written 06/25/97, by snpf
So Wednesday morning I watched christoph get all of his wisdom teeth out. This is a description. This is not an intent to gross you out, but it is detailed. Be warned, therefore.
I watched the entire time. The setting up of the anethesia: saw the IV go in; the nitrous oxide start taking effect; the demorol and valium being slowly injected into the IV, in a series of five (5 mg per injection, perhaps) because the effect of each injection was being closely monitored. There was a small discussion about how different people take different amounts; they had a patient coming in later that afternoon who would be taking three times the amount christoph needed.
On christoph's nose was the nitrous oxide dispenser--looks like something from H.R. Giger's world; gray cap with two accordian tubes out of each side. Also attached to the dispenser was a small clear tube which went to a machine to monitor the amount of Carbon Dioxide that was being exhaled.
The Dentist asked if the nitrous oxide was having any effect. Christoph said "No," so he "knocked" it up a notch. Then I said, "You have to breathe through your nose, though." We were teasing. But apparently this had happened: a patient was talking a lot, and the nitrous wasn't taking effect. "You have to breathe through your nose." There was laughter.
Christoph says that as soon as he said No, he felt the nitrous oxide.
After about a half an hour, christoph was in the "perfect definition" of conscious sedation. This means you can talk to him; he will hear you and respond, but he is comfortably...shall we say, "numb". As an example, the dentist told christoph to open his eyes. Christoph did so. He also responded when spoken to (if he could move his mouth).
I think it was nice for him for me to be there...partially because doctors and assistants (in this case, another doctor perhaps, I don't know, was assisting) occasionally talk amongst themselves during an operation, and the person on the table feels like a "patient", rather than a particular individual. (They did ask christoph if he minded them talking during the extraction.) Do you know? I have had this sensation. It was okay, but it would have been nicer to have someone....be a guardian angel. :) "Be a good patient."
Onward. Shot-needles with interesting metal coverings and thumb hoops on the top were used to inject Novacaine. They also had bendy 45 degree needles so that the correct portions of the mouth and gums could be injected. He used quite a bit of that (which was good). It was simply more than I expected could be injected into such small areas. He injected lots around each tooth that was going to be extracted.
I missed most of the first tooth's extraction. It was the top left tooth. I caught sight of it as it was coming out: A Big tooth cooperating. Then sutures with small curved needle, and gut thread--which dissolves after a couple of days. The best kind of thread for surgery because I don't know about you, but I hate having the threads ripped out (as was done on a 6 inch incision on me earlier in my life.) However, this is not about me. ;p okay, perhaps.
Let me describe the two main tools used for extraction. There is a lever type instrument, and then full-on pliers (90 degree grips at the tip). So first he levered the tooth, to loosen it, and then took the pliers and eased the tooth out; of course in the opposite direction from the roots.
The second tooth was the lower left. It was already mostly rotten, and so very soft (and gray). Unfortunately, this makes it so the tooth basically crumbles when you try to grip it. So that one broke. There were several tries for the pieces--the top came right off, but the roots had to be seperated with the drill, and then extracted. I think by the end there were about five pieces. At one point, it was almost as if the dentist's entire fist was in christoph's mouth, pulling and pushing, and his jawbone/head was the base support for the levering.
"Come out!" I was thinking. I almost asked the doctor if he ever asks the patient to let go of the tooth. He was busy, though.
A picture stays in my head of the hole in the gum, with the roots of the tooth there, rather deep into the hole. The void above the remainder of the tooth reminded me of a barnacle, in a way. hm. I hate barnacles. I sat down at that point, and didn't watch while they sewed up the hole.
That one took a fairly long time. They got all of the tooth though. Near the end, the doctor said "Good catch!"...apparently a chip was trying to escape, but the assistant sucked it up into the saliva-sucking tube.
During some of this, I watched christoph's hands--they were splayed into the air with a slight grasping motion. That was endearing. Christoph later said that this was conscious, that his hands were cold. And they were. I had to hold his hand for a moment after the second tooth was finally out, for my peace of mind and to give comfort to the ignorant.
The third tooth was the upper right. It came out after about a minute. It was tiny! I said so..."Almost like a bicuspid". The doctor said, "Not even that big." I said, "An incisor then." I am not sure why I was trying to show my limited knowledge of teeth names to DENTISTS. The assistant doctor said, "Nope an incisor has long roots." and my dentist said, "You flunked Dental Anatomy!" And then we laughed. Me: "No....no, I didn't!" *heh* The dentist said that the upper right wisdom tooth is a highly variable tooth--sometimes it is tiny tiny, and sometimes it is Huge. And "if you believe in evolution, the wisdom teeth are vestigal--our brain cavities are getting larger, and our mouths are getting smaller, so there isn't room for these 'third-order' teeth." I believe in evolution on optimistic days.
