Ignore It and It Will Go Away

You've heard people say this haven't you? Maybe it is something irritable that is bugging you and a friend tells you to just ignore it... says it will resolve itself on its own.

I remember seeing a billboard advertisement for a dentistry practice many years ago that said, "Ignore Your Teeth! (And They Will Go Away")

Last week was my birthday. Always thankful when the ol' life odometer flips to the next number. But it wasn't a very happy birthday. A couple of days beforehand, I started having severe pain in one of my teeth. And since it happened to be a tooth that had previously been crowned, I knew this was probably not going to end well... likely I was going to need either a root canal or, heaven forbid, an extraction. That back molar had cracked several years before and I apparently waited too long to have it crowned. When the dentist removed the crown and drilled down to verify the condition of the tooth and begin the process for the root canal, it turned out that the crack was pretty significant and the whole tooth was nearly split down the middle.

In 2009, I was fortunate to go on my 2nd mission trip to Ecuador. This trip was a medical mission trip and a few of us non-medical folks were there to assist the physician, nurses, clinicians, pharmacist, and the one dentist on the team. Turns out, I was assigned to help Dr. Rhoda Sword, our dentist.

The instruments

One of many teeth Dr. Sword extracted

Oh, she didn't let me anywhere near a patient's mouth... our job was to assist with setting up the trays of instruments,  supplies, etc., hold the light, and to clean and sterilize the multiple sets of instruments afterwards. It was fascinating to help and observe. Being in the remote areas of Ecuador, the primary treatment was extraction of damaged, unhealthy teeth. The people were so thankful to finally be rid of terrible tooth pain. But after witnessing dozens of extractions and the nearly medieval looking instruments involved in the process, I made a silent wish to never have to have that done in my mouth (I was asleep during my wisdom teeth removal.)

Fast forward 6 years, which was 2 years into my retirement... January 2015 I decided to go back to work. I applied for a job at a local dental laboratory. It was a great job for a former retiree... they were looking for a delivery driver. My job was to pick up and deliver "cases" to area dentist offices. Our lab made custom titanium abutments, crowns, and bridges (and other fixed prosthodontics.) Being nearly 60 years old, I found myself immersed in a whole new world that I had nearly zero knowledge of but, I needed to learn in order to perform my job well. Dr. Geoffrey Sheen is a prosthodontist (with a full-time dental practice) and is the owner of Mustard Seed Dental Studio (a dental laboratory) which is right next door to his practice. He was my boss and is the type of boss who doesn't just operate a business, he has a teacher mindset and believes that the people who work for him need to know so much more than just performing their specific job task. He teaches. I am the curious type and was fascinated with the whole world of dentistry and the dental lab. I acquired a whole new vocabulary that I previously had no clue about. I began to understand far more about teeth and how they are restored than I ever thought I would want to know. I kept asking questions, and he kept on teaching. (By now I was no longer the delivery driver... I was in charge of production and handled much of the customer service.) Two years ago, I left my job at Mustard Seed so my wife and I could move to Florida to be near our grandchildren. But...I left with a head full of knowledge that I would have otherwise never have known had I not gone to work for Dr. Sheen, one of the most brilliant people I have ever worked for or with.

So, let's get back to my tooth. Only because of what I learned while working at the dental lab, here's what I know. The dentist told me that my #31 (2nd molar... it's a mandibular molar...meaning it is a lower molar mesial to #32 which had previously been removed because it was a wisdom tooth) needed to be extracted. He also said that a bone graft would be needed and recommended the immediate placement of a dental implant, which would later be restored with an abutment and crown. Knowing that we would be leaving Florida in a little more than 3 weeks, I was troubled that one dentist would place the implant and another dentist would be doing the rest of the work (this is not unusual however, since it is not uncommon for oral surgeons, for example, to place an implant to later be restored by a dentist.) But, I now knew a bit about implants since Dr. Sheen did this nearly every day in his prosthodontic practice and we worked with implant cases every day at the dental lab. I asked him what brand of implant was he planning to use.

osseointegration under microscope

At this point, I should explain that a titanium dental implant is a medical device that is placed into the bone of the maxilla (if an upper tooth) or the mandible (lower.) The dentist or surgeon will cut the gum to expose the bone and drill the appropriate sized hole for the specific implant being placed. Through an amazing process of the human body called osseointegration, the cells of the bone, over time, actually adhere firmly around the titanium; its almost like the implant becomes part of the bone.

