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When I was a resident and teaching fellow at the University Of Pittsburgh, I had the distinct pleasure and duty of supervising 3rd year dental students administering their first injections of local anesthetic.
Lots of fun and games ensued from patients hollering and crying and even some dental students throwing up on the floor. It was a real learning session not just for the students, but for me as well. I did my best and tried to teach them not only proper techniques but the proper chairside manner in which to approach and talk to the patients. One clinic in particular was extremely stressful not only for the students but for me as well. One student just stood in front of his patient holding the syringe, muttering to no one in particular, “I can’t do it, I can’t do it.”
We all reach a stage in our lives when we begin to think back and review the years that have passed us by. There is an old Amish saying that goes as follows: “Ve get too soon old, und too late schmart.” How true that really is. When we were young, our parents did the best for us and in the majority of cases we didn’t really have to worry about money or room and board. With my generation, parents would sacrifice their own wants and desires to give to their children. We wore nice clothing and never thought about what they cost or how our parents skimped or saved to purchase them for us.
As I look around and observe the many general dental and specialty practices today, I note that a very large number of them are involved with implants, all types of implants. Some are long, some short, some thin, some fat and some thinner and fatter.
There are many companies that manufacture implants and each and every one claim that theirs are better, stronger, more durable, more accurate in fit and more reasonable in cost. Who do you believe? Do you take a guess and just close one eye and pick the one that has the best designed packaging? I don’t know the answer myself and I wonder how others make their choice and selection.
Never in my wildest dreams did I ever think that a question concerning the safety of a harmless toothpaste would ever be asked or considered. However, in this day and age, this has now become a serious problem.
Several products manufactured in China have now become suspect and the citizens of this country and others have been warned not to purchase or consume them. Toothpaste is one of them. Manufacturing companies in China apparently have added ingredients to these products that are dangerous to human and other animal life. It is well known that some dog and cat foods manufactured in China contain deadly ingredients that have been responsible for serious illnesses and even the death of many precious and dear pets in Canada and USA. Now we have been warned that milk products that are sold and fed to infants and young children, contain melamine that has been implicated in causing severe kidney damage and the deaths of many Chinese children. We are also warned here in Canada not to purchase or consume certain brands of candy manufactured in China as they may also contain melamine, which is a chemical used in making plastic products.
Sub Acute Bacterial Endocarditis (SBE) is nothing to joke about. Several years ago I read of the death of a nineteen year old female who died in one of our major Toronto hospitals. Extractions were performed on this patient who had a history of a heart murmur, but she was not given preoperative antibiotics.
This is not the first case of this nature where the patient died following oral surgery. Several cases have been recorded of deaths that relate to the failure to provide adequate antibiotic for patients who have a history of rheumatic heart disease, mitral valve defects and other cardiovascular diseases that affect the heart muscles and valves.
In a recent issue of Spectrum, I wrote about the pitfalls and negative aspects of our health care system in Ontario and Canada. I still feel that there are imperfections inherent within the system that must be changed and many improvements made. However, shortly after my article was published, I had an opportunity to witness the positive side of our health system which I will now relate to you. Around the middle of May, late on a Friday evening, I began to experience abdominal and back pain so severe that I begged my wife to take me to the nearest hospital. I was admitted in the emergency room shortly after arrival. The ER physician examined me and ordered a myriad of tests and an ultrasound. Less than two hours later I was given the diagnosis. The pain that I was experiencing was from my gall bladder. It was inflamed and full of stones. It had to be removed pronto. I was given a prescription for pain medication to make me comfortable and within a few days my surgery had been arranged.
When I opened my office in Newfoundland to practice general dentistry, Cecil Snooks was one of my first patients. A real tough fisherman, he had lost all of his upper teeth when he was about twenty years old and had gotten his first denture as a Christmas present. When he sat in my chair the upper denture was already over thirty five years old. Cecil needed a new denture and was referred to me by one of his sisters.
“I needs a new plate sir,” he said to me as he squeezed into my new chair.
“Dis one keeps fallen out every time I opens me mouth.”
Cecil was a very cooperative patient and when I inserted the impression material in his mouth, he became as still as a dead mackerel. It seemed like eternity until the material set and then with the flare of an experienced dentist which I was not, I popped the tray out of his mouth. Cecil spit some of the excess material into his worn, red hanky and with a smile said to me, “ I tought she was stuck for good just like a fish hook in a salmon’s mouth.”
We both laughed and I advised him that he must return on Tuesday for a try-in.
“Ok sir, “ he replied as he jumped out of the chair. He paid me a deposit and disappeared out my front door.
