine in recent years.  A bridge is a much more destructive approach where the dentist files down the teeth on either side of the gap and then fits crowns over both.  The artificial tooth is then attached to and anchored in place by those two crowns.  Obviously, the big disadvantage of this is that it requires otherwise perfectly good teeth to be damaged and crowned.  The implant process leaves the other teeth alone.

The next step of this process will be the extraction of the baby tooth, which is scheduled for Wednesday, May 7th.  They mentioned that they would call me if an appointment opens up that would allow it to be done sooner, but I admit that I’m not in that big a rush.  I’m sure I’d be more anxious if I were in more continuous pain, but right now I simply find this to be something I dread more than welcome.  I know I need to get it done, though.

In addition to doing the extraction at the May 7th appointment, the doctor said that they would take the necessary measurements and impressions to prepare for the implant procedure.  They also will give me all the remaining information that I need at that appointment to get the surgery scheduled.  I’m not sure how long it will end up being between the two procedures.  Fortunately, the tooth is towards the back, so I shouldn’t look too much like a clumsy hockey player during that time.

Look for the next installment of this story shortly after May 7th!