The last tooth, which was, yes, the lower right, also came out fairly easily. There was a bit of muscling involved...and when it came out, the tip of the root had broken off, but it was still hanging on to the tooth. The dentist said, "What luck! I meant to do that." As he pulled that last one out, a sizable bead of blood flowered bright red on christoph's cheek.
So the extractions were finished. Now, a new set of tools were brought in, and they prepared to fill the cavities in two of the remaining teeth.
The assistant said that she didn't really like this part much; that surgery really excited her. The dentist said, "I can see that, you're really good at it, and I don't mean that in a condescending way at all." I found the condescending comment interesting. He went on to say that he liked the variety of things he could do since he has an anesthesiologist's license; flexibility in the job.
On with the cavity fillings.
They had a pink plastic flexible shield (Think "Dental Dam"...wow.) attached to some metal prong-things which were put around the tooth with the cavity. A ballet skirt, if you will. He pulled out the drill, and began drilling the cavity out. This was a tooth on the upper left side. I watched the drilling. It seemed that the entire tooth was going to be drilled out; it was beginning to only be an enamel shell. I asked if he could tell when it was all out, was it color or amount of resistance? He said, "Both". The assistant said, "The rotten parts of the tooth are so soft that you can literally scoop it out with a spoon."
When the dentist finished drilling, dentist-person brushed a little bit of what smelled like wart-killing medicine on the inside of the tooth. I asked what it was, and the dentist said, "It's an old technique that I really like; it's a type of varnish."
I could see the whorls of the root of that tooth in the bottom of the hole. I thought about photographs and studies of the contours and shapes of teeth. They're quite amazing.
After the varnish dried, they filled the tooth with white stuff which had been shaken up in a tube in a tiny little machine. It was a silver alloy; the little shaking machine was needed to activate the mixture; the assistant then put the mixture in a little mortar, and used a silver wand as pestle. The pestle had a little opening in the hammer-top so that when she "mixed", the silver alloy went into it. It had a setting time of 10-15 seconds, so she had to quickly hand it to the dentist; he pushed on the pestle and the mixture went into the tooth. Then he artistically made the filling align with the contours of the tooth. It was neat to watch that.
The assistant spilled the "varnish" then. But it was okay, because it was "cheap". But um, it sortof stank.
The filling didn't look silver at all, but I was told that later it would look like regular old silver. The assistant told me exactly what was in the alloy, but I cannot remember. Three ingredients. :)
For the next tooth with a cavity, since I was interested, I suppose, the doctor had me look over his right shoulder. (Before that I'd been looking over the assistant's shoulder, on the other side of the chair on which christoph was lying.) This tooth was on the upper right side. As he was drilling this time he pointed out the difference in color between the rotten parts (brown), and the healthy parts (ivory). "The English and dental term are the same: a cavity is literally a hole in the tooth."
Just now I really wish I had pictures.
He drilled quite a bit. There were two holes the bacteria had made inside that tooth (I was amazed at how deep and wide the cavities were); he pointed out that one was much closer to the root/nerve than the other. So he put a special white insulating material into that hole to make it the same level as the other. He specifically pointed that out while the tooth was drying. I could only think to say Wow. Part of the purpose of the insulation was to make the tooth less sensitive (to cold, et cetera).
Then they filled that one. Finished exactly on time. Took all of the tubes off of christoph that they'd spent a half an hour setting up. Dentist said, "Yes, I know you'll be disappointed, chris." (since he was taking all the drugs away.)
The assistant doctor had asked me at some point if perhaps dental school was for me. Am I not too old to start something completely different? I've never thought about being a dentist. Something to percolate.
Anyway, the dentist mentioned that it was unusual to have a spectator during surgery. I thanked him and told him that I'd found it very interesting. He said he was used to it, from students and other doctors watching at UCSF.
Then he left, and the assistant cleaned up the room amazingly fast. Soon it looked as though nothing had occured there. Before she took the tray with the bloody teeth on it away I told her that christoph had wanted to keep the teeth. She said, "okay, but they are really infectous right now, so I'll run disinfectent over them and we'll see what we can do."
She brought them back in a little plastic box--but not including the tooth that broke.
Christoph was sortof there...she told him that I'd watched the entire thing; that they were impressed.
Christoph said, "That's because she likes blood."
She said, "People in the medical profession like blood. That is why we're in it."
I had to laugh. ;)
The effects of trauma, emotional and physical, on the human body are veeerrryy interesting.
Also, the triple point of view: 1) the clinical watching of human teeth and surgery on them, 2) the sympathetic human response of "how would that feel" and knowing the aftereffects of the trauma to the mouth from personal experience, and 3) caring deeply for the person who was having the operation.
My apologies for poorly constructed sentences. I am surprised by the detail.