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Anesthesia free dental work

            We were about five minutes into the wrestling match and still hadn’t made much progress in identifying the source of the evil smell coming from Carmella’s mouth.  Normally she was a friendly and outgoing Boston Terrier, but she just didn’t understand why this stranger was trying to pull her lips back along the sides of her teeth.  I think she suspected I was trying to smother her, so she was whipping her head back and forth and up and down trying to buck me off like a bronco.  I briefly wondered if my own dentist ever reflected on how lucky he was to work with patients who comprehend the process and play along, making his dental examination and treatment a relative cakewalk. 

             I finally gave up trying to force the issue, turned Carmella’s head loose, and without touching her just peered inside her mouth as she panted .  I got a fleeting glimpse of red gums, and blackish tartar on her upper first molars, way in the back of her mouth.  They were most likely abscessed, causing pain as well as stink, and they almost certainly needed to be extracted in order for her mouth to be healthy.

            The estimate to have Carmella’s dental problems addressed included pre-surgical bloodwork to make sure there were no surprises like surreptitiously compromised kidneys or liver that would spell trouble down the way,  IV catheter and fluids for systemic support during what was probably going to be an hour long procedure, general anesthesia, dental x-rays for teeth that were of questionable soundness, surgical extractions, ultrasonic scaling, tooth polishing, pain medication, and antibiotics.  It was several hundred dollars.

            A few days later Carmella’s owner called with questions.  He couldn’t understand why this procedure was so expensive.  He had spoken to someone who said that she could do an anesthesia-free dental cleaning which would be much safer and could be done at a fraction of the cost.  She had also said that that rather than extracting the teeth she would  be able to clean them up and save them.

            I asked Carmella’s owner to take a moment to consider how effectively her teeth could be treated by someone poking sharp instruments into her mouth when she wouldn’t even let me lift her lips with my fingers just to look at her teeth.  The truth is that even with an extraordinarily cooperative awake patient the best that can be achieved is scraping the most visible tartar off the outside surface of the teeth.  Although the teeth  look better, nothing effective has been done to remove the tartar under the gums that is the real source of problems.  The enamel on the teeth would be gouged by the instruments and not polished, so in the future tartar would build up faster.  Because infected teeth cannot be cured with antibiotics alone they must come out for the mouth to be healthy, and it is impossible (or at least inhumane) to extract them without anesthesia.  A thorough exam of the entire mouth to determine which teeth are sound and which are not, a process that often requires x-rays to be taken from inside the mouth, also cannot be accomplished without anesthesia, no matter how nice a patient is.  Chipping the gunk off the outside of rotten teeth does make them seem prettier for a while, but it doesn’t qualify as “saving” the teeth.  A more accurate description would be willfully allowing a serious medical problem to fester.

            In the end the decision is up to him--A lower cost procedure that would involve an hour of thrashing and struggling with Carmella to achieve a halfway cleaned up mouth with all serious problems left untouched, or a more expensive procedure done painlessly and thoroughly that would lead to actual oral health in the long run.

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