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Living at the Dentist’s office

            Lately I’ve been living at the dentist’s office, or the oral surgeon’s, depending on the week. First there were regular checkups to see how I was healing from this summer’s oral surgery, and then at about the three month mark a crack appeared in the temporary upper teeth, not visible on the outside, and, luckily, the oral surgeon had been testing out his own 3D printer this fall and made a second version of my temporary device, so it was available to be switched out for the cracked one. And after that, I had to start the process of going from a temporary implant to a permanent one, which means molds and try-ons and who knows what else.

            But in the meantime, I also had regular cleanings, and more extractions, because my bottom teeth were jealous of all of the attention the upper teeth had gotten, and I had to get a temporary tooth, called a flipper, to fill the empty space up front, so now I have to be even more careful about what I eat, so I don’t accidentally pull out the flipper and swallow it with my dinner.

“That doesn’t sound yummy at all.”

            I wish this was all as entertaining in real life as it looks on paper.

The bone and gum loss in my mouth is so premature and seems to be a big honking clue that there is some underlying systematic disease process at work in my body, but no one can explain it or tie it to a specific diagnosis. So I continue to lose my teeth, and I continue to get more and more exhausted, and nothing I try seems to be able to slow this process down, let alone reverse the damage already done.

            I’ve also had to go for blood tests, and a mammogram, and a gynecological checkup, and there’s the oral pathologist and the primary care doctor and the gastroenterologist coming up, and, of course, the continuing dental visits.

And I’m tired. I’m tired of having to spend money on my teeth, and on tests and supplements, and I’m tired of having to spend so much energy and time going to doctors and researching potential diseases and treatments, without success.

            My nutritionist mentioned that someone she knows, with similar autoimmune issues to mine, had some success with Low Dose Naltrexone (the regular dose, which is prescribed to interrupt opioid addiction, is covered by insurance, but the low dose is an off label use and therefore only available at a compounding pharmacy, and therefore not covered), so now I’m doing research online and asking my various doctors what they know about that. But I’m worried that either the doctors won’t prescribe it, or that they will and then I’ll spend more money and time on yet another possible solution and get no improvement.

And in the meantime, my micro-part-time job is getting harder to manage, and when, on top of that, an emergency comes up: like the smell of gas in the building (leading nine members of the fire department to stomp into my apartment, silencing even Cricket, and then they turned off the gas for the whole building, for two weeks, while they checked the connections in every apartment), or the toilet leaking into the apartment below us (leading to a new wax ring and therefore a new toilet and new tiling because our toilet had been set in place with concrete, for some reason), the resulting invasion of workmen makes life even harder.

“Oy.”

            But, Mom has been doing better, and has had a string of good luck with new doctors who seem to know what they’re doing and care what she has to say. And the dogs both passed their yearly checkups with flying colors, and Ellie survived yet another dental cleaning and now has fresh clean breath, and I still love my work, and have tons of good things to watch on TV, and good books to read, and good food to eat…

            And I feel like I should be celebrating all of this good fortune, but I don’t have the energy. So I keep trying new probiotics, in case the gut microbiome is the source of all disease (as Facebook keeps telling me), and I keep trying new breathing exercises and yoga poses and guided meditations, in case a calm mind really is a healthy mind (again, Facebook), and I hug the puppies, and I take my naps, and I read my mysteries. Because what else can I do?

“Bark. At everyone.”

If you haven’t had a chance yet, please check out my Young Adult novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

            Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?

The Ritual Slaughter of my Nightguard

            There were so many things about the oral surgery that worried me: I was worried about the pain, and the anesthesia, and being out of commission for a couple of days, which meant leaving Mom to take care of the dogs, even though she was still recovering from her second hip surgery. And I was worried about how I would look, with the bruises on my face and the temporary 3D printed implant. And I was worried about the idea that they would be putting screws into my cheek bones, through my sinuses. How could that not cause problems? I wouldn’t even think of piercing my nose or lip, and now they were going to pierce my sinuses?!

            But I knew I had to do it anyway, because just since the surgery had been scheduled even more of my teeth had become obviously loose (rather than just looking loose in my x-rays).

“No, Mommy. Just no.”

