Yeah, in my last entry I mentioned that the dental hygienist commented on what good shape my teeth were in -- that comment only dealt with what good daily cleaning care I was giving them, not about any problems that existed there.
I've put a lot of time and effort and money into my mouth. I've had oral surgery multiple times, have had a number of root canal procedures over the past thirty years or so, and if you were to spot a tooth in my mouth without fillings you are probably looking at a tooth that has been crowned or capped.
I have one particular tooth (number 19, for those of you who understand such stuff) that has had a "guarded prognosis" for a couple of decades. About three years ago I had bone grafting done to repair some serious bone loss under that tooth. It seemed to have been very successful... at first. Then I got an infection that caused great pain and required antibiotics to cure. More recent x-rays indicated that bone loss was now almost as bad as three years ago and I had an appointment scheduled for treatment (including another bone graft procedure) in November. I had to postpone that because of a business trip to Pittsburgh. Then I had to go to France in December. Then my early January appointment had to be rescheduled for February because of a class I had to teach. In the meanwhile, in late December I began to experience bouts of pain in that area -- the kind of "discomfort" that wakes you up at night. I went to my general practice dentist and, as he put it, the "good news" was that this was not a healthy tooth going bad, this was number 19. He gave me the x-ray he had taken and told me that this was a job for my periodontist.
They consulted by phone and my periodontist prescribed antibiotics for the infection and scheduled an earlier appointment than my mid-February appointment. A week on antibiotics helped but a day or so after finishing the antibiotics the pain was back. My periodontist asked me to come in right away, checked it out and scheduled me for surgery Friday afternoon.
So yesterday I sat down in the dental chair around three o'clock and didn't finish until almost quarter past five. Once they got down in there (I ended up with two periodontists taking turns working on me) they presented me with some alternatives: one was to complete the bone graft procedure, but with little hope of it being a permanent fix, that in a year or two I would probably be back in again except with greater bone loss, etc. The other choice would be to remove the tooth in expectation of either doing an implant or a fixed bridge (numbers 18 and 20 both already have crowns)... I hated to do it, but I decided to have them extract the tooth and go for the implant. (Now this means I will eventually have two implants because he installed the required titanium screw to replace that broken tooth a few months ago and in another month or two I should be able to have the implant put in.) So they removed the bad tooth and then did a bone graft so that (hopefully) it will be ready to get its titanium screw implant in a few months.
One of the reasons I decided to go for the extraction was to permanently clear this infection because I am convinced that is the reason I have felt so exhausted over the past several weeks (I mean on top of travel and work and the cold and sore throat, etc.) and although this may be partly psychological, despite the soreness I feel in my mouth from the surgery, I already feel better than I have in weeks.
Before I close this entry I have to share a great story my periodontist told me. Please remember that this is Rhode Island and the Providence area is home to some families who may have certain affiliations similar to those depicted on "The Sopranos" -- yeah, you get the picture, right? So my periodontist is treating an older gentleman who owns a cement business. He has a very rough and raspy voice. He has two adjacent teeth that have been extracted and need to be replaced with implants. My periodontist has implanted the titanium screws but only one "took" -- the other needs to be done again. Making conversation while waiting for the novacaine to take effect, the periodontist asks the patient to explain the difference between cement and concrete. The patient says (you have to imagine a rough gangster voice) "Concrete is cement plus a little sand, maybe a little gravel, and maybe a dead periodontist if this don't work this time." My periodontist told me that he knew the guy was just joking around... but that nevertheless he was sweating while performing the procedure.