A cold, hard fact about dental heath: money decides

by Brian Clarey

It’s been a good year for prescription drugs in my house.

Which means, of course, that it’s been a bad year for medical problems. It’s also been a bad year for alternators and car batteries, income tax irregularities, tires, crabgrass, legal missteps, heat pumps, romantic evenings for two, termites and plumbing. But none of these other maladies come with the saving grace of a doctor-prescribed four-day pill-popping bender.

I’m on the first day of my little binge as I write, and the hydrocodone is just starting to work its magic against the deep and abiding ache in my jaw, blunting the corners and softening the edges enough so that I don’t mind all that much being trapped at my desk and grinding against deadlines while the rest of the world has punched out for the weekend.

I lost a couple of teeth this morning. One, a wisdom tooth not worth the calcified phosphorous its made of, has been begging for extraction since it erupted from the gum 20 or so years ago and I do not mourn the loss. The other, the No. 15 molar, has a more tragic history.

A little backstory: It’s possible that, over the years, I have not been as’… attentive’… to my choppers as many professionals recommend. When I was a boy my dentist was my grandfather and he would look in on my mouth with utmost diligence. But after he retired there followed a period when I became less committed to regular checkups, due in part to the impression I was under at the time that my body was as hardy and resilient as a strap of leather but also because, without the benefit of dental insurance, proper care and maintenance of my teeth were prohibitively expensive.

I don’t know when it happened, when capable, professional dental care was deemed a privilege and not a right, but happen it did and these days you can buy a great used car for the price of a modest amount of time in the dentist’s chair and fill it up with a tank of regular grade gasoline to boot.

And having a healthy smile is important. Your teeth, like your shoes, are a subtle indicator of taste and status. Alas, a good pair of shoes is not as hard to come by as, say, a porcelain inlay or a painless root canal.

Back to the tooth.

My dentist and I had hopes for this little guy. It had been filled years before with some old-school (and likely poisonous) metal by my grandfather, but some decay had developed underneath and a fissure had formed on the inside wall. But she thought we might be able to bring it back with some drilling and filling. Worst case scenario: root canal.

But a root canal, it turns out, is a luxury.

The procedure is recommended when the decay has infiltrated the nerve of the tooth, deep in its center. It involves hollowing out the inside of the tooth all the way down the roots and then restoring the interior with filling. It is a fairly intricate operation, and it costs approximately 10 times as much as a simple extraction.

Another difference between the two: A simple extraction is covered by my dental plan; a root canal is not.

So it was time for my No. 15 and me to part ways. But when I informed my oral surgeon of my plans, he gave me a look of incredulity, similar to the look I got from my father when I told him I was thinking of changing my major to sociology.

I explained to him the motivations and reasoning behind my decision, yet he still deemed the call to be’… questionable.

“I just think you’re letting your insurance plan make a decision about your health,” he said.


But then’….

How has it come to be that a “dental plan” has become less of an actual plan for overall dental health than a road map to the cheapest and easiest way to make the problem go away? Why is it that my dental plan tacitly encourages the extraction, rather than the restoration, of the very commodity it purports itself to be insuring? Is it the hydrocodone or am I crazy?

Do a lot of people make their decisions based on their insurance plans? I wanted to know.

The oral surgeon guffawed.

“They all do,” he said, and then he laid into my gums with the needle that would make half of my face go slack and my tongue feel like a slab of meat.

The teeth came out with little protest – he had them on the tray before I even knew they were gone – and after he stitched up my gums I asked through a mouthful of bloody drool if I could see them.

His assistant dropped them in front of me for the briefest of moments and I got a fleeting glimpse of them, a malformed pair of dice with remnants of tissue clinging to the sides, before she whisked them away and covered them with a towel.

I wasn’t allowed to keep them. Like anything else removed from a human body they had to be disposed of in a proper, responsible manner. Incinerated, or maybe dumped in the ocean.

And that’s okay – I wouldn’t know what to do with them, anyway. Everybody knows there’s no such thing as the tooth fairy.

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