Stibbe - Reasons to Be Cheerful

It was quite normal for dentists to self-treat back in 1980, especially lone practitioners, but an intolerance to lignocaine meant that JP Wintergreen, dental surgeon, was unable to perform anything but the briefest procedures on himselffor only minutes after being administered a local anaesthetic hed experience numbness in his synovial joints and therefore lose the ability to grip anything in his hands.

He could do the basicsscaling and the odd filling towards the front on the lower jawbut, for anything further back, more complex or painful, he had to call his old pal Bill Turner from a practice five minutes up the road. It was a reciprocal arrangement.

Late one afternoon I noticed that JP had pulled the Medi Light 400S right over to the desk side of the surgery and was up at the wall mirror, licking his front teeth and picking at them with a probe. I was in a hurry to leave and my heart sank. I had to collect my baby brother from Curious Minds nursery by half past fiveand it was already five to.

JP skimmed his dental record across the desk at me. Extract upper left and upper right one fit partial denture, immediate restoration, he said, meaning for me to write it up.

I glanced at the clock.

Dont worry, nurse, he said, I shant take more than a couple of minutes.

Marking up the chart, I recalled the sorry state of the teeth in questionreceding gums, blackened dentine, transparency, stained ridgesand it occurred to me that Id never have to see them again, grinning at his own joke, coated in coffee-skin, or sinking into the icing on a bun. Also, I reasoned, the post-treatment care usually associated with an extractionthat could take up to fifteen minuteswouldnt be necessary, the patient in this case being a dental surgeon, and therefore I neednt panic about getting to Danny in time.

and fill out an FP 17 for the denture.

He rifled among the instruments cooling on the draining board, eventually settling on a pair of straight anteriors, and, after tossing them from hand to hand like a hot potato, ran them under the cold tap and put them in his breast pocket beside a pack of Gauloises.

Back at the mirror, he loaded a syringe, lifted his upper lip and injected himself somewhere above the right incisor. This first jab was easy, although painful, and his tongue waggled from side to side like a snakes. The second jab, into the palate, was slower and required considerable force. His thumb wobbled on the plunger, the lids on his half-closed eyes fluttered, and a slight grunt escaped him. I looked away out of decency. When hed done, he dismantled the syringe, jabbed the sharp end into the rubber of the cartridge and flung the whole thing into the sink for me to clear up later.

He tapped one tooth and then the other with the heavy end of the probe before inspecting a little denture hed had made. It was rather smart with a cobalt palate that looked like liquid silver, and handsome clasping.

Will you want me to assist chair-side? I asked. Id already folded the chair up for the night, pulled the treatment table in, and turned off the spittoon.

No, thank you, nurse. He worked his mouth. I shant need to sit down.

Id learned during my months at the Wintergreen practice that teeth arent pulled out, as such. Pull is the wrong word. There is no need for leverage or brute force like in the old cartoons, no boot on the wall. Teeth are removed in the same way a gardener might take a radish from the groundthat is, with a push, a rock and a twist to break it free of its bindings. Theres actually very little pulling involved, even with a turnip (our code for a very large, or difficult, multi-rooted tooth).

Numb now, JP tapped again and exhaled in short puffs. He started with the upper lefta very compromised tooth with many restorations including an ancient buccal inlay and a mesial silicate filling. In other words, the crown was weak, there wasnt much actual tooth left and hed need to be careful. (Imagine using a rusty, over-cut Yale key in a stiff lock.)

All righty. He curled his lip up and, breathing noisily through his nostrils, began a gentle but brisk revving. Then he stopped, leaned over and flobbed the inlay into the basin, where it would be caught in the amalgam trap. I stood quickly and turned on the spittoon.

More twisting, a loud groan and the rest of the tooth, minus its root, was there in the forceps, having snapped off at the gum line. Gah! How had he let that happen?

I glanced at the clock. I had less than twenty minutes now to get up to Curious Minds.

JP abandoned the upper left and switched to the upper right. This time he jammed the beaks up hard between the periodontal membrane and the alveolar bone and with two jolