Mind The Gap …A History Of Dental Malpractice

I was born with a genetic defect.
Well, not exactly born with, and in the grand scheme of things actually a very minor defect, but, a genetic defect nonetheless.
At birth, I appeared perfect with the requisite Fingers, toes, arms, legs eyes and nose. Then I grew teeth. However, the teeth were not perfect. My front teeth suck out and there was a huge space (wide enough for a tooth) smack in the middle of my two front teeth. In everyday parlance, buck teeth with a space in the middle.
Currently this condition could be coveted, particularly among those familiar with literature or the world of fashion. Chaucer speaks admirably of the gap-toothed woman in “Canterbury Tales”. Lauren Hutton is a model that make gap-toothedness sexy. But when I was struck with the afFliction Lauren Hutton had not yet been born and my parents were not literary. My father was identiFied as the carrier. He had a dominant gene for bad teeth. It went unnoticed because at the age of twelve his front teeth were involved in a collision course with a hockey puck. The teeth were totaled. The hockey puck went on the lead a useful life.
My parents taught me to smile with my mouth closed but wanted a more permanent solution and marched me off to the local dentist at the First possible moment.
The dentist rendered his professional opinion. He opined that if my baby teeth were surgically removed the adult teeth would emerge straight and gap free. I still remember the surgery, the feeling of sheer terror, the either mask clamped over my nose and mouth. This was pre-Novocain. “Count backward from ten,” he
instructed. This was a difFicult task for a Five-year-old but mercifully darkness descended before my ignorance was revealed. I awoke to no front teeth, a condition that remained for two years. Finally my adult teeth surfaced. Buck teeth with a space in the middle.
Although I cannot remember how I felt about this at the time, my unnecessary toothlessness must have resulted in a loss of trust in the world in general, dentists and parents in particular. How could I continue to believe in the nobility of pain when this pain clearly did not lead to gain. I was robbed of the comfort of predictability and certainty. Looking back at it now, I feel outrage. I entertain revenge fantasies, slapping an either mask over the inept dentist’s mouth and nose and yanking out something that would not grow back. Admittedly, the brightest and the best of dentists were probably not attracted to the small Saskatchewan on the prairie but how could this guy be so misinformed. His professional opinion deFies logic and science. Did my parents ever hear of second opinions? What were they thinking? Asking a child of Five to count backward from ten should have been another clue.
Our family moved to a larger city in the neighbouring province of Alberta. My gap prevented the consumption of each and every row of corn from the cob but this was only a seasonal disability and it did not lead to major nutritional loss. My schoolmates taunted me by yelling “No Tooth” whenever they saw me but the development of a sense of humor and a certain obsequiousness prevented major psyche damage.
The science of the 1950s prescribed a delay in orthodontia until the late teens waiting for the mouth to mature. Braces were promised but delayed. I remember yearning for the privilege of wearing braces. Just prior to my starting high school, the three of us, Mother, Dad and I went to the First orthodontia appointment. This was nerve wracking in and of itself, the last time I was part of this trio I lost my ability to bite. But Phew! This time no counting backward and I left with what I came with. Dr. Q., the specialist, was a small wiry man, wearing ‘dental whites’ of the time, white pants, a white shirt with a sort of clerical collar, with pens in their protective plastic collar peeking out of the chest pocket. Looking back at the situation now some Fifty years later, looking for clues, I guess Dr. Q could have seemed a little furtive and didn’t exactly exude self-conFidence. But still a spark of hope was ignited. I was, after all, seeing a specialist and the science was tested.
After this First consultation I went to the appointments alone. I climbed on the bus weekly for the journey to my not terribly friendly orthodontist. Braces, elastic band and pain accompanied my high school years. But I was transported back to my naïve, ignorant and hopeful self. Not only did I think I would end up with perfect teeth forever, I anticipated that with perfect teeth I would be beautiful, focusing on my most apparent defect. Graduation from high school and from braces occurred simultaneously. Surprise! No space! Surprise! No beauty. Just me with no hole in front.
