Thursday, February 25, 2010

Progress with Pain

Dentists inflicted much pain on me during my youth (See October 1, 2009 Post, “Unintended Consequences”). My horrific encounters with drills and scraping instruments without the benefit of pain killers had a lasting effect. I am terrified by the prospect of visiting a dentist.

So when a routine exam revealed that one of my molars was in serious trouble and needed to be pulled, I was not a happy puppy. I even got a second opinion. It confirmed the diagnosis. I was referred to an oral surgeon for the work, which came as a surprise. More than a dozen of my teeth have been extracted over the years, and every one was yanked by a dentist as part of his general practice. I didn’t know things had progressed to the point where a family dentist would refer extraction work to a specialist.

I did know that a lot of progress has been made in dental techniques since the days of “Painless” Parker, who was sued for claiming in ads that his work was painless. Of special interest was knowing that painkillers are more effective today than they were 40 or 50 years ago.

Fifty three years ago my last remaining wisdom truth was in serious trouble. I didn’t need any professional opinions to realize it had to be pulled. A referral from members of the family who owned the weekly newspaper where I worked sent me to “the best guy in town.” Town was De Pere, Wisconsin.

The De Pere dentist shot me full of local anesthetic that numbed a big part of my lower jaw. He had to split the roots before he could get the tooth out. He did that with a couple of smart whacks with a hammer on a chisel. I thought the world was ending. But I survived the jolts, the tooth finally was gone, and I was more than ready to get out of there.

“Where are you going now?” the dentist asked.

“Back to work.”

“Oh, no, you’re not. When the novocaine wears off, you won’t want to go anywhere. Call your office and tell them you won’t be in today. Then stop at the liquor store and buy a half-pint of brandy. Go home. When the bleeding stops, get in bed and drink all the brandy.”

I followed the advice. After sleeping fitfully from mid-afternoon until the following morning, I made it to the office. Constant pain accompanied me through that work day. The pain diminished gradually, but it didn’t disappear for several days.

After that, I didn’t let a dentist touch me without first administering a dose of laughing gas (nitrous oxide) to provide something of a feel-good aspect to any work on my teeth. My favorite caper was to schedule dental work for late Friday afternoons. When I got home, still somewhat goofy from the gas, a single martini usually was sufficient to launch me flying a little high into a relatively painless weekend recovery period.

Sandy, our keeper of up-to-date medical knowledge, briefed me on oral surgeons before my recent appointment. She said they usually are very skilled and offer all sorts of ways to reduce pain. Included, in addition to modern local anesthetics (novocaine no longer is used), are the old reliable “laughing gas,” oral drugs, intravenous drugs, and even all-out anesthesia to render patients unconscious throughout the procedure.

Sandy insisted on driving me to the surgeon’s office. She assumed I would be “put under” when my aversion to pain became known. Her opinion got backing as we waited. An assistant came into the waiting room and instructed a man to drive around to the back of the building. She said his daughter’s extraction was complete, and she would bring the recovering girl to the rear exit and help get her into the car. I thought, “Aha, they do put you out. I’m going for that if there’s a choice.”

A different assistant read my medical history carefully, asked a few questions, and took my blood pressure. “That’s really good,” she said. “Any bad reactions to anesthetics?”

“Absolutely none,” I said. “What are the choices?”

“Looks like a routine extraction. We almost always just use local anesthetics for them. The doctor will numb you up real good.”

Perhaps puffed up into a state of mini-machismo by the compliment about my physical condition, I lost my wits for a moment and said, “OK.” In an instant, areas around my soon-to-be-missing tooth were swabbed with topical anesthetic to numb the surfaces. I don’t recall topicals being used 50 years ago. I do recall jabs with local anesthesia needles hurting something fierce.

J. Mark Domin, DDS, appeared with some comforting, and not so comforting, news. He said my extraction indeed appeared to be routine. I felt good about skipping the gas. He said roots would need to be split, and I could expect to hear a “rasping sound.” I felt less good about skipping the gas.

However, when Dr. Domin numbed me with the big needle, I didn’t feel much of anything. I felt absolutely no pain as he broke off an old crown, sawed (I think) through the remnants of the tooth, and pulled the pieces out. I was told taking a nonprescription painkiller would be a good idea before the anesthesia wore off. I was given a prescription for stronger stuff that could minimize pain for two or three days.

I took no pain killers. When the numbness wore off, there was no pain. Hours later, there was no pain. Days later, there was no pain. Wow! Dental science has made mighty strides toward greater patient comfort in the last half century.

But improved dental technology has at least one painful price. Prominent in the post-operative instructions sent home with me by the oral surgery staff were these words: “DO NOT USE ALCOHOL FOR ONE WEEK FOLLOWING SURGERY SINCE IT DELAYS HEALING.”

Now, that hurt!


Anonymous said...

Ha! Nice story, Dick.


Dick Klade said...

Thanks, Arik.