            But the one thing I was looking forward to about the surgery, other than having a new set of strong, healthy, upper teeth, was that I wouldn’t have to wear my nightguard anymore. I’ve worn the same nightguard since my early twenties, when a periodontist told me that I grind my teeth every night while I sleep. I wasn’t sure how he could tell, but I assumed he was right. My dentist revised the nightguard once, without commenting on how impressive it was that this same piece of plastic, created by the periodontist a million years ago, was still holding strong.

I’m only finding out now, per Google, that I was supposed to be doing a monthly deep cleaning of the darned thing. I always brushed it with toothpaste and rinsed it and dried it before putting it away in its case (though now I’m also finding out that my toothpaste might have been too abrasive. Oops.). But I’d never heard about doing a monthly deep cleaning with denture cleanser, or alternating half hour soaks in hydrogen peroxide and vinegar. But then again, the article that told me all of this also said that a nightguard should last an average of five years, so… maybe I was better off without the deep cleaning after all.

“Hygiene is overrated.”

            It’s still possible that I will need a nightguard for my new teeth, once I get the permanent implant in a few months, but it won’t be the same one I’ve had all these years. And even though I will not miss this nightguard, I still feel like I need to come up with a satisfying ritual to say goodbye to it, instead of just tossing it in the garbage. It deserves my respect, if not my love, for watching over me every night and helping me keep my teeth in place as long as possible. The idea of ritual slaughter came to mind, even though the nightguard is not a living thing, because the temptation to hit it with a hammer, or chop it into tiny pieces with a cleaver is very high. But I also like the idea of burying it, like you would do with a ritual object you can no longer use. The problem with that idea is, one, the nightguard is plastic and won’t degrade underground, and two, if I bury it in the backyard, the raccoons might dig it up and then I’ll see it on someone’s porch one morning, after the raccoons have tried it on and realized it didn’t work for their teeth.

“What?!!!”

            But even if a ritual burial/destruction is impractical, maybe there’s a blessing I could say before throwing the nightguard out. Like, Thank you, nightguard, for keeping my teeth safe lo these many years. Now your work is done and you can take your long needed rest. But, again, anthropomorphizing a piece of plastic feels kind of creepy.

            Maybe instead, I could thank the periodontist who made it? Or the dentist who revised it? Or the inventor who came up with the idea of a nightguard in the first place? I’m realizing that I rely on many different inventions to keep me functioning like a semi-normal person: my glasses, and orthotics, and painkillers, and anti-depressants, on top of the nightguard and now the new implant. And there are so many other inventions that make my life possible: like air conditioners, and washing machines, and indoor plumbing (!!!), that did not exist for my ancestors a thousand, or a hundred, or even fifty years ago. So, maybe this should be my blessing: Thank you to all of the people who have worked hard to make our lives healthier, safer, and more comfortable. I hope you were paid well for your work. And, may I never have to see this little piece of plastic ever again. Amen.

“Amen.”

If you haven’t had a chance yet, please check out my Young Adult novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

            Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?

The Importance of Teeth

            About two months ago I went to see an oral surgeon, sent by my regular dentist, to see what my options might be in treating my Lichen Planus (an autoimmune disorder that impacts the tissues of my mouth, causing gum recession and bone loss and resulting in loose teeth). I had expected my old dentist to have a plan to help me, because he’d said he had one, but then he retired, without telling me his plan, and his replacement suddenly wanted me to go to an outside expert for advice, without saying what that advice might be.

            I had no idea what to expect at the appointment, but my new dentist had praised the oral surgeon for his ability to deal with autoimmune patients like me, and she seemed to believe that he’d have better treatment options than what she could think of herself, or what my previous dentist had left behind in his notes. She made it sound like there could be a way to slow the tooth loss, and to treat the Lichen Planus more effectively than the oral pathologist had been able to manage for years now.

“Who me, skeptical?”

            So when I walked into the oral surgeon’s exam room, after a full x-ray of my mouth, and he immediately began his spiel about how he would remove all of my upper teeth and replace them with an implant that would be anchored into my cheek bones, because I don’t have enough bone for regular implants, and he doesn’t think bone grafts are stable enough, and a partial implant would be a waste of time and money, and the whole thing would cost $40,000, and none of it would be covered by my health insurance.