Unfortunately there was yet another surprise. Dr. Q. was addicted to alcohol. That was the slightly sweet smell under the cover of mint and antiseptic. Dr. Q. left for the cure without supplying me with a retainer. My teeth slowly began to drift apart. My college graduation photo shows me smiling with my mouth closed hiding buck teeth with a space in the middle.
This time I was listless. Didn’t miss the corn that much and I married a man who didn’t seem to mind women with buck space in the middle. However, my husband’s best friend, Dr. S., new to the practice of dentistry, seductively offered a rescue mission using a new untested theory: cure the gap by reintroducing braces and correct the bite, ignored by Dr. Q., through the use of retainers which would force the back teeth to grow toward one another, eventually meeting. It sounded like magic. I believed him. Things were going well. Perhaps, at the time I was the oldest living person wearing braces but I was on my way to recovery.
I was never really sure of Dr. S’s motivation in offering this new and improved care. He didn’t bill us. But later, while on a solo visit to Edmonton, I suffered a dental emergency. Dr. S .Fit me into his busy schedule, seeing me after hours and then attempting to probe areas other than my mouth. I did not succumb. I have never succumbed to the physical demands of dentists. I have my pride.
But back to the story. I was driving to work one morning with my new braces and retainers engrossed, I suppose, in the dream of my new found beauty with the realigned bite. In this state of reverie I failed to notice that the car in front of me had stopped. I slammed on the brakes but crashed into the stalled car. The Ford Falcon was totaled and I ate the steering wheel. A plastic surgery consult ensured that there would be no permanent damage to my swollen and bruised face but my teeth were another story. Still buck teeth with a space in the middle but one faced front, the other pointed back. There was no time for restorative work as we were moving to San Francisco. In 1967 I went to San Francisco with Flowers in my hair and strangely askew front teeth.
Next came Dr. P., a dentist in group practice on Geary Street. Dr. P exuded self-conFidence. He was a large, boisterous man with a crew cut and a commanding presence. He looked misplaced. He should have been in Vietnam ordering Marines to attack and slaughter. “Why didn’t those other guys see this. The muscle between your teeth keeps them apart. Cut that sucker out and they’ll come together.” I was a sucker. A restoration of hope coupled with the belief of beauty. I was scared stiff, probably post-traumatic stress disorder from the First surgery but NO was not a word in my vocabulary. This was post Novocain but prior to mind-altering drugs. I was conscious during the procedure but suddenly felt dizzy and nauseous. I lost consciousness. I was told that I had a grand mal seizure aspirating blood and perhaps dental equipment. Practically died right there in the dental chair.
But I lived to go through another round of braces, root canals and then crowns that minimized the gap. Gap free but not dentist free.
Dr. P., sensing a need for a continuing business relationship, followed my move to Marin. Another new theory was postulated, promising a better proFile. Gold crowns would build up the back teeth so that the upper molars would meet the lower molars resulting in a regular bite. It was an arduous process involving tens of visits and hundreds and hundreds of dollars later. The new proFile was not as I expected but I was armed with a new weapon, if I opened my mouth in direct sunlight I could blind passers-by with the reFlection from the gold.
Dr. P. retired, probably with the proceeds of my dental care. Dentists by now were a way of life, sort of a Stockholm syndrome. I had to have one.
Ever noticed this about dentists? Go to a new one and they always criticize the work of their predecessors and insist on removing prior Filings and redoing the work. Doctors never do this, never criticize the prior surgeon’s appendectomy and perform surgery again. They rarely accuse your prior doctor of a missed diagnosis and launch you on a completely different regime of treatment. But go to a new dentist and you have a whole new set of problems.
The new dentist, Dr. V.P., said all of my teeth were loose and were going to fall out. They wiggled. Apparently my front teeth had never recovered from their acquaintance with the steering wheel and the newly reacquainted back molars were crashing down on one another with such velocity that is was jarring them loose. It was impossible not to trust Dr. V.P.; he was a friendly, folksy guy, dressed like an adolescent, played cool albums over his sound system, rhapsodizing about the artist as he prodded your mouth. Even better, he freely administered nitrous oxide, even for minor procedures like teeth cleaning. My kind of guy. But the complexity of the
case called for a new referral to another specialist , this time a periodontist. Dr. H. was incredibly handsome and he knew it. Most of the patient-dentist interaction was with the technician. Dr. H. would swoop in to consult, rather like a star’s cameo appearance in a Robert Altmann movie.
