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December 30, 2004

The Marvels of Modern Medicine

I (finally) got to visit the dentist today, after enduring an on-again/off-again toothache since October. I won't keep you in suspense: the visit's climax was the removal of one of my wisdom teeth, #16 if I recall correctly. The visit was a fascinating view into modern dentistry, something I've been fortunate enough to rarely experience.

I started feeling pain in my upper left jaw in mid-October, while I was at JRTC. So I altered my oral hygeine habits on the assumption there was either a bit of food caught between my teeth or that I was feeling a minor cavity that could be addressed through careful brushing and flossing. Since I was TDY, my dental records were all back at Fort Carson, so I hoped to at least forestall the need for treatment until I returned in January (those were the golden days when we thought we would be done in December). A foolish decision, but not atypical of people who probably should visit the dentist but would prefer not to.

The pain continued through November, however, and I decided that I had better go see a dentist and try to get it fixed. It took me a while to find out how to get treatment while TDY; I expected that there would be some odd procedure I'd have to go through to get treated, since I wasn't officially stationed at Fort Bliss. It turned out that the Army apparently still allows common sense to rule in limited areas: all I had to do was tell the DENTAC that I was TDY and didn't have my records. Unfortunately, I would not be allowed to make an appointment and would instead have to go to dental sick call. By this time (mid-December) I was in the middle of trying to plan the holiday training for D Company 1-172 AR, and since I was in charge of it all, I didn't feel comfortable taking a day off to see the dentist (sick call begins at 0700 and they will see you when they see you, the Army's form of rationing its limited dentists' available time). So I continued to take pain medicine and ignore tooth as best I could.

Today, however, the stars aligned perfectly. Our holiday training included a four-day weekend over New Year's to give the unit its last opportunity to spend some time with family and friends. But in order to resume training as soon as the rest of the brigade returned to Fort Bliss, our four-day weekend started today, while the rest of post would enjoy a four-day weekend beginning tomorrow. So I could spend all day, if necessary, in the dentist's chair without missing training.

So I was sitting in front of the DENTAC at 0630, because that's what time sick call starts at Fort Carson. After waiting some 20 minutes, I stopped an MP driving by to see if he knew if they would be open today. He thought they might be on holiday hours. So I returned to my room. I called the DENTAC around 0815 and was told that sick call was going on right then and would continue until 0900. Back to the DENTAC. I reported to the front desk, explained my situation, and the receptionist put together a temporary set of dental records for me on the spot. I sat down and waited perhaps 15 minutes for my name to be called. There was not much traffic there on the day before a four-day weekend. The dental hygienist took me back to an examination room, determined I didn't have x-rays available, and sent me across the hall for x-rays.

Truly we live in a marvelous age. The Army now uses digital x-rays: they still put the uncomfortable plastic doohickey in your mouth, but it's attached to some kind of digital x-ray detector that is, in turn, attached to a computer. They aim the tube at your mouth, step out of the room, you hear the odd humming sound of x-rays being generated, and voila: on the screen you see an x-ray of your teeth. The Panorex was also digital, so within another ten minutes my x-rays were complete and the dentist came in.

The x-rays didn't show any damage, however. Whatever was wrong with my teeth, it wasn't a cavity or damage below the gum line. So the dentist asked where it hurt. I indicated the left top rear molar, which already had an impressive filling in it. The dentist nodded, checked the x-rays, and marvelled that my previous dentist hadn't simply pulled the tooth at the time. He then proceeded to explain one of the great philosophical debates of dentists: whether to pull wisdom teeth, or to try and save them. My current dentist was of the former school, while my prior dentist apparently subscribed to the latter. In any case, the odds were good that the deep filling was touching the root of my tooth and was causing the pain.

I had assumed I was probably losing a tooth going in, so I didn't really argue. If it meant ridding myself of the nagging ache in my jaw of the last few months, it was good enough for me. By 0930, the offending tooth had been removed cleanly and easily (although the odd grinding sound I could have lived without). It was actually rather fascinating to observe, as best I could from my vantage point. All he used was a curved piece of metal that he pressed against the tooth until it popped, at which point he used a pair of pliers to actually remove the tooth. (OK, they weren't technically pliers, but some medical device that probably costs ten times as much. I'll bet my Leatherman could have gotten the tooth out just as easily at that point, though.)

What I found particularly fascinating, however, was the hit-or-miss artistry required of the dentist. After examining the tooth's surface and looking at the x-rays, all he had left to go on was my description of where the pain was. He also had the knowledge that the filling in that tooth went extremely deep, and his experience in dealing with toothaches, but in the end all he could do was play the odds. It's rather disconcerting to think that I've given up a tooth simply in the hope that its removal will stop the pain. I suppose I may come to regret losing the tooth, if the pain doesn't stop, but it's far too late for regrets. If the pain returns, I'll have to try something different and see if the second time's the charm.

That is how so much of life works, isn't it? Those of us who believed an invasion of Iraq was the correct course of action did so based only on our knowledge of history and our belief that fundamental change in the Middle East could eventually eliminate Islamofascism. We can point to some evidence that such an approach can work (Germany and Japan following World War II), but those who disagree with us can point to evidence that suggests the approach will not work in the Middle East. Ultimately, our side prevailed, and the invasion went forward. I often find myself laughing at those who believe that the reconstruction has already failed or that it is destined to succeed; it is far too early to know whether or not our efforts in Iraq will bear fruit. All we can do is continue to do our best with what we've got. If this fails, we'll have to try something else. What's really frustrating about that is the knowledge that, like my dentist, we still won't have a clear course of action. We'll simply have to use our best judgement, tempered with what we've learned in Afghanistan and Iraq, and pull another tooth.