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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?

Miss Ellie Goes to the Vet

 

We took Ellie for her first vet visit last week, or her first one as an official member of the family, but for some reason she didn’t see it as the beautiful rite of passage I’d imagined. She sat on my lap in the waiting room, ignoring Boopy, the African Grey parrot (even though he was whistling and banging on his noisemakers to get her attention). She also ignored the enormous German Shephard puppy on the floor, and the little apricot poodle on the bench across from us, and just sat there and shook.

boopy giving me the eye

Boopy, giving me the eye

She didn’t need the kind of restraints Cricket generally needs during her exam, though she was clearly tempted to pee on the table. The vet took blood and gave shots and added another tag to her collar (we’d gotten her a blingy grey collar, and red flower name tag by then). Then the vet answered my questions: about a grain-free diet (because we’d been told that Havanese dogs need a grain-free diet, but the vet said no way, research has shown heart trouble resulting from unnecessarily grain-free diets); and about wet versus dry food (both fine, to Ellie’s great disappointment, since she was hoping for a prescription for whole roasted chickens). And then he said that Ellie would need a dental cleaning, as soon as possible. Eek! He showed me the plaque at her gum line, just to make sure I got the message, that only bad dog mommies would leave those teeth uncleaned. We paid for the visit but I didn’t schedule the dental procedure right away, because, one, anesthesia scares the crap out of me, especially for someone as small as Ellie, and two, the cost of the cleaning would start at $400 and go up from there depending on the seriousness of her dental situation.

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Ellie, very concerned

My last experience with anesthesia was with Butterfly’s emergency hernia surgery, a few months before she died, when, with her heart disease, she had less than a fifty percent chance of survival. I tried to talk myself through the differences between the two situations, but flashbacks were inevitable. Of course, I decided to go through with it anyway. I trust Cricket and Ellie’s vet, both on what he thinks my girls need for their health, and on what is safe or unsafe for them. And I want Ellie to have her teeth for as long as possible. Miss Butterfly made do with the teeth she had, but I know she would have enjoyed having more teeth to chew her food with.

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Miss B

So, a week later, we took the food and water bowls off the floor at nine PM, because Ellie had to be empty for anesthesia. And no one got treats after the first walk of the day the next morning, because I was afraid that if I gave one to Cricket, Ellie would wrestle her to the ground and grab it out of her mouth. She likes food, a lot. Cricket stared at the treat shelf for an extra ten seconds, to let me know that I was making a horrible mistake, but she actually gave up pretty quickly and both girls went back to sleep.

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The girls, resting with Grandma

The real problem came when I went to put Ellie’s leash on, and Cricket pushed in front of her and started jumping at me, looking for her own leash. Usually Cricket gets her leash on first, so clearly something was wrong. I told Cricket that she didn’t want to go to the place where Ellie was going, and that as soon as we left she’d get to eat her breakfast, but she didn’t believe me. I had to pick her up and hand her off to Grandma, so that I could get Ellie out the door.

Ellie sat calmly in the backseat of the car, and then sat by my feet in the waiting room until the vet tech arrived to take her to the back. She even made sure to give me nose kisses before she was taken away, and that helped a little bit. Well, it helped me.

We got the call about an hour later that she was already out of the anesthesia and awake and no teeth had to be extracted. I’d been ready for a day of worrying, that I’d never see her again, or that the procedure would get complicated and she’d lose ten teeth and maybe a limb, but here they were calling and saying, nope, all good. We weren’t allowed to pick her up until three o’clock in the afternoon though, and, since I couldn’t think straight, I ended up doing a jigsaw puzzle for the next few hours, until we were finally allowed to go get her.

Cricket refused to be left at home for the pickup, even though I made sure to remind her that we’d be going to the vet. She sat on my lap in the passenger seat of the car while Mom drove, and then she huddled behind my neck as we got closer to the vet’s office, and then she jumped out of the car as soon as the door was open half an inch. When we went to the front desk to tell the receptionist we were there to pick up Ellie, Cricket spoke up too, and then we heard Ellie’s little whisper bark from the back room. She’d heard our voices! She knew us! Either that or she’d been barking at every noise for the past four or five hours, but I prefer my version.

C waiting for E at the vet

“Where’s my sister?!”

They had to do a few more things in the back room, though, and Cricket was impatient to see her sister, so she waited at the door, ignoring Boopy’s whistles and greetings. When Ellie came marching out she was perky and totally fine, and I was shocked. Even after just getting x-rays Miss Cricket always looked like she’d been hit by a truck, but here was Ellie, after anesthesia and dental scraping, looking like she was ready to party. And she knew exactly who I was, and that I was her home. How had she learned that so fast? I was sure she’d be angry at me, or think I was a stranger coming to pick her up, but no, she was blasé about the whole thing. Like, Hey Mom, are you ready to go? Anything good for lunch?

