March 15, 2003

A Pain in Any Case: A Parable for the Ides of March

location of tooth #12Over the course of the last month, the pain in my lily-livered liberal all-American heart has only been exceeded by the pain in my #12 all-American tooth. Each conveyed a kind of dull, background ache as I carried on my daily routine. When focused on other things, like coding Web sites or writing, the discomfort seemed to disappear. But when I sat quietly for a moment, with no outside interference, I felt #12 pulse rhythmically.

As things started to heat up in the Persian Gulf, so too did the searing in my upper jaw. I drove 40 miles in a driving rain to my dentist (a holdover from my life in a nearby city). X-rays ensued. A little decay behind a deep filling but he didn’t think that should have cause this much pain. To be on the safe side, he’d start with a visual check and replace my aging filling.

“Hmmm,” he said, as he rummaged around my mouth. “There’s more decay than the X-ray showed. That’s not unusual. Even Superman couldn’t tell without going in and looking directly. Yes, that could cause your pain.” That was somewhat assuring. It wasn’t just in my head. He gave me a nice new porcelain-colored filling (my daughters want to know what those older, mercury-filled “dark spots” are on my teeth). And we hoped that would be the end of it.

For two glorious days I was pain-free. This coincided with Saddam’s destruction of his illegal long-range missiles. Inspections, both in the Gulf and in my mouth seemed to be proving a success.

But then, as negotiations for a new U.N. resolution seemed to falter, my pain returned. It was time to take the next step. While Colin Powell tried to persuade African countries on the Security Council to vote pro-American, I, too, was in deep negotiations to secure a good (and gentle) endodontist. For the first time in years, the words root canal entered my lexicon. I hadn’t been “here” since my last one twelve years ago. And things had obviously changed.

It’s no longer a two-day procedure. My newly found specialist, Dr. Eda Elbirlik, uses all the latest technology including digital X-rays. No film and as soon as the technician runs behind the ray-proofed screen and you hear that beep, the image appears on the doctor’s computer monitor. I was intrigued. I was to be her very last patient for a while. She was nine months pregnant and due momentarily.

After concise analysis of the data, though, she was not convinced #12’s time had come. “I’m a conservative…” I winced. Political identification is rampant in this city but, really, medical ethics should prevent it from entering the examination room. “…in these matters. I don’t want to start the procedure only to find out it was the wrong tooth.” I relaxed.

She did further tests as she tapped and applied hot and cold to each tooth. The pain was not localized, that is, we couldn’t tell which tooth it was coming from. The nerves are all interconnected. Nothing. Nothing out of the ordinary. She was gentle as she worked and made sure I was not in any undue pain.

She removed her mask and gave it to me straight. “I want to watch this for a while and see what happens. Come back in 72 hours and we’ll recheck.” I knew this would happen. When I go to the doctor I like to come out of the office with resolution. Again, my tooth’s condition seemed pegged to world events. Everyone was waiting.

Three days later I returned. My pain had actually subsided somewhat. And I had used the time to study it carefully. I was pretty secure that I would once again come out of the office the same as when I walked in. Nothing much had changed. The pain was there, off and on.

But when the doctor sat down she told me she had been studying this case. In examining the evidence she was pretty sure #12 would need a root canal, if not now, within weeks. Number 11 might need one too, but that was less likely. She could do both at once but that would be quite a financial investment (the cost of war pales in comparison to the cost of a root canal on a per capita basis).

I gave the thumbs up. And she prepared for battle.

For those of you who have never had this procedure, let me briefly outline the plan of attack. When the roots of your tooth start to die or become infected, that causes pain. In my case, both tooth 11 and tooth 12 have deep fillings that are very close to the nerves of these teeth. Given the cavity that had formed in #12, it was possible the nerves (or more precisely the pulp under the outer layers of the tooth which contains the nerves) were traumatized and causing my pain. To save the tooth, the dentist removes this area and replaces it with “root canal filling material.” Essentially, after it’s over, you have a tooth with no sensation.

Root canals cannot always save the tooth. During my last procedure in the early 90s the dentist got through 99% of the two day procedure only to suddenly pack up his materials and announce: “I couldn’t save it. You’ll have to have it pulled.” The very next day I sat in a new dentist’s chair and within seconds I had one less tooth. It was scary how easily that tooth came out.

X-ray of the real tooth

I was luckier this time. When Dr. Elbirlik actually opened the tooth, she confirmed her suspicions were correct. The tooth would have gotten worse if it hadn’t been treated. My roots were in the early stages of decay. But they weren’t infected. Like computer-guided bombs we’re shipping to the Middle East, her tools worked precisely. I was hooked up to her command center’s computer which told her just where she was in my roots. The procedure took all of an hour and I was walking out of the office with post-procedure instructions in hand and a lot less money in my bank account.

When I returned to my office the next day and announced what I had just gone through everyone was amazed. “You’re not swollen at all!” they remarked. I was in a good mood. Nothing sours my day like a cloud of uncertainly hanging over my head. While the prospects of an American Empire still clouded the horizon, this was one issue I could check off my list.

And then the phone call. That morning Dr. Elbirlick was reviewing my X-rays. Like her counterparts at our military’s Gulf Command Center, she had been scrutinizing my photos. And she thought she saw a third canal! Most teeth have two. Some have one but very rarely does a tooth have three. I was an anomoly that had to be investigated.

Just when I thought this had come to a sensible and comfortable resolution, I was suddenly back in that chair. She reopened the case as she prodded and picked, searching for that third root. X-rays could only indicate the possibility. It required a direct and observable incursion. Whereas the initial procedure took about an hour, this time I was in the chair for almost two. It was the elusive inspections all over again.

When her visual acuity failed her, she brought in the laser-guided microscope. Where was that third canal? Was it even there? I could see her working in the reflection of the lens. Its distortions only magnified my concerns. She called in her associate, Dr. Hsu, to search with fresh eyes. They wanted to make sure they had inspected every conceivable hiding place. They were searching for a weapon of mass destruction. The entire tooth could be wiped out if this third root went ballistic. The domino effect wouldn’t be far behind. My whole mouth could go down.

But they didn’t want to push and prod too hard. “I don’t want to perf,” I heard her coworker announce [perforate the surface of the tooth]. This military-dental lingo. Was it meant to obfuscate? What was happening? It was tense. Was I an anomaly or wasn’t I? Just where was that third root? Just what weren’t they telling me?

They never found that extra root. They looked everywhere. It might have once been there they concurred, but if so it was calcified now and offered no further danger. I was relieved, if only temporarily. I have thirty-one more teeth. Each region of my mouth could suddenly become a flash point of ruination. I would have to be on guard. Pain would be my global early warning system.

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