            I had no idea what to say, or do. I couldn’t talk to anyone in the aftermath. Even talking to my Mom just turned into hysterical crying. Mom called the dentist for an explanation of what the oral surgeon was proposing, and the dentist said that my situation was much worse than my now retired, dentist had told me, though he had noted it down in my chart. The dentist said that she would consult with the oral surgeon, and with the oral pathologist, and get back to me with an explanation of the options available.

            She didn’t call back though, and I didn’t have the courage to call her myself. I didn’t want to be on the phone with a relative stranger, crying and feeling helpless and inarticulate, especially when I couldn’t even figure out why it was all so overwhelming. I just couldn’t think at all.

“I know the feeling.”

            My therapist wasn’t really concerned. She said I should just get a denture instead, because it would cost less and be just as good. I was wearing my face mask at the time so she couldn’t see the look of horror on my face at the idea of dentures. She also expected me to be able to call the dentist and talk through the options, even though I kept trying to tell her that I couldn’t do it; that I couldn’t even pick up the phone, let alone dial the phone number or, god forbid, talk.

            But then Mom got the news that she’d have to have hip surgery (first on one hip and then, three months or so later, on the other), and I found out about two possible diagnoses that might explain my various medical issues, and I got distracted with going for more tests and making appointments with new doctors, and Mom and my therapist got excited about the possibility of my finally getting a diagnosis, and the whole question of my teeth was forgotten. Except that I kept looking in the mirror at the two precariously loose teeth, close to the front of my mouth, that could become infected or even fall out at any time, leaving me feeling like a hobo, unable to go out in public or show my face on Zoom, and with no plan for what to do.

“I make missing teeth look cute.”

I wrote down my questions for the dentist, and a long list of questions for myself about why I was getting so stuck, but then I put my notebook aside, because not only couldn’t I think of any answers, I couldn’t even stand to look at the questions.

            But now I’m getting closer to my next regularly scheduled appointment with the dentist, and I know I need to prepare myself, but it’s still too freaking hard.

            I know that the money issue overwhelms me. I feel selfish even considering this zygomatic (cheek bone-anchored) implant, which would require a student loan-sized debt, on top of my existing debt, instead of accepting the idea of a denture. I don’t even know if there is a way to borrow the money for such a thing.

            And I’m angry that this is happening, given how much effort I’ve put into taking care of my teeth, and how much effort I’ve put into trying to deal with the medical issues that caused all of this, and I am angry that my health insurance doesn’t cover dental issues even when they are directly caused by medical issues. And I am so angry that my previous dentist, who was my dentist for more than twenty years, didn’t prepare me for this in some way; didn’t even tell me to put money aside, just in case. He just kept telling me to trust him, that he’d take care of things, and that we’d make a plan when the time came. But when he announced his upcoming retirement, and I asked him about that plan, he didn’t make time for me, just sent me on to his replacement.

            And I’m angry that basics like dental care, hearing aids, and even glasses, aren’t covered by health insurance. They’ll cover the eye exam, but not the glasses that are prescribed. They’ll cover the audiologist, but not the hearing aids. And they’ll pay for my visits to the oral pathologist to treat the Lichen Planus, but they won’t cover the damage the Lichen Planus does to my teeth, or more accurately, to my gums and bone, which hold my teeth in place.

            I’m afraid of how a denture or an implant will change the way I look, or eat, or talk, or sing. And I’m afraid of being in even more debt. I’ve already paid off two masters’ degrees in writing, and I’m about halfway through paying for my third, very expensive, master’s degree in social work. And I’m afraid of losing the two loosest teeth, the ones that are visible in the front of my mouth, before I figure out what to do.

            I don’t know how to make a decision while I’m still feeling too humiliated to even ask the dentist the most basic questions.

            I guess the humiliation is at the core of all of this, as usual. But knowing that doesn’t change how overwhelming it feels. I feel guilty and worthless and small and unimportant, again and again. But it’s possible that being able to write all of this down is a sign that I’m getting somewhere. I hope.

“I believe in you, Mommy.”

If you haven’t had a chance yet, please check out my Young Adult novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

            Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?