the Root of all evil

I have a congenital orthopedic flaw.  I walk with my right foot about 30 degrees out from the proper alignment.  The flaw is in my genes and therefore has been passed on to my children and grandchildren.  It can be corrected by leg braces but, of course, this does not pass on to later generations.  

This flaw caused me to wear out the heel of my right shoe faster than normal and this frustrated my mother no end.  As a solution, when I started junior high she had steel taps nailed onto my shoes.  It was too bad I didn't have  any rhythm because you could hear me walking a block away.  The taps reduced the wear on my heels and they also reduced my traction.  This led to an embarrassing accident which has had long range effects on my life.  Walking down the junior high school steps, I slipped and tumbled head over heels, finally coming to rest with my face firmly planted on the polished cement floor of the basement level of our junior high building.  I was able to pick myself  up and check to see that all systems were go.  It seemed that my front teeth were a half inch further back than they should be but a quick prying motion with my thumb solved that. Other than being shook up a little, it seemed that no harm had been done.

Was I ever wrong!  Not only had I chipped one tooth but I had also killed the roots on that one and two others.  And those  three teeth would cause me problems the rest of my life.  The latest incident was just yesterday.

For the past week I had felt a pressure irritation in my front gums, a feeling that I was familiar with.  In the past it has meant an infected abscess, a pocket of dead cells and pus.  My dentist concurred and referred me to a specialist, an endodontist.  Luckily, I was able to get an appointment for a consultation even if it was 8:45 Friday morning.  I knew by experience that this doesn't go away so the quicker I could handle it, the better.  The consultation went well, almost exactly what I would have predicted.  Of course there were some unknowns because you can see only so much with an x-ray.  Only when you actually operate can you see what needs to be done.  But it looked like a "simple" operation taking less than an hour.

As I was negotiating an appointment next week for the operation, word came that an afternoon appointment had been canceled.  Would I like to come back Friday afternoon?  Well, yes and no.  I wanted it taken care of but I was still trying to used to the whole operation thing.

At 3:00 I came back.  At 5:30 I was standing somewhat unsteadily at the front desk to pay our portion of the $1,500 bill.  This was not the Friday I had planned for.  And of course the worst was yet to come as the anesthesia started to wear off and I could start feeling the incisions, sutures, and blunt trauma done to my gums.  I can tell I won't be doing much this weekend.

Dental computer

I had my teeth cleaned this morning. George, my dental hygienist, picked up my chart from the reception area and directed me back to the chair he was using today. He asked me to sit and when I was comfortable, he clipped a napkin around my neck then lowered the back of the chair. He directed the light onto my mouth and picked up his tools to begin inspecting my teeth. He then did something I had never seen or heard of before except in science fiction movies. He said, "Computer, listen". I was astounded. I was impressed.

For the next 2 to 3 minutes as he checked the gum pockets around each of my teeth, he called out numbers such as 2, 2 to 3, 2 to 4, 4, 2, etc. Every once in a while he would call out a tooth number such as "tooth #9". I kept expecting a reply by the computer like "Yes, master George" but it never came. Finally, George said, "Computer, exam save. Computer, sleep."

At previous visits, George has measured my gum pockets and called out the numbers but it has always been an assistant who has written them down, a human assistant. Then someone, either George or the assistant, had to input the numbers into the medical record. This time, thanks to voice recognition software integrated with the medical record system, the entries went in directly. George said he really liked it.

As we finished up and George suggested that we get together in 4 months, he made the appointment right there rather than having the receptionist involved. It felt a little more personal and didn't take much of his time. He also gets a feel for how business is going as he looks over the upcoming appointments.

I've been very impressed with this dental practice and highly recommend Arden Oaks to anyone in the northeast Sacramento area.

A crown, a crown, my kingdom for a crown

Having experienced the intake process and tooth cleaning from my new dentist and having been very impressed with both, I was interested to see if the same professionalism would be evident in a slightly more involved process - a crown.

One of the molars on the right side of my mouth broke a couple of years ago. There was a large filling in the tooth and there wasn't much to hold the side of the tooth together. But since it wasn't causing me any pain, hadn't exposed a nerve, and wasn't in danger of immediate decay, I postponed doing anything. Also, my previous dentist had put me through a very traumatic experience with the last crown I had fitted. I wasn't anxious about facing the same amount of pain and suffering.

But Dr. Fife convinced me that it really was time to take action on this tooth so I agreed. The procedure went in two steps. The first was to remove the old filling, prepare what was left of the tooth for a crown, take an impression for the permanent crown, and put a temporary crown in place. That step was slightly painful, about as much as having a normal filling. The dentist and his assistant worked around my bad gag reflex and worked about as quickly as I've ever seen.

The second step (which should be the easier and quicker of the two but wasn't for my last crown) involves removing the temporary, putting the permanent crown in place, and making sure it feels good. Everything went extremely well. The crown was just a micron or two high in one or two places but the dentist stayed with it until I agreed that it felt comfortable. I've learned from experience that just a small protrusion, like a rock in your shoe, doesn't get better with time.