Bright and early Tuesday morning the phone rang. I answered the call and found myself speaking to one of Cecil’s married sisters.
“Doctor, this is Mary, Cecil’s sister. Cecil won’t be comin in today for his teeth,” the voice said.
“What’s wrong with Cecil,” I asked, “is he sick?”
“Yes, he’s real sick, sir. He’s dead,” she replied.
The patient sat nervously in the dental chair watching as the dentist examined the x-ray of the upper left 2nd molar. She grasped the arms of the chair as he probed in her mouth with a sharp explorer. Finally, after much prodding, pushing and digging, he announced to this frightened mass of a nervous wreck: “The tooth is too far gone and can’t be saved.” The roots are all exposed and there is extensive bone loss all around.” I’m afraid it will have to be extracted.” Without skipping a mbeat, he proceeded to add more local anesthetic to the already anesthetized tooth, which sat alone just below the maxillary tuberosity. I guess when his professor in dental school announced in class, “Beware The Tooth That Stands alone,” this guy was playing hooky.
He adapted the molar forcep to the tooth and began to luxate vigorously heaving from buccal to palatal surfaces in an attempt to lift the tooth from its bony crypt. Back and forth, side-to-side, the forcep and the tooth gyrated until there was a loud cracking sound that could be heard all the way out to the reception desk. “What the hell was that?” his secretary asked to nobody in particular.
The importance of recording a patient’s blood pressure cannot be argued or ignored. The levels of both the Systolic and Diastolic tell us a great deal about the status of the patient as they sit, stand or lie down. Hypertension can be one of the first signs of many medical conditions such as cardiovascular, kidney diseases and cancer. Do you remember the last time you visited your family physician for an annual check-up? What’s the first thing he/she performed as they examined you in their office? Correct. They took your blood pressure. They didn’t administer any medications, they didn’t give you any injections, they just sat you in a chair or on an examining table and told you to roll up your sleeve. Just the thought of it and the apprehension made your blood pressure go up by about 10 points or more. My physician takes my pressure even when I return to have my prescriptions renewed. Some patients have an automatic pressure machine whereby they check their own pressure on a daily basis. Not a bad idea being aware of one’s own vital statistics and quite simple to perform.
Now however, let us take a visit to the dental office of Dr. Tom Molar and Dr. Winnie Wisdom. They both practice together and as well as performing many procedures relating to esthetics, they also do a lot of surgery. Their first patient of the day, Mickey Muchnick, is a 49 year old male, heavy set, overweight, and a heavy smoker. His medical history records that both his mother and father suffered from hypertension and heart disease. His father died at 52 years old following a heart attack. The patient presents today for the extraction of eight badly decayed teeth.
Every day I am thankful to my maker for the health he has given me and my family. The competent members of the medical and dental professions and all of the allied branches have made my life a beautiful thing. In my case, the hand of fate, knock wood, has provided me with a strong mind and body that I enjoy and utilize to its fullest extent. Are we all fortunate in receiving this blessing? My observations tell me that this is not the case.
A short while ago my brother, an oral surgeon who lives in California, developed a bad cold. The situation deteriorated and the cold became pneumonia. Extremely ill, he was rushed to the hospital where he was admitted and treated on a 24 hour basis. His lungs filled with fluid and he eventually progressed into congestive heart failure. The heart has a big job pumping blood through the entire body under normal conditions, but now, it had to work even harder against the severe high pressure built up by the fluid in his chest and lungs . The situation turned from bad to worse and as his family sat by his bedside, the specialist warned us that the prognosis was not very good. He was given massive doses of diuretics to help the body eliminate the fluid that was making it difficult for him to breath and placing a terrible strain on his heart. The medication was working but not fast enough as the fluid eliminated was replaced immediately with more at greater amounts.
Many years ago, as a young dentist and recent graduate, I tried my best to follow the appropriate methods and techniques taught to me in dental school. Most of the time I succeeded, but sometimes I failed. Let me give you an example: I attempted the extraction of a lower first molar shortly after I opened my office in Corner brook, Newfoundland, on a rather large and nervous male patient. If this wasn’t enough, I was more apprehensive than he was. During the course of the surgical procedure, when he zigged and I zagged, the apical third of the mesial root fractured. Despite my shock and exhaustion, I immediately explained the situation to him and said that between the two of us, the root would be removed. At no time did I attempt to conceal this fact from the patient nor to leave the infected root in the socket, despite the fact that I was more apprehensive now than when I started. I was honest with the gentleman and despite his disappointment; he was very forgiving and understanding. Practicing in a small town where there were no specialists, I did a lot of surgery that probably should have been referred to an oral surgeon.