Tuesday, November 11, 2014

Dental Update: A Possible Resolution on #13; Recap of My Long, Difficult History with #14

**This entry was posted November 11, 2014.**

As an update to the sudden weekend recurrence of my chronic dental problems, I called at quarter to nine this morning and after a bit of to-and-fro with the receptionist on the schedule, I was able to get an 1150AM appointment at Dr. Tsaknis's downtown office at D and 7th Streets NW. I was seen by one of his dental associates (Dr. Suh) who saw me back in Sept. 2013 during one of several trips then to both Dental Bug offices.

To be clear, there is one D Street one and another on Massachusetts Avenue (and now a new one at L'Enfant Plaza).

Those trips were for treating an abscess (which simultaneously involved going to my medical doctor), necessarily extracting tooth #14* (Dr. Tsaknis did that himself), and having a cavity filled (on Halloween 2013, which Dr. Tsaknis also did).

*The numberings here are in the Universal Numbering System.

For starters, I was correct: I had a cavity on #13 -- the tooth just "frontward" of where that giant horse's tooth-sized gap is (and that is mercifully just out of regular sight).

Dr. Suh quickly and adroitly performed the drilling and filling. (That's not to say I wasn't a little bit scared with all that drilling and the horrible sound it always makes and the perpetual fear that something could go wrong.) However, the issue is that this tooth had another filling that was replaced today -- I'm not even sure when I got that or where -- and it and the cavity above it were perilously close to the root.


So while the issue is now resolved, it might only be a temporary resolution in that the tooth requires a root canal and crowning for which I would have to pay about $1,638.00. Yes, I would do it because any missing tooth #13 would in fact be visible for the world to see -- plus it would be next to another gap.

As of tonight I can't tell whether the tooth and its new filling are going to be fine or need the full root canal / crowning procedure. I don't feel any pain per se but I also get the feeling that the tooth is pretty weak and it is in a location that is contributing to the low-grade sinus problems and headaches I get. My guess is its 60-40 I will have to do it.

At this point, though, I made another appointment for Dec. 1st for a cleaning and to get yet another cavity filled (on #15). There is also the issue of one impacted wisdom tooth but I'm not going to worry about that now. Interestingly, tooth #32 -- a wisdom tooth -- has come in PERFECTLY in the 14 years since the ghastly episode back in Feb. 2000 during which severely infected tooth #31 was extracted at an awful clinic in Riverdale, Maryland and an near-fatal and severely facially disfiguring abscess developed and lasted for weeks.

(I was a poor student with no support and no insurance so I got the treatment you would expect -- nay, that libertarians demand you get -- in America. In the end, I only survived because of the antibiotics plus pain killers.)

The old Firemen's Insurance Building at the corner of 7th St. and Indiana Ave. NW, Washington, D.C., 1:06PM November 10, 2014. It's best known for its gleaming gold dome.

*******

Anyway, back to the present, that's how the day shook out. After the cavity was filled, I walked to my office at L'Enfant Plaza across the Mall, which is incredibly blocked off these days due to the huge lawn and dirt replacement. And it was even more blocked off in preparation for the massive Veterans Day "Concert for Valor" event.

I know I mentioned it in my blog entries back in 2013, but I actually knew Dr. Tsaknis -- John -- waaaaay back in the early-to-mid 1990s when I was still a late-stage undergraduate at UMCP. He remembered me by sight and said (as I recalled in this entry):

"I remember you, yes ... Hair is grayer but you look the same and same mannerisms."

We were in a chemistry class together circa 1993 or early 1994, and I actually was at his house once back when he lived in Berwyn Heights. He had these two ginormous dogs -- a Rottweiler and, if I recall correctly, a German Shepherd.

I managed to splash myself in the face with some liquid in a test tube (don't ask, please) and he (who is a lot bigger than I am) dragged me over to the eye wash. I mentioned that last year and he said, "You're really going way back ..."

*******

The remainder of this entry ended up (unplanned) being a detailed recap of all the gyrating history I had with tooth #14 and how I ended up having Dr. Tsaknis as my dentist ...


The story starts back in 2002 or 2003 (I don't actually recall the year) when I had a series of three or four crowns done (I actually can't recall at this point). As I recall, two were done by Lawrence Singer ( of DC Smiles) and one or two by Dr. William Ebbs (of The Washington Dental Studio).

What I do remember is that none of these teeth ever had root canals -- only crowns.

Fast forward to March / April 2011. This was after many bad years personally for me although only nominal dental issues, specifically, once when one of my crowns came off (don't recall which but I don't think it was #14) and I was able to get it cemented back on at Dr. Ebbs' office. It was in March 2011 that I started to develop an infection under the crown of #14.

I was working (again) by that point and returned to Dr. Singer, who had done the #14 crown. While it was too long in the past for him to have any obligations, he offered as the one and only solution he would accept extraction of the tooth (on that point, he was ultimately right) AND implanting a titanium post dental implant at a cost of $5,000 which I would pay by taking out a credit card, paying his office immediately, and then paying off the debt at some interest rate to the creditor.

I remember his office admin person coming into the room, sitting next to me, and saying, "Here at DC Smiles, we're your family..."

Even she didn't believe. As for me, I just wanted to get out of there.

The procedure itself required me to take sleeping pills in order to be fully knocked out and then sleeping it off for a while in a back room.