 

We loaded back into the car and Cricket immediately took up her spot behind my neck, letting me know that her ordeal had been much more traumatizing than anything Ellie had gone through. And Ellie was cool with it, leaning forward to see what was going on, sniffing Cricket’s nose, and licking my arm.

E showing teeth

“Look at my beautiful teeth!”

The fact is, even in the short month they’ve been together, Cricket and Ellie have learned how to work as a team. They wake me up early to go out for their first morning walk (and then their morning treat, and breakfast, and their second morning walk). Ellie waits for Cricket to finish as much as she’s hungry for, before she gobbles up the rest of the food in Cricket’s bowl. Sometimes they elbow each other out of the way when scratchies are on offer, but they’ll accept tandem scratching. They even nap together, or at least they nap in the same place and at the same time.

When we got home, Ellie was only allowed to have a few ice cubes and still no food, but she was still fine with everything. I was wiped out and in need of a three hour nap, but she looked like she could have taken another five walks. I don’t know where her resilience comes from, or how she’s managed to adapt to life with us so quickly. She trusts me. She snuggles next to me. And she smiles. She asked to come up on the bed, and she let me look at her newly shiny teeth, and then she stretched out for a nap, a few inches away from me on one side, and a few inches away from Cricket on the other side and she fell asleep. I’m pretty sure she was dreaming about eating roasted chicken, but maybe she was just sending herself to sleep with the knowledge that she was finally home, where she belongs.

ellie relaxed

Cricket’s Lost Teeth

 

Recently, out of nowhere, one of Cricket’s front teeth started to stick out. When she was really tired one night, she let me touch the tooth, and it moved. She is eight years old, middle aged for a dog, so losing teeth now is a permanent thing.

"Who needs all those teeth?"

“Who needs all those teeth?”

I worry that this happened because of all of the weeding I let her do earlier in the summer, grabbing and tearing and chewing tough roots out of the ground. She’s not a working dog; she just liked the challenge, and the flavor, of the weeds.

The happy chewer.

The happy chewer.

After the first tooth disappeared, the second tooth, right next to it, pressed forward and stuck out – kind of like her teeth were giving me the middle finger (which is very much in character for little miss Cricket).

The second tooth stayed like that for a few days and then it disappeared too. I have no idea where Cricket’s lost teeth went. Most likely she swallowed them and pooped them out. I have not been searching through her poop for evidence, though. The problem is that there are no teeth to put under her pillow for the tooth fairy, and she sleeps in so many different places, and without a pillow, so I’m not sure how the tooth fairy would know where to put her treasure anyway.

Sleeping on the people couch.

Sleeping on the people couch…

and in front of the dog bed...

and in front of the dog bed…

and in her apartment.

and in her apartment.

I should take Cricket to the vet, but I’m reluctant to put her through the trauma – she loses at least half a pound just from shaking herself silly in the waiting room. And Cricket doesn’t seem to be suffering. She has all of her strength and spring and energy. She certainly hasn’t lost her voice. She sleeps and eats and poops and pees, just like always. And those two little teeth were always crowded and crossed over each other. But, what if she loses more teeth and has to struggle to chew her chicken treats? Chicken treats and Grandma are what Cricket wakes up for in the morning.

I think what’s upsetting me about the lost teeth, though, is that at eight years old, Cricket isn’t really a puppy anymore. She is getting older. I think about mortality too much; my own, a little bit, but more the mortality of the people and dogs that I love, so this sign of frailty in Cricket hits a nerve.

Cricket’s expected life span is eighteen to twenty years, but eventually she will be an old lady, and she’ll be the curmudgeonly type, rather than the sweet old lady in the rocking chair. She won’t be able to jump up as easily, and if she wants to get on the couch or the bed she’ll have to let me pick her up, or learn how to use the doggy steps, and she won’t like that. She will, of course, continue her crazy barking to the end, just at a lower pitch, like a smoker’s cough.

I knew an elderly Cocker Spaniel who rode around in a dog carriage and barked his commentary at the neighborhood as he passed by – a deep, flemmy, insistent bark from his royal transport. Cricket would love to do that.

Cricket would love this! (not my picture)

Cricket would love this! (not my picture)

Eventually, Mom and Cricket are going to be old ladies together. They’ll both have to wear slipper socks and housedresses, and they’ll complain about heartburn and digestive issues. I’ve had previews of this when Mom gets a cold and Cricket curls up with her on her bed and acts sick too. They need tea and toast and special treats brought to them, and they grumble and mumble and whine to each other between naps.

Cozy time for Cricket and Grandma.

Cozy time for Cricket and Grandma.

So, I’m kinda hoping Cricket, and Mom, can hold off on the aging thing for a while longer. Maybe another thirty years?