Dentists as artists

 

I have found the entire business absolutely extraordinary:  the shock of sudden crippling, the multiple aspects of "patienthood," helplessness and dependence; excruciating sensitivity to the behaviour (and especially the motives) of those round one; ....

--Oliver Sacks (Letter of September 30, 1974) (complaining about aftermath of climbing accident in Norway)

Yesterday morning, at 8:45, I found myself sitting in a dentist's chair in an office high above the streets of downtown Seattle.  I was scheduled to have a crown installed on one of my lateral incisors, a tooth that had received fillings at least twice in the past.

The tooth looked fine.  The fillings were not the old silver colored blights, but a composite that blended totally with the tooth.  The tooth hadn't been bothering me.  But despite my protests, and my alarm at the expense,the dentist had finally persuaded me that the fillings weakened the tooth, and the whole edifice would eventually come crumbling down.  Crumbling and possibly leaving nothing to work with in restoring it.

I didn't ask whether the urgency of the situation was related to his son's Harvard tuition payment coming due.  Such a joke/question would have been unworthy of me.

The procedure was scheduled to last three hours.  I have had crowns installed on other teeth by other dentists, and I didn't recall that it had taken them that long.  (Rather than leave you, my readers, in suspense, I'll just say at this point that it took just short of a full four hours.)

At first, all went as expected.  The numbing of the gum, the injection of anesthetic, the study of x-rays that were on a screen before my own eyes to remind me of why I was there.  Then the drilling away of most of the tooth, including the old fillings, leaving only a post on which the crown would be mounted.  The drilling did take a very long time, but the dentist seemed very skilled (and he in fact was), and he was a perfectionist.  I have no fear that this crown will ever come loose or need re-doing.

After a little more than an hour, the drilling had been completed. I won't describe the details of what happened next, because I couldn't see what was being done, but if you've had a crown fitted in recent years you're familiar with the process.  His dental assistant scanned the site of the drilled tooth and the rest of my mouth with an electronic instrument.  In modern times, unlike in the uncouth days of my youth, another electronic instrument then created the crown, making loud and unpleasant noises  in a room across the hall.  The rumblings went on for at least 45 minutes while I sat in the chair staring out the window.

Being confined to a dentist's chair is hardly a matter for complaint while the doctor and his assistant are working on you.  But when you're left alone, you begin to understand Oliver Sacks's feelings of helplessness, dependence, and irrational paranoia while he was hospitalized with far more severe problems than anything your tooth could imagine.

But finally, the mountain finished laboring and brought forth a small tooth-like item.  The assistant stuck it tentatively on my stump, and he and the doctor studied the lay of the land.  There had been considerable discussion between the two of them while the drilling proceeded about the color that the crown should have, to best match my other (somewhat variably shaded) teeth.  The dentist wasn't quite satisfied with the result.

To me, the crown looked quite toothlike, quite the color of my other teeth.  It was off-white, for god's sake.  But there was discussion about how they could improve the match between the exact shade of the crown and that of nearby teeth.  I suddenly realized that neither the doctor nor his assistant was merely a tooth technician.  These guys were frustrated artists -- hear the language they used about varying the shade near the visible edges of the tooth; the shade names and number that they used, like pigments a painter chooses; the friendly disagreements they had between themselves, and the way those disagreements were resolved.  

Calling them dentists or dental assistants would be like calling Michelangelo a guy who colored canvases.  The dentist apologized.  They wanted to "shade" my crown a bit differently.  I visualized them slapping a little paint on it.  "How long will that take?"  Not long, they assured me.  We had already reached the three hour mark.  

It took another 45 minutes, using the crown-making machine.  They returned, agreed that it looked better, and stared at it a bit more.  "I really think we should have used more of the blah blah blah," the dentist said.  "Do you mind if we give this one more shading?  It shouldn't take more than twenty minutes."

I hesitated.  My patience was exhausted.  I told them I appreciated their "artistic integrity," but the nuances would be lost on me.  I wouldn't be able to see the difference between one shade or another.  And no one else would either.  

The dentist looked a little sheepish, and laughed quietly that he often got carried away trying to reach a perfection that his patient couldn't care less about.  The patient just wants to go home.  Yes.  I just wanted to go home.

He didn't accuse me of being a philistine, a dental barbarian.  He was just sad.

So the "not quite perfect" crown was installed.  I gave it a good look under a bright light when I got home.  It looks fine.  It looks like the other teeth.  He did a great job.

I guess there's a moral to this story.  Just don't let the "perfect" be the enemy of the "good."  Especially when you're asking your patient for his patience.  And his money.