Before You Complain about Your Dentist
March 2007
We’d polished off a roast beef dinner, and as a treat were having do-nuts for dessert. As dad bit into his donut we all heard a loud crack. His jaw went rigid, and his neck and face flushed an angry red. Glaring pointedly at my fiancé, he cursed all dentists, then got up and left the table. Too young yet to have had such problems ourselves, we all laughed hilariously.
When it comes to my teeth, the problem is gold crowns and onlays. First of all there’s the pain and expense of getting them, which is surely enough. But just to make matters worse, it seems that one of them insists on coming loose and falling off when I’m traveling in some far-away country, nowhere near my dentist.
This time, it happened in Jaipur India. We were at an old and rather tired, but once elegant theatre, watching a Bollywood movie. We’d bought pop-corn, which I was enjoying until I bit down on something bigger, and more jagged, than an unpopped kernel. My tongue separated and pushed out the little golden nugget. I spent the rest of the movie exploring what was left of my tooth with my tongue, holding the onlay in my sweaty palm, and wondering what I was going to do.
As we had tickets to go to Jodhpur the next day, I decided to wait. As soon as we arrived at our hotel in Jodhpur we asked our host, the ever-helpful Mr. Govind, if he could recommend a dentist. He said there was one just below the hotel, but that he was “very costly, too costly I think.” He volunteered to make an appointment for me with his own dentist, who was a 15-20 minute rickshaw ride away. We decided we’d try the “costly” man first. Naively I hoped that “costly” might also mean “good.” I was hoping he could just glue the only back on, with temporary cement. Then I’d have it done properly when I got home.
When we arrived at the dentist’s office, we found the dentist, dressed in an almost white cotton shirt and pants, standing in his little “waiting room” (waiting for customers?). The waiting room was open to the street, as almost all shops and offices are, and contained a few old chairs and a small rickety table. I explained my problem, and showed him my onlay, which I had removed and cleaned with my toothbrush as well as I could. He pounced on me like a hungry cat on a helpless mouse, and insisted that of course he could fix the onlay: “no problem madam, no problem at all! Come and sit down!”
He evaded my question about cost, instead making a great show of washing his hands in a very old enamel sink with only one (cold) tap. He pumped the soap dispenser vigourously, but no soap came out, and there was no lather. Nevertheless, having gone through the motions for MY benefit, HE was satisfied.
While he was doing that, I lowered myself gingerly into his decrepit black vinyl dental chair and surveyed the fixtures and equipment around me. It was exactly the sort of place that I had just finished telling my husband that I was dreading. The drill, which thankfully I did not anticipate being used, was ancient, and so completely covered in dust that I could not imagine that it had been used for a very
The chair side sink on my left was of once-white enamel, very stained, and very dirty. Clearly it wasn’t the dentist’s job to clean it (no upper caste Indian cleans up after themselves - that’s what servants do). It looked thoroughly disgusting, so I shifted my attention to the metal tray before me, which was littered with an array of dirty, dulled metal dental instruments. I don’t suppose they had ever seen the inside of an autoclave, and wondered if they were even cleaned. Although there was a good selection of them, there wasn’t one that I wanted anywhere near my mouth. Directly across from me was a wall with three open shelves on which were arranged a few old boxes, some papers, some bottles and other dental debris. The certificates on the wall, which he pointed out to me with great pride, indicated that he had graduated from the Bombay University some 40 years ago. I presumed that his chair, drill and equipment dated from that time. It was quite possible that none of them had ever been cleaned!
The certificates on the wall, which he pointed out to me with great pride, indicated that he had graduated from the Bombay University some 40 years ago. I presumed that his chair, drill and equipment dated from that time. It was quite possible that none of them had ever been cleaned!
After washing his hands, and drying them with a singular piece of tissue, the dentist asked if he could inspect my onlay. Holding it like a precious gem (which in fact it was), he voiced his admiration – “very fine work, very nice” – and then asked me to show him the tooth on which it should fit.
The moment of tooth – as it were – had come. Would he want to poke at my tooth with one of his dirty instruments? Would he put his hands in my mouth? Thankfully, he just looked, pronounced that it looked “very fine, no problem,” and asked me to put the onlay on my tooth so he could see how it fit. I did this two or three times until he was satisfied he’d gotten the hang of how to do it.
Then it was his turn. Working of course without gloves (I doubt he had any), he put the onlay on the tooth three more times himself, marveling at the very good fit. “Oh, this is very fine. They are doing such very fine work in Canada. Too fine, too fine!”
We were ready to cement the onlay. I reminded him that I wanted him to use a temporary cement. “Yes, yes, I am understanding what you want, no problem, no problem at all!” he replied. But of course there was a problem.
After some rummaging through a cupboard filled with dusty old boxed he found a particularly old and battered box of cement. He presented it to me with a flourish: “Principal cement,” he exclaimed, “the very best, from America, the very best!”