Unfortunately, within two days the crown (or the tooth under the crown) had become very temperature sensitive. I was told that that wasn't unusual but usually it goes away within a week or so. When it still hadn't gone away after two weeks, I asked for another appointment. This time the dental assistant found a chunk of crown cement that hadn't gotten removed and the dentist decided the crown was still a little too high. With those two things taken care of, I was asked to wait another few days to see if everything would be okay.

So far it appears to be taken care of but after two weeks of additional pain that I didn't bargain for I'm afraid I'll have to say this was a B for Dr. Fife and his crew this time.

Getting to the root of the matter

Having my teeth cleaned has never been one of my favorite activities. The setting and pain involved usually have me imagining that I have somehow been captured by forces of evil who are hell bent on making me suffer for not flossing regularly. Sharp steel instruments and noisy sucking tubes are thrust into my mouth until I gag when I'm not wincing and vice versa.

I can't really report that my most recent teeth cleaning at our new dental office was pleasant. It wasn't. But it certainly went better than other sessions I have had. For one thing, George, the hygienist, kept up a running commentary on what he was doing, making me feel that I was somehow part of the team, not just the specimen under the knife. For another, George used a state-of-the-art ultrasound pick to scrape away much of the plaque around the base of my teeth. And lastly, he was quick. I was out of the office in half the time I've usually had to spend in the chair.

But my gums are still unhappy.

Evaluating the dental office

In a previous post about selecting a new dental office, I didn't explain what criteria I was using other than the physical facility. Actually, there were more criteria, specifically the following list that I had taken from the website of Stuart A. Greene, DDS, a dental practice in Texas.

1. Receptionist should be friendly on the phone and at the front desk
2. Be prompt and do not keep patients waiting
3. Do not let dental assistants do very much without first explaining things to the patient
4. Be willing to work out more flexible financial plans
5. Give patients personal attention and don't make them feel rushed like a number
6. Tell patients what is being done before charging them
7. Call and remind patients of their dental appointment
8. The office must look, feel and smell clean
9. Be more helpful in processing dental insurance
10. Explain sterilization standards practiced in the office

My problem was that many of these concerns can't easily be evaluated until you are actually a patient. That certainly doesn't mean the criteria aren't useful. I decided that I would keep them until after my first appointment and then compare the results.

I am happy to report that on the basis of the intake process, Arden Oaks Dental passed with flying colors. I saw evidence of positive responses for every one of these criteria.

Dental Intake process

Okay, so we got assigned to a new dental office by knowing the right people. But did we get the right dentist? With Carolyn out of town on one of her many field visits, it fell to me to try out the new practice.

Fortunately, they had an opening the very next day after we were accepted and had our coverage verified. Upon arrival, I was asked to complete a short but detailed health history. Then Milly, a dental assistant, escorted me into a room that had been specially designed for full jaw x-rays. It didn't even have an examination chair as the x-rays are taken with the patient standing. That makes it easier for the contraption to swing all the way around the head while x-raying the jaw. I was very impressed with the speed of the process. Of course the imaging is all handled by computer so there is no film to develop. It makes you wonder why anyone even thinks of using film anymore.

I was then led to an examining room and seated in the usual recliner. Milly took four more smaller area x-rays, again using computer processing rather than any x-ray film. Thus, the images were ready immediately. Before turning me over to George, a dental hygienist, Milly placed a battery operated blood pressure cuff on my wrist to get a baseline reading for that.

George then carefully examined the gum line on each of my teeth, calling out numbers to the dental assistant who was entering them in the computer as fast as he called them. After George finished, there was not even a minute's wait before Dr. Richard Fife came into the room and began examining my jaw for any motion problems, my mouth and throat for any evidence of cancer, and then each of my teeth in turn for fillings and crowns or the need for such. Very professional and efficient. Milly continued to take notes for each tooth as the doctor proceeded.

It took less than an hour and I had my dental records in place, an appointment for my next cleaning, and another appointment for a crown which I have been putting off for several months. I think I'm going to like this place.

Signing up for a new dentist

Our previous dentist (my cousin) recently retired almost coincidentally with our losing insurance coverage under my employment and having to switch to Carolyn's plan. The dentist who purchased my cousin's practice isn't in the group covered by our new plan. So we set out to find a new dentist. Unbeknown to us, the plan had actually assigned us to a dental office about 3 miles away from us but they had neglected to inform us of this assignment.

I called and visited several offices covered under the plan but didn't have much to go on. All were obviously acceptable to the plan and none had any black marks from state licensing. Some were in office complexes that weren't attractive or in run down strip malls. Another looked really good as it advertised "Spa Dentistry" where they can give you aromatherapy, a foot scrub, or even a massage while you're getting your teeth worked on. But it turned out they were no longer accepting new patients with this plan.

Another one that looked nice and had a great web site was staffed by members of our church but when I called the front office, they said they weren't accepting new patients covered by this plan. This time Carolyn took over, asking our friend in the church how to circumvent this restriction. He said simply, "Ask for Renee and tell her Ralph sent you." It worked.