Choppers

Choppers

By

Leo de Natale

          “Okay, Mr. O’Brien, one more and we’re done,” said Dr. Jonathan Twine, a periodontist located in South Boston, a primarily Irish Roman Catholic enclave.  “This may hurt but I’ll have extracted the last tooth in your mouth.”

          Twine had been practicing his profession for nearly 30 years.  O’Brien, who was in his mid-50’s, was just another patient who now resembled Moms Mabley,  the black comedienne whose shtick was performing toothless and talking while playing with her gums.  After O’Brien’s procedure ended, he looked at Twine and smiled.  Yep, Moms Mablely, with an oral cavity showing only gums and a sunken mouth.

          “Ah be-glory, Doctor,” O’Brien slurred with a thick Irish brogue, his mouth still affected by the novacaine injection. “I’m finally rid of that goddamned tooth!”

          Soon after opening his practice Twine noticed a pattern that constantly perpetuated itself.  Not all, but many of his patients had almost a disdain for human teeth and an utter disregard for dental health. If I lose a tooth, so what? was the attitude.  Cigarette smoking was common among his patients.  Like so many negative aspects of smoking, nicotine has a deleterious effect on dentition.  The longer you smoked, the greater chance of dental problems.

          Twine’s primary job was preventing gum disease and its consequences, most common of which was tooth loss. The Northern European inhabitants  — British, Welsh, Irish, Scots and German were infamous for their poor dentition.  Just ask the fictitious Austin Powers who said, “I know, baby, I’ve got bad teeth!”

          The oddest aspect of Twine’s observations was that many of his Irish patients had a distorted sense of  dental care’s cost.  More than one of his patients would say, “Aye, Doctor, just yank ‘em all out.  I’ll have me choppers and won’t need to see you no more, don’t you know?”

He’d explain how absurd that notion was. He’d tell them as toothless persons age, their gums shrink. New dentures require periodic replacement. Otherwise, the old dentures start floating around and can fall out of the mouth regardless of the amount of Poligrip adhesive applied. He rarely mentioned an additional side effect the creates foul odor: denture breath. Actor Clark Gable was infamous for his denture-induced bad breath. It’s far worse than ordinary halitosis, he’d say. And those fake pearly-whites will yellow over time. After the extraction, Dr. Twine arranged for a denture fitting and like so many before him, he scheduled an appointment for Mr. O’Brien’s brave new world of perfectly white fake teeth, complete with nice pink gums. As an aside, one of Twine’s favorite Youtube videos is an elderly woman skydiving. The wind velocity was so high her dentures suddenly fly out of her mouth and are sent hurtling into oblivion.

After O’Brien left, Twine was reminded  of an Irish family– the Murphys – father, mother and three sons all of whom wore dentures.  The sons were hard-nosed blue collar types.  They frequently fought.  On one such occasion, they began arguing at the dinner table.   The oldest son named Jacky was incensed by his brother and, in a fit of anger, removed his upper denture and hurled it as a weapon.   

Jacky missed his target and the choppers were shattered against the dining room wall.  His arguing brother hurled his dentures at Jacky.  Those choppers broke a living room window.  Brine laughed to himself.  It was the only time he’d heard of smelly, slimy dentures being used as assault weapons.

The above scenario is something that you can “sink your teeth into” and that’s what this essay is all about: dentition.  In modern times, dental care is a fundamental of living a good life.  Since the 1960’s water fluoridation has greatly reduced cavities in children.   Orthodontics – getting fit to braces during a child’s middle school years—has become a rite of passage.  There is less teasing and ridiculing these days.  Fewer children endure the tauntings – “Hey barbed-wire mouth” or “When do you lose the grille?”.   Many children pass through youth and adulthood without paying much attention to dental health.  But, are they aware of the minefield awaits them if such inattention occurs?

Millennials and Gen Z’ers are prime examples of this disregard.  An example unrelated to teeth is the mainstreaming acceptance of tattoos.  Once considered socially unacceptable, sporting tattoos  is commonplace.  Many of this age group have at least one tattoo.  There are the meatheads who defile their bodies with ink on their faces, necks, forearms, hands and chest. 

Rock stars and professional athletes are a prime example of this body desecration.  You want to scream “Hey you idiots! When you’re 50 of 60 years old, do you realize what those tats will look like?  Just blobs of blue, yellow, red Rorschach tests!  They’ll be gross and unrecognizable.”

During his career, Twine adopted a cynical attitude towards educating his patients.  In healthcare, noncompliance is the greatest source of frustration among professionals.  For example, Twine had an optometrist friend who would complain about contact lens abuse.  Sometimes it was a case of poor patient education, his friend said.

More commonly, however,  the abuse was a sense of invincibility, laziness, penury or  utter disregard for rules and regulations.  Some contact lenses are “daily disposables”.  Those are the healthiest for the human eye.  Wear once, throw away and reduce the chance of infection.  Other modalities are two-week disposable lenses and four week intervals.

Twine’s colleague described the following scenarios: “If it’s a daily contact lens, patients will wear them for two days,” the optometrist said. “If it’s a two week, they’ll change them every four weeks; one month lenses will be replaced every two months. Some of these idiots will not remove the contacts for months. Economics is a factor in this abuse. Folks want to save money so they push the envelope. Many, for chrissake, have no eyeglasses, the optometrist would say.

Naturally, some of these abusers wind up with pernicious corneal ulcers, some of which can cause permanent damage or even loss of an eye.  Twine had learned in dentistry the circumstances are different but the outcome is similar.  Noncompliance is always the cause.  Patients sometimes skip routine cleanings that lead to tooth decay, abscesses, gum disease and eventual tooth extraction.

By the time patients see Twine the ship has already sailed and he’s left with the task of salvaging what remains of a sick mouth.  His years of experience enabled him to draw odds on the future of so many teeth that could have been saved.

This guy’s headed for a new set of piano keys, he’d say.  This middle-aged lady will have a “partial”.  Many will develop gingivitis requiring surgery, “gum jobs”, a procedure requiring resectioning of the gums.  Periodontistry  is a challenging dental specialty,  Twine’s clientele  were divided into two groups: those who don’t fear losing their teeth and those who’ll pay thousands of dollars to save them.  The first group, exemplified by Mr. O’Brien, have an I-don’t-give-a-shit attitude.  He has dealt with former far more than the latter.

Financially periodontists  do well.  All those procedures help pay for the summer home on Cape Cod and the winter condominium in sunny Florida.  From afar, dentistry seems to have an appeal.  In reality it’s a gross profession.  Dentists spend their time sticking their fingers into mouths.  The odor can be foul, especially with patients with industrial strength halitosis.  Their job deals with blood and pain.  It’s drill and fill, rinse and spit.  They can’t share the usual doctor/patient banter.  Dentists stare at hairy nostrils, face such potential hazards of hepatitis and have one of the highest suicide rates among health care professionals.

During the past century, dentistry has made incredible advances in improving patients’ health.  Instruments have become more sophisticated, novacaine a godsend.  Cosmetic dentistry had become a sub-specialty for patients who can afford costly veneer procedures and leave the office with  pearly whites. Unlike Mr. O’Brien who’ll be whistling through those yellowing choppers until it’s time for a refit, aye bejesus.