It was clearly the only box of cement he had. It was a complementary “starter kit” that had been sent to him in 01/06, either January of 2006 or June of 2001, depending on how the expiry dates were written (why can’t they use letters for the months?). Furthermore, it was definitely a permanent cement. I had no idea if it would hold, but tried to look suitably impressed, and nodded my weak assent to its use. I felt like I had little option.
The dentist then made a show of pouring some alcohol over my onlay, “cleaning” it with one of his dirty metal picks, and then putting a cotton ball, held with some equally dirty tweezers right into the bottle (how many times has he done that before?) and swabbing the onlay more carefully, mixing all the germs around quite nicely, I’m sure.
Once that was done, he got out an old slab of marble and started mixing the cement, a white powder which he measured carefully with the enclosed plastic spoon. He then put three drops of liquid from the little bottle onto the slab, and using one of his dirty dental spatulas began to mix the two together.
I watched with a mixture of fascination and horror. I hoped that the cement would be powerful enough to kill any bacteria that might be lurking on my onlay, the spatula or the marble slab. By the time he was finished, the cement was a drab gray and distinctly unhygienic looking colour.
The dentist asked me to open my mouth again, and before I realized what was happening, he liberally flooded my tooth with whatever water flows through his antiquated sprayer. He didn’t need to tell me to spit. Indeed I was in such a hurry to get that water out of my mouth that I didn’t stop to think about the dirty sink, until it was staring me right in the face. I closed my eyes and spat.
Then he sprayed some air at the tooth, and told me to keep my mouth open. He was preparing to cement the onlay. I hoped he would get it right. The fit was a little tricky, as it looked like the onlay should fit one way, but it actually fit another.
Just before he cemented the onlay, as I was dutifully keeping my mouth open, he brandished a pick towards my mouth and started to poke at the tooth. I recoiled in real fear, visions of swarms of Hep B, HIV and AIDS viruses trapped under my “very fine” onlay, and made a noise something between a scream and a burp. He only got one brief touch in, but that appeared to satisfy him, or else he was afraid to do more, lest he upset me and I refused to pay.
He managed to place the onlay onto the tooth without any difficulty, although where the glue had come in contact with my lip it stung fiercely, and I could feel a burning sensation on the tooth, under the onlay. This actually gave me considerable comfort, as I figured the
Once the onlay was in place, the dentist exhorted me to “bite down, bite down as hard as you can.”
The dentist suggested that we wait ten minutes for the cement to set up. He tested the cement that remained on the marble slab several times. Each time, it looked the same to me – gooey like thick honey.
After fifteen or twenty minutes, the dentist declared he was satisfied, although the cement looked about the same consistency to me. Certainly it had not “hardened.” At this point I was not too optimistic about its holding at all, let alone holding for the three weeks I needed to get home.
The fee for all this was a whopping 500 rupees ($15), which though expensive by Indian standards I gladly paid, just wanting to get out of his ‘care.’ At my request, he wrote out a receipt on a piece of his letterhead, carefully ripping the Hindi version of his name and address off of the bottom of the sheet. Perhaps to justify his exorbitant fee, he then gave me four little hand-rolled paper tubes of some sort of powder. He very carefully and patiently instructed me on how they were to be used.
I was to dissolve one packet in warm water and rinse my tooth in it, spitting out the mixture, NOT SWALLOWING IT! I was to do this that night, tomorrow morning, and tomorrow night. The extra packet was precautionary, in case I made a mistake. He even wrote out the instructions in diagram form, in case I could not read (as many of his patients cannot). Then, coming out into the waiting room with me, he repeated the instructions to my husband, who was to make sure that I followed his instructions to the letter. He then went on at some length about what good cement he had used, and how this repair would last me for years, not just mere weeks, and how if I had any problems, “any problems at all,” I was to come back and see him straight away.
Finally we managed to get away, and I spent the next several hours with a wad of cotton between my teeth, waiting for the cement to “set up.” The next morning the onlay felt both “high” and insecure. So I again spent several hours with some folded up toilet paper between my teeth, wandering around Jodhpur with clenched teeth, hoping for the best.
I am avoiding eating anything sticky, and trying to be even more vigilant about avoiding hard bits. This is not so easy to do, as in pretty much every meal there is at least one, and often several, hard bits of seed, nut-shells, sticks or stones that have escaped the notice of the women who sort the rice and herbs by hand. One eats “on guard for teeth,” chewing tentatively at first, trying to remove any hard bits before they have a chance to do any damage. Dental woe befalls those who are careless or forgetful!
Post Script: The onlay did last until I got home, and to my own dentist, who took a look, and some x-rays, and gave me the bad, if predictable, news: “I’m afraid there’s decay under the onlay. It wasn’t seated quite right, and it’s leaked.”
A few visits, the usual discomfort, and $800 later, the onlay was replaced by a full crown. But… the dentist, and all of her staff, loved the story. So the tooth had a gold lining – for someone.
Above photo actually taken on another trip, in Morocco....
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