A Healthy Mouth is a Wealthy Mouth


root - Posted on 31 December 1969

by Tiny

Knife-like corners of starched cotton cut into my reclining thigh.

“You don’t have the money to keep your teeth” his voice, like his face was flat like the top of a table – round and flat and shiny and his eyes darted urgently from scalpel to drill arranging and re-arranging his tools as though he was preparing to solve my dental emergency.

“Ms. Gray I can’t help you,” this time the words were louder, a slight edge around can’t. “I’m afraid saving your teeth would require a root canal and you stated on your intake form that you don’t have the financial resources to afford that kind of procedure.”

“What can I do?”

“You have no choice but to have these teeth pulled, and I would suggest that if you are in pain, you have the extractions done immediately.”

“But you said these teeth are restorable – and if they are missing it would be rather obvious...”

“That’s all you can do.” Suddenly he stopped arranging tools, snapped off his gloves and threw them in the trash with a pointed thump. Before that time I’d never hear rubber gloves make a thumping noise.

“Well, our time’s up.” He made a complete military pivot and left. The whack of the door-slam vibrated the steel clamp that had seized my skull since these two teeth had become inflamed. He left me in that room in the overly reclined dental chair. What could I do now? What did I do wrong?

Working or unemployed, dental work was a luxury. Ongoing dental insurance an impossibility. Now I was being encouraged to pull two teeth that were very near the front of my mouth. Ok..ok...sure...take ‘em all out – I’ll spend the rest of my years gumming my food like my poor grandmother, drinking cheap coffee, and smoking Lucky Strikes (I don’t smoke or even like cigarettes but I’ll learn, just to complete the aesthetic vision).

As I staggered out, the secretary suggested I try the UC Dental Clinic.

Several calls and voice mail matrixes later I arrived at the UC Dental Clinic. The windows were massive – mirrored glass revealing the lush body of trees that spoke to the wind – California redwoods – Pine and Fir, whistling, flirting, lightly daring a touch at the shiny transparent reflections of themselves.

I knew the trees would understand what I was about to do.

“Can I help you?”

“I have an appointment.”

“Lily Smith.”

“Ok, just fill this form out and the doctor will call you,” her voice, light, upper registers.

I walked very slowly to the chair, my eyes focused on an angry arm of the redwood tree flogging its glass counterpart.

I sat down with the metal clipboard. I loved its solid edges – the way it resonated with my touch. The intake form paper crackled under my pen. A steady pounding began in my ears. The sweat on my fingers began to lubricate the pen. I glanced over at the secretary – did she see me – she was turning on a walkman.

I began to fill in the application......Lily Smith. I glanced over again – I knew she knew – I could see her lips move as she answered a phone call, “Can I help you?” This was a code phrase – she was saying “There’s someone in the waiting room committing fraud.”

The pounding in my ears became a synthesized drum – I started to move across the page faster with the false information. Under my sweaty pen a new person was born. A healthy, problem-free, well paid, responsible individual with an amazing health history.

... Past surgery? No...Any health problems? No...just a little too busy with all her many high paying businesses to retain a permanent dentist.

As Lily Smith, the perfectly pure patient was being birthed, the deep throb that started somewhere in my upper left jaw had become more solid, more comfortable, in its systematic attack on my teeth – the throb stood alone, ate alone, and when its host was under any kind of pressure it launched a special assault of reds and purples a dripping bloody knife – fight into the depths of my gums.

I stood up – guided by the throb – passing the ominous security guard – up to the secretary, thrusting the completed form onto her desk, without even a blink, I returned to my seat. If I were arrested, I would plead, “Not guilty,” coerced, to commit fraud, I would tell the judge, by “The THROB.”

The throb and I sat together, watching the trees, listening to the distant musak, “When you’re down and troubled, and need a helping had.......You’ve got a friend.

“Ms. Smith........Lily Smith?” A tentative voice called out my name.

“Lily Smith?....................”

“Oh yes, here I am.”

“Lily, I’m Dr. Rogers. How are you today?”

“Just fine.....” the throb answered bluntly.

“Well, hopefully we can take care of your problems.”