But even the two of them, double teaming were not able to restore dental health. More surgery, more pain but no more promises. Now it was a life or death struggle. The seizures returned and did not limit themselves to the dental chair. The prescription drug Dilantin controls seizures but has several effects. One is gum hyperplasia. That is the one my body picked. The swelling of the gums coupled with loose teeth was a a recipe for disaster. Bacteria crawled into the pockets, creating painful abscesses that required more dental visits and sometimes extractions.
I was called in for another consultation with Dr. H. and Dr. V.P. There was a new theory, a new technology. My upper teeth would be removed. I would then be Fitted with implants. Implants were screws – screws in your jaw with teeth attached. They were permanent, didn’t have to take them in and out. No one would know they were not the real thing. Implants somehow insured that there would be no bone loss.
I was not amazed. I was immune. I had grown up. It had taken almost forty years but Finally my innocence was irretrievably lost. The sense of hope, the sense of wonder did not spring forth. I could also read the Fine print. Implants, the literature warned, were not indicated for people with gum disease. Gum disease was my presenting symptom. Even the scare technique, photographs of a toothless old hag
with no jaw bones because of bone loss failed to frighten me. Vanity had deserted me as well.
The least intrusive procedure at this point was to remove all my remaining upper teeth, about Five and get an upper plate. An upper plate is not something you keep on the highest shelf of the china cabinet; it is dental speak for false teeth.
This involved a referral to another specialist, a ‘surgeon’. (Some things had changed since those Saskatchewan days, when the dentist did everything, probably even sweeping the Floor.) This was a typical surgeon, albeit a dental one, no talk, just action. A friend gave me a ride home after the procedure. I was single and living alone at this point in my life. I awoke lying on the Floor of my bedroom. I apparently had a seizure but fortunately had not aspirated any blood and gore. I had again lived to tell about it.
Despite my conservative choice there were still more surprises. Dr. V.P. misFitted my false teeth. The teeth were ill-Fitting, made me look like a kamikaze pilot and kept breaking in half, generally at a most inopportune moment. (But when would it every be opportune to have your teeth crack in half and jump out of your mouth.) Another series of x-rays and consultations concluded that I had a severely distorted occlusion. My jaw had been broken when I was about twelve. I had not received any medical treatment at the time so my upper and lower jaw were completely out of alignment. This condition had not been diagnosed by either Dr. Q, Dr. S or Dr. P.
Dr. V.P was strangely reluctant to refer me “out”, as the expression goes. But after three sets of broken false teeth he referred me to a prosthodontist (false tooth
guy). This guy looked and acted like Woody Allen. He didn’t attempt to sell me implants, gold crowns or new pro=iles, didn’t try to seduce me. Just gave me false teeth that work. I think I am in love.
I have recovered from Stockholm Syndrome and my addiction to dentists. Twice a year I grit my remaining teeth and go to the new guy’s of=ice to get my teeth cleaned. But no more braces, elastics, retainers, surgery and other invasive procedures. Pass me that corn on the cob.

(This piece was inspired by “Parallel Play: A lifetime of restless isolation”, an article in the August 20,2007 edition of the New Yorker. The article, written by Tim Page, chronicles his lifetime struggle with Asperger’s disease. This framework, called the personal story, has been used by many New Yorker authors to chronicle their struggles with disease. An on-line search of New Yorker archives revealed that John Updike has written a personal history chronicling his psoriasis; Lauren Hillenbrand used this style to describe her chronic fatigue syndrome; Stephen King his recover from a near fatal encounter with a van driven by a hit and run driver. Other lesser known writers have used the personal history vantage point to describe alcoholism, AIDS, bypass surgery and blindness. Disease, thankfully, has not played a major role in my life, but my tooth story seemed to rise to the occasion in that it set me apart and shaped my world.)

Leave a Comment

Your email address will not be published. Required fields are marked *