That last point raises a related one: By early 2011, Dr. Singer had become quite odd -- gliding about (as I saw myself) his D.C. office in a large robe and with a little therapy dog named "Disco" following him. The office itself had a sort of a meditation spa d├ęcor with gurgling tiny fountains, ambient lighting, and New Age-y music (think the "Door Jam" episode of Frasier). Oh, and there is a huge picture of him with the Washington Redskins Cheerleaders because Dr. Singer was at the time their "OFFICIAL DENTIST".

I don't recall him being that wacky back in the early 2000s. He was a bit more matter-of-fact then. (His Yelp and other online reviews suggests he keeps careful monitor on them and does whatever he can to keep them positive.)

Hippo good oral hygiene is a must.

Anyway, in March 2011, I went to Dr. Ebbs' office and was told that this was not necessary -- I could simply do a root canal and a re-crowning for $1,400 out-of-pocket in what sounded like a straightforward process. The root canal was done and a temp crown was placed on it on March 28, 2011. The problem then was I could not afford it all at once so I had to wear the temp crown far too long (nearly a month) and it became infected. (That should have told me something was wrong.). Finally, I had the regular crown place on April 25, 2011.

The ultimate problem was that Dr. Ebbs' oral surgeon did not do it properly -- he failed to get at all the roots of the tooth, thus leaving a sealed anaerobic "cave" that eventually became infected.


The infection under the second crown (or, if you will, the re-reinfection) occurred starting in late August 2013 in what seemed at first to be a sinus infection. By early September 2013, I knew I was in trouble and I knew that the whole damn tooth, crown and all, had to come out. The crown was ginormous and whereas once it looked really nice, it now looked a bit scary to me as I knew full well what was happening under there.

No, not these kind of crowns.

For his part, Dr. Ebbs and his staff had little, if any, interest in getting to the root of this problem on a tooth that he (or more specifically, his oral surgeon) had worked on in a complicated two-part procedure 2-1/2 years earlier (a fact I NEVER brought up). (As a detour, I tend to be overly polite in dental offices and NEVER argue. I had a very bad experience in a shoddy dental office located next to an X-rated video store in Beltsville, Md., back in the mid-1990s that almost involved the police and after that, I never argued in one of those places again. It was a horrifying experience.)

Anyway, Dr. Ebbs' people suddenly began demanding that I undergo a "planing and scaling" procedure -- also known as a "deep cleaning" at a cost of $1,700. This amount was justified, I was told, because I had periodontal disease.

That determination was made during an "examination" around that time performed by this dental hygienist (or whatever she was). I remember her reading off these incredibly large (and ultimately bogus) numbers of millimeters of gum recess that only a special "deep cleaning" could reverse. (The second opinion on that called bullshit on those numbers and diagnosis.)

That dentist sure looks like FDR. (Is this a Photoshopped image??)

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I initially agreed to it -- I'm sure the Chicago "fresh water" School has some mathematically beautiful and sophisticated theorem about high-velocity and infinite information and rational expectations -- and I even set up a payment plan with my ATM debit card. However, with the abscess and botched root canal still unresolved, on a follow-up visit to deal I changed my mind. I told Dr. Ebbs and HE AGREED and walked out of the room -- only to have minutes later the dental hygienist (the one who had done the bogus examination on an earlier visit) walk with a tray of equipment to start the procedure.

I literally jumped out of the chair and politely (after paying) left the office. (My experience is not atypical, although sometimes folks (not surprisingly) argue back more. I knew that wasn't an option for me there.) That doesn't always happen with all of his patients.) I also cancelled my ATM debit card -- although, in fairness, after several weeks and trusting the office enough to give it my new ATM debt card, I got a refund of the first (and only) installment.)

Again, to reiterate: Hippo good oral hygiene is very important. Especially when we're talking about Pablo Escobar's hippos...

*******

It was then that I switched dentists to Dr. Tsaknis, who was in my Delta Dental provider network. I had seen his name over the years on his Massachusetts Ave. office and I remembered him and that he had been planning to be a dentist.

I switched in September 2011 and when he saw me, he agreed there was no way to save tooth #14 and performed the actual extraction on the most auspicious day of Sept. 11, 2013. He has been my dentist since that time, although I actually didn't go at all from last Halloween (2013) until yesterday (Monday).

Two concluding points:

First, I have developed a hypothesis on why American dentists (I just can't speak for other those in countries) so often act this way and why their staff -- including office managers -- are so aggressive:

It's built into the structure of their business operation in a way that is not with medical doctors.

This is because dental insurance (unlike medical insurance) typically pays only a fraction of various dental related costs (itself a strange artifact of the notion that saving teeth through root canals and crowns is somehow simply "cosmetic).

Thus, it is necessary to have this kind of high-pressure power relationship with patients who (let's face it) are often in pain and willing to do anything. In some cases (such as Dr. Ebbs' office), it becomes outright adversarial and a bit scary.

The converse to this -- and the moral to my point -- is: If you have a good dentist you trust, stick with him or her to the extent you can.

Secondly, on a personal note, while my oral hygiene is good now, I am paying for when it was not so good (especially with flossing) back in my teenage years and 20s, although, of course, there is a certain bit of genetics and even luck at play here as well.

OK, that concludes this entry. I was going to try to post another entry tonight but it's much too late.

As for tomorrow, I have the day off tomorrow for Veterans Day. I had a good gym workout tonight and just made dinner. As for tomorrow, I am supposed to go with Gary out to the exurban purgatory of Northern Virginia (Fairfax County) to see his mom.

--Regulus

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