“Uh..yeah,” my tongue glided across the gutted contents of my mouth. How could I explain all these rotted, broken teeth with partial fillings, demi-teeth and exposed roots? Lily Smith would have been able to afford the necessary crowns, root canals, bridges and replacements – financial problems would not have impeded her dental health.

Dr. Rodgers led me to an exposed cubicle with two beige dividing walls, in the middle of one of the walls there was one small square of floral wallpaper.

“Have a seat, Lily.”

I climbed into the pre-reclined dental chair.

“Open up,” an odd smile contorted his face as he peered into my mouth. “Whoa, you have a lot of problems, just a minute,” he ran out of our room leaving my jaw agape. Should I close it? Or will he really be right back....?

Suddenly three very large men in buttery soft linen shirts, wool garbardine slacks, woven cotton and silk sweaters and vests with hastily applied white coats entered the room. They began a brief procession around my chair, when each one of them would look up from my mouth they would shake their head, at one point I think I saw them all shake their heads together – almost in unison.

Tri-syllabic dental words were exchanged between the three men and then they turned inward, looking at one another while one spoke out, “Ms. Smith, you have a serious set of problems that require a series of complicated surgical procedures, there will be at least 8 visits over the next three weeks.

“Ok.” I tried to nod without losing the dental dam.

“And you will have to brush every single time you ingest any substance.”

“Ok.”

“You won’t be able to chew solid food during this time, and if you eat at all you will need to floss immediately.”

“Ok.”

“I notice on your application, that you carry no insurance – these procedures are going to run into several thousand dollars – are you able to handle that?”

“Uh.....ok.....but will you be able to take me out of pain today?”

“Sure, we will be performing a pulpotomy which is just the beginning of one of your problems – that will take you out of pain temporarily, I notice you have a lot of unfinished procedures in your mouth – why didn’t you complete the work?”

“I was too busy.”

They shook their head understandingly and filed out of the cubicle. As they left, the fear began to settle in my abdomen, a chilling, nail scraping terror slamming against the walls and ceiling of my stomach – the throb had transformed into a dangerous animal kept against its will in my body – determined to torture its captor – tools were readied – engines were activated, protective gear was applied by the various white coated technicians who would attempt to control the beast – I tried to keep up with the fight – stay awake through the lengthy procedure......

“Ms. Smith....Ms. Smith...wake up..you’re all done for today.”

Lily Smith held up my shattered body that day as I crept out of the cubicle – into the waiting room – past the secretary – my eyes downcast – my breath in small shallow parcels.

“Ms. Smith?” ... I almost didn’t turn around.

“Yes?”

“I’ve made your next eight appointments, the doctors say it is urgent that you keep all of these appointments.”

“Ok,” she handed me a small piece of paper with a list of days and times on it.

“Oh and Miss Smith, please bring at least $500 next time. This will be your first payment.”

“Ok.”

In the subsequent months, depending on the severity of my pain – new identities were created – new treatment plans started for new people who never seemed to come back for their follow-up appointments.

To ease my guilt for the crimes of poverty I continually committed I would spend frustrating hours on the phone researching other possible affordable options, even a possible small payment plan at UC dental school always ending where I began – with nothing.

To avoid this whole devastating process I began to deny the pain when I had it – I drank smaller and smaller sips through increasingly smaller canals in my mouth; french bread, fresh carrots, gum, candy, soft or hard, steak, steamed vegetables, anything cold or hot, etc, all became dangerous luxuries I dare not risk salivating over. This life of culinary asceticism with a heavy dose of denial sort of worked....until one particularly sunny day in the middle of April.

My weary face warmed by a sharp clear April sun, I bit into a lukewarm, pre-cut bite of processed turkey....At first I only felt a crumbling sensation, something your normally associate with gravel beneath your feet, and then before I could figure out the origin of the crumble; deep, fresh cleaves of pain shot into my jaw and out through my skull. I looked out of my parked car’s window certain an earthquake had ripped open the middle of the street – fast on its heels was a tsunami that must be barreling down the sidewalk by now – but instead of people running, screaming and ducking for cover – passersby walked, laughed and casually consumed all variations of the dangerous substance known as lunch, while I sat beneath them trying to contain blood curdling screams.

