Bracing Up

Dear Dad

I’ve decided: I’m going to do it. I have talked and discussed and debated and wrestled ad nauseam with friends, with family, and (aloud) with myself. I have spent countless sleepless nights, agonising, and praying, asking for guidance, and wisdom, and (dare I say) signs to lead the way.

And now, I have finally come to a decision. Or, really, I should say, the decision has come to me. As things turned out, the decision was not made by me; the decision was made for me.

Okay, are you ready for this? Very soon — like, in two months — I shall be sitting on an orthodontist’s chair, and wires and brackets will be attached to my teeth. Yes, I shall be fitted with — what I am probably overaged for — braces.

Then, for two years or more, I know I’ll be trying every waking hour to hide a “metallic” smile, speaking with gusts of wind pushing between my teeth, and tripping over every word that has ‘f’, ‘s’, and ‘th’ in them. And, for two years or more, if you must know, I shall be (sigh) quite — no, very — un-kissable.

These gripes, though, are not the focus of my post. To make my point, we will have to go back in time to examine the trajectory of my dental affairs. I’ll try to make it brief, I promise.

You will remember that the alignment of my teeth has always been thought to be wanting. It’s not SO bad to render me hideous — some might disagree — but it has all the time been less than perfect, which no doubt explains the indecision over the years.

Well, a couple of months ago, I was found with a root fracture, and the periodontist (or gum doctor in my vocabulary) issued a stern warning that the affected tooth would have to be extracted (FAST! he said), that I risked suffering “mammoth” swelling if I chose to ignore it. And that even if the infection did not manifest itself, there was the more sinister consequence of bone erosion, he told me, that was already chomping away at my tissue and teeth structure.

Right.

I was distressed, but resigned. “I’ll call to fix a time for the surgery,” I told him; when I have gathered enough courage (and madness) to go under anaesthesia for something that’s not as yet bothering me, I told myself.

Then, there came the question of what we’d do with the gap. Being an upper second pre molar, its absence, albeit not front and centre, will still make smiling a tricky exercise.

To cut to the chase, a tooth implant was thought to be the obvious option, since I’m not prepared to entertain the thought of wearing dentures — the word alone sends shivers down my spine.

You see, an implant, being essentially an unmovable, permanent, and literally screw-on implement, precludes future orthodontic procedures indefinitely. So, if I still harbour any inclination to have straight teeth, ever, it’s now, before the implant, or never.

Yet, what’s truly perplexing is this: the orthodontist I am consulting is positively indifferent about the fractured tooth; he queries the urgency of taking the tooth out; he also goes out of his way to suggest braces before extraction, which might not end up being necessary, he says, if my immune system is consistently robust.

And herein lies my grouse.

Now, both the periodontist and the orthodontist (and really anyone who has -ist in their title) are supposed to be specialists with expert knowledge. They are presumably ethical professionals with their patients’ interests at heart, or, that’s what we’d like to think, anyhow. And so, when they have conflicting views, one wonders why.

See, the periodontist is fully aware that only a specialist like himself could competently remove the cracked tooth by surgery because a normal extraction will fragment it and debris will get left behind. My cynicism tells me it works in his favour to emphasise its seriousness, lest I change my mind — the trouble tooth is not immediately affecting my daily life, after all — not to mention that his opportunity to perform the (highly-expensive) implant could quite easily slip by.

By the same token, the orthodontist runs the risk of losing a lucrative case, should I decide to take the tooth out and settle for the implant straight away.

I know how people often talk about getting a second opinion. But when the opinions are diametrically opposed, each uncannily biased to their own respective benefit, who does one believe? What does one do?

Seek out a third opinion, and if that turns out ambiguous, a fourth, then a fifth, meanwhile defraying copious amount of hard-earned money in order to arrive at a credible prescription, free from the prescribers’ self-serving interests? Or, should one scour the Internet and make half-baked decisions based on half-baked interpretations of arguably half-baked information?

True, medical practices are going concerns; they are organisations that need to profit to survive. But is it acceptable practice for doctors and dentists (who often own the practices themselves) to consider their bottom line ahead of patients’ welfare? Is it too much to expect medics to transcend the ruthless rigours of the business world, and be compassionate life-savers and care-givers?

The Australian Dental Association Code of Ethics recommends a set of guiding principles, one of which says, “the primary responsibility of dentists is the health, welfare and safety of their patients” while the Australian Medical Association also suggests as guide that “a physician shall, while caring for a patient, regard responsibility to the patient as paramount.” But none of it is mandatory(!) — although I do agree enforcement will admittedly prove challenging.

So, where does that leave us, okay, me: the ignorant, bewildered, and disillusioned patient?

To my own devices.

Well, I have since scheduled a time with the periodontist for the surgery to have my tooth removed . And it will take place before I clamber up and onto the orthodontist’s chair. For all their zeal and insistence, contradicting each other, both will have me as their patient in the end. All I was asking was sound advice for a safe treatment plan.

The thing is, at the crossroads, I decided eventually to rely on my own humble reasoning: the fractured tooth has to come out — I wasn’t going to leave it there, and depend on my (fragile) immunity to stave off potential ramifications, as the orthodontist had suggested — so, why wait, and subject it to inevitable stress when all the teeth in my mouth will soon be yanked and pulled and shoved by metal whilst wearing braces? Then again, the surgery does not have to happen NOW; it can wait a couple more weeks, when my workload permits.

The worst bit, however, is this: after all that angst, the ordeal has not even started.

Wish me luck; I need loads of it.