There are many different designs, sizes, and brands of dental implants. Each have various characteristics that the manufacturers claim are better or more suited to particular applications. I was familiar with nearly all the leading brands as well as the various clones of the brands that were more "open source" type, if you will. What I knew was that I didn't really want one that I had never heard of or was proprietary. If proprietary, it would possibly mean that the abutment which would be delivered later to support the crown, would probably have to be a stock abutment. Custom abutments are preferred since they can be designed to more exactly fit the unique patient's need as far as size, shape, angle, emergence profile and several other benefits that I cannot remember off the top of my head. When the dentist showed me the implant in the box, I realized that it was an implant brand that I had never heard of.  So, after extracting the tooth and getting all set up to do the bone graft (to restore the bone loss) and perform the implant placement, I said that I didn't want the implant placed... only do the bone graft. (Let me say here that the dentist, who was able to see me on very short notice, was excellent, very capable, and professional.) I just knew that, in 3 weeks, I would never see him again and he used an implant brand I was totally unfamiliar with. By not immediately placing the implant, I was choosing to push out the treatment plan timetable by 4-6 months or more... meaning, I would be without a #31 tooth for that much longer. And I had something else I needed to keep in mind. When we lose a tooth, it is not uncommon for the teeth that are distal to (meaning farther from the midline, or front of your mouth) the missing tooth to move. If I had lost #30 (1st molar) instead and still had #31, #31 could actually move mesially (towards the front) and begin to move into the space left where #30 was removed. But, since it was #31 I was having extracted, I don't have a tooth behind it to move forward. So, no worries there.

But here's another fascinating thing about teeth. Even though I don't have to worry about an adjacent tooth moving into that empty spot, I still have to realize that #31 had a partner. It's the tooth above it... #2, my upper 2nd molar. It is what is called the opposing tooth. You know how it's said that it takes two to tango? It also takes two to chew. You can't clap with one hand and you can't chew without an upper and lower tooth. My upper #2 has now (temporarily) lost its partner. Yes, I can chew on my right side with my upper and lower 1st molars but, those 2nd molars, which are typically larger, do it really well. But its not just chewing. When our upper and lower teeth are in occlusion (like when our teeth are clenched) the upper and lower teeth "fit" together a certain way (although there are different "classes" of bite.) In the more common Class 1 bite, the upper teeth overlap the lower teeth slightly.

As an example, an upper #3 1st molar contacts the #30 opposing 1st molar as well as the #31 2nd molar behind #30. But, because I now have no #32 or #31, my #2 upper molar makes no contact with anything when I bite. I've now left him hanging, at least temporarily. One option is to do nothing as far as replacing my newly lost molar. I mean I still have 27 other teeth to handle all my chewing needs. But, our teeth are amazing. Because #2 now has no opposing tooth, it is possible that my now 52 year old #2 molar could start to change. Teeth that lose their opposing tooth and now have no occlusal contact in maximum intercuspation (they don't touch any opposing tooth when you bite down) can begin to grow (erupt) as if seeking out its partner. In worst cases, they can, what is called, super-erupt, which, in addition to making it longer, can also make the tooth unstable. Our jaw bones are continuously trying to push our teeth out and it is the contact with opposing teeth that keeps our teeth in the proper position... maintaining the correct occlusal plane.

super-erupted molar

Dr. Sheen has reassured me that if we get the dental implant done in a reasonable time, even though I have extended the timetable due to my being "dangerous" with my still woefully incomplete dental knowledge, I shouldn't worry about my #2 upper molar going rogue and starting to get longer.

So, if you've made it this far you are likely thinking... "doesn't Mike think he is so smart throwing around all those dental terms and trying to show how smart he thinks he is and trying to impress somebody." But, you would be wrong. If I was so smart I would have taken much better care of my teeth and wouldn't have gotten all those cavities during my younger years, leading to all those fillings which eventually led to tooth failures that led to having to need more dental work done.

Ignore your teeth. And they will go away. I once had 32 permanent teeth (4 of which were wisdom teeth which I had removed.) That left me with 28. I really had hoped to make it to heaven with all 28 of my remaining, God-given teeth. But alas... I must say goodbye to my #31... 2nd molar. But, he'll be back soon made of titanium and ceramic. I'll take better care of him this time.