I tried to compose myself and start the car – I must get home, at least I’ll be in a safe place for the next attack. I reached for the ignition and then it came down like a hammer – a new double strength force struck the side of my head – I slumped over the steering wheel – the sun beating down on my broken body.

UC DENTAL SCHOOL, NEXT DAY:

This time the fraud was easy, too easy................

The wind was strong today – screaming through the trees – “Be careful – Be careful,” it warned through fatal slaps against the glass – I walked up to the front desk – in deference to my deception I wore glasses and a new sweater.

“Do you have an appointment?”

“No.”

“Have you been here before?”

“No.”

“Are you sure?”

“Yes.”

She tilted her head to the side of my reply – I guess she was trying to picture me in my other sweater. “What’s your name?”

“Lisa Graham.”

“Ok, fill this out and have a seat.”

The false information flowed freely from my pen – my wits were dulled by the severity of my pain – I looked with longing at concrete walls – believing I could ease the pounding in my jaw if only I could smash my head against a hard surface. “Here,” I handed over the clipboard.

I watched her over my torn remain of a hospital waiting room magazine. I prefer I was enthralled with a story on “How to buy a home with only $200,000,000. After making a few phone calls, with pointed stares in my direction and an excessive amount of loud paper straightening accentuated with a punch to the stapler, she abruptly left the front desk area.

Five hours later, a new secretary led me back to the dentist’s area. As I left the outer room I noticed that the trees had fallen silent – the smallest hints of afternoon were streaking across the beige linoleum – it was too quiet – even the musak became more faint – “AH, AH, AH, AH, Stayin’ ALIIIIIIIIIIIIIIIIIVE” – I was not only the last patient – I was the only patient............in the universe.

“Miss Graham...” a round faced woman wearing a too-small uniform was directing me to the chair.

I watched the burgundy polyester slice into her back and arms as she readied the tool tray and then I heard a voice behind me.

“Thanks Gena” those two words raced up my spine – the tone overly clear – on the edge of a laugh.

“So I guess you are Miss Gray – oh excuse me, Miss Graham.” He was tall, very tall. His head was lush with soft chestnut curls, the florescent rays in our cubicle shone upon the delicate gold highlights that frosted each ringlet. “So I guess these all belong to you.” He slapped his hand on a large stack of files, each one of them rife with notes, bills and charts...the stack teetered under his fingers, threatening to tip over and reveal the multiple personalities associated with my mouth.

He watched me for a second. “I know how it is” – he paused to laugh, a large comfortable laugh, “I used to sneak my friends in to get free dental care when I was in my first year of dental school....” Again he chuckled, a wayward curl falling forward onto his wide brow, and then suddenly, he stopped all parts of his laugh, focusing his eyes into mine. “So what brings you in here today?”

“I’m in severe pain.”

“Let me take a look,” he peered into my mouth....”Wow you’ve got a lot of problems, let me see your arms – I mean, so we can take your blood pressure.”

“Why?”

“Just routine.”

Not its not, I screamed inside, this man thinks I am a junkie.

He got up from his chair to make room for Gena and her blood pressure apparatus. Gena started rolling up the sleeve of my shirt – he stood by long enough to see my veins – then left the cube momentarily.

“Well Ms. Gray,” he was talking very loudly in a new, sharp tone, eyes wandering over the walls of the cubicle, “you know there is really nothing I can do for you, apparently you owe $200 in back fees, so I can’t even do an emergency procedure until you pay off the balance.” He smiled, “Hey, I know how it is.”

3 MONTHS LATER, POTRERO HILL DENTAL CLINIC

His eyes were round pools of warm volcanic water, they watched me as I spoke, only interjecting when he was sure I was finished.

“Where is the pain from, which tooth?”

“My whole mouth is in pain, I’m not sure which tooth is the problem.”

“Well, let’s just say the worst pain you’ve been having recently?” He asked very gently with no conciliatory or punitive tones – each word tied up carefully in its own special enunciated package.

