Ceci n’est pas un blog

Taking advantage of the best dental insurance I’ll ever have, I’ve agreed to let my Boston periodontist remove and re-do the implant that was under the crown. He didn’t approve of the work of EITHER of my NYC dentists. The implant is too low, not straight, too small. This means 9 more months of a hole in my mouth. Sure hope this one comes with a lifetime guarantee.

I understand the issues of interoperability in the world of technology a little (as with so many technological issues, my colleagues at Berkman have written extensively about it), but I now know they exist in the rest of the world too. For example, dentistry. Because of a lack of dental interoperability, I spent nearly 90 minutes of my sunny Saturday morning with a frustrated dentist drilling more or less continuously (with bit after different bit) at a single tooth implant that I had paid two highly qualified dentists obscene amounts of money to install in my mouth a couple short years ago.

The crown, which in this case means not a cap on a tooth but an entire artificial molar, replacing a tooth that had been pulled, was badly fitted you see, leaving a teensy-tiny little gap between it and the gum that food could get caught in, very frequently annoying and occasionally causing my gum to get all infected and puffed up and tender. This was done by a dentist in the West Village of Manhattan I loved and had been going to for almost a decade. Referred by a friend whom I know to be appropriately elitist and fussy about medical care. A dentist who I still believe to be very good at what he does, honest, etc. And of course expensive. So why did he do me so wrong?

Here’s how it all happened. I had a tooth crisis, an old root canal gave up the ghost, tooth definitely had to go, called my downtown dentist. He’s out because he only works 3 days a week, has a pager number. I scribble it down, dial it, it doesn’t anwer (or it does but he never returns the call, I don’t remember). Panicked, I call another friend who has (by marriage in this case, but no matter) equally discerning taste in medical professionals (hers are all Upper East Side, which is now more convenient than the Village, as well as even snootier). She sends me to her periodontist, on Fifth Avenue. Floor to ceiling diplomas, photos from her exotic vacations, supersmart, funny, specializes in single tooth implants. Great. She has me to a surgeon to get the tooth out and then, after the bone recovers, does the surgical procedure of the implant, essentially installing a tiny esoteric bolt in my jawbone. So far, so good. She tells me she can refer me to “one of her guys” to do the crown part, that is, actually putting something I can chew with into this gaping hole. I say I’m going to ask my downtown dentist to do it. She says she doesn’t know him. I shrug. I know him. That’s enough for me.

So I go back downtown. My dentist says he would have sent me to his periodontist (turns out I mistranscribed his pager number by one digit). He takes a look at what uptown dentist has installed. Doesn’t recognize it. Complicated negotiation where I get her office to send his office the part number (in hindsight, this should have been the tipoff! Run away!) He’s never worked with this manufacturer. But no matter, he’s confident, apologetic about the time it’s added (I have to come back after he’s gotten the info and ordered the parts), forges ahead, takes an impression, makes me a new tooth, and glues it into my mouth as if forever.

Some time later, I go back to uptown dentist to discuss another implant I need (the same molar on the other side, root canal from the same time 20 years ago has also died, she’s pulled it), she looks at downtown dentist’s crown and is horrified. It’s a disaster. It’s not seated properly, it’s got a gap, it’s a terrible texture, she can’t believe it doesn’t bother me, etc. I should insist he redoes it. Of course, she’s not going to call and tell him all this. Some professional etiquette. But I should.

Next time I see downtown man for cleaning, I gently suggest that food does get trapped under the crown. He looks at it, says oh no it’s fine. I don’t push it.

I move to Boston, get a new job with even better dental insurance, decide to get this nonsense sorted. Get a recommendation for a super-duper periodontist, right downtown (this time I don’t even care how expensive, I never see the bills, thank you Harvard thank you so much). He xrays, pokes, says wow that’s a disaster. The crown (downtown guy) doesn’t fit and the implant itself (uptown gal) is really strangely done, he doesn’t approve at all. They’re BOTH wrong; where did I find these people? Recommends at least replacing crown, possibly re-doing implant. His colleage the prosthetics guy can remove the crown. He looks at it, doesn’t recognize the type of implant, I have to have the uptown dentist’s office send the parts info (I’m old enough to like private, but I find it nuts that I can’t authorize one doc to ask another for my records, I have to do it myself).

Anyway, eventually (last Saturday) I’m in with the “mechanics” guy, and he pulls and drills and wiggles and drills and swears and drills and drills and drills and twists and drills and twists some more and finally cuts the damn multi-thousand dollar profanation out of my mouth, leaving a deep well in my jaw with a tiny metal bolt sticking out of it. I insist on keeping the burnt and mangled tooth as a souvenir.

Next week the periodontist will look at the hole and decide if the implant is ok enough to re-use, whether he needs to add some bone grafting to make it better, or whether it needs to be re-done too.

I actually believe all four of these folks (downtown NYC dentist, uptown NYC periodontist, Boston periodontist and Boston prosthedontist if that’s the right word) are tops in their field. I am sure that if I went to my downtown dentist’s periodontist, he would have put a perfect crown on top of that familiar implant. OR that if I had gone to my uptown periodontist’s crown guy, he would have done a fine job with her implant. But working with unfamiliar parts, it just didn’t happen. And it turns out neither one of them was right according to my Boston guy.

Anyway, I’m inside one shop now, really hoping I can get back to a full set of teeth while I have this insurance.