As we spoke he prepared for the exam, barely tilting the fragile body of air in the small office;

a delicate snap...

the gloves were on

a cushioned click....

the face mask was down

a subtle whir...

my visual perspective was dipped

I was his, yet I was not afraid..........

I watched the motion of his over-washed white coat as it hugged his size thirty-six shoulders, the soft crevasses that ran through his carmel face and as he guided the exaggerated needle into the depths of my jaw. I listened rather than cringed, “It will be very fast and only a moment of discomfort...it should pinch just a little...and only for a second...that’s it...that’s it...it’s going to be ok...,” and as he continued his soothing murmur/speak I caught the corner of the Disney-sized needle withdrawing back into it’s space-craft where it and it’s fellow needles are kept until they are summoned. This satellite is only known to dentists – and most dentists have no control over the pain these needles wreak on their victims – but this dentist had a special relationship with all dental instruments of torture, a calming effect if you will, that confused the needles, rendering them helpless in his hands. In the same soft murmur, he said, “the anesthesia takes a few minutes to effect, I’ll be back.”

I tried to not focus on the corners of my mouth which became strangely large – each lip line becoming a cavernous canal, the tongue becoming mad until it decided to take its new found largess and stand in revolt of years of food abuse, standing erect and inflamed between my blood soaked teeth, like Moses parting the Red Sea. I tried to not think about the ramifications of this revolt, and the fact that in addition my jaw felt as though it was filled with 100 pounds of foam. I tried, instead to be overjoyed that due to a micro-dot of privilege I had attained (through a kind boyfriend’s American Express card) I would actually be completing this dental procedure. YIPPIE!!!! I cheered with out moving my dental dam.

As I started to get terrorized that this procedure was actually going to happen, my dentist came back in the room followed closely by the nurse in a light cloud of mousse and cotton starch who was calling after him, “Dr. Taylor what should we do?” The medical examiner from Delancy Street said no matter what they won’t approve anything but extraction.

Nervous whispers were exchanged above my head. My dentist stopped, changed his gloves, and looked at the piece of paper she had been waiving in the air, he began to shake his head from side to side emphatically...”That’s ridiculous – that would be bad medicine – that tooth can be restored.”

I remembered those men in the waiting room – tall, drained, dark eyes darting from one to the other, regulation chinos – white t-shirts – one of the men clutched an over-folded piece of paper – massaging it with wide flat fingers – clicking it with nails bit to the cuticles.

“You don’t have the money to keep your teeth”...the refrain of my dentists sailed above their heads.

...white t-shirts covering pounding hearts,
mouths
filled with the residue of blood and cigarettes
days when there was just laughter and sugar and....
Today they would pull his good restorable teeth at
county general hospital..........if he was lucky.

“So how do you feel?” The whir died down, my eyes opened, sort of. I saw the bottom of my pants. They seemed calm. My calves were relaxed and organized inside my pants. My hands were beside my body, quietly, as if they had nothing to say.

“We’re all done.” My dentist watched me, his countenance stern, calm and sad.

I’ll miss him, I thought. I finally identified myself as the participant victim/observer I aspired to be, requesting just a few minutes of his time for questions.

“So what’s the situation with the UC dental system – why was I denied care consistently for lack of money?”

“They are mandated by the state to not operate at a loss.”

“Oh!” I winced – my humiliation was valid and for a larger purpose, visions of shrunken, screaming dental students strapped onto aluminum tool trays floated past my eyes...

“What would you like to improve on here, if you could?”

“More patient hours – right now we’re only allowed 52 per week.”

I remembered the subtle encouragement by the receptionist not to make more than two appointments within on month. I knew it wasn’t a perfect system and I was already becoming luckier than my poor ex-con brothers by receiving this much care.

My root canal procedure cost $150 (50-75% less than the standard rate if you qualify as low/no income and 30% less than the dental schools). This is for care with a professional, experienced dentist and the fee is payable over time, with many of the basic services free to people on General Assistance. I also knew I was in the presence of an expert in his field and inside a public health system that allowed him to be there.......

A crooked, anesthetized smile consumed my cottony mouth
as i left the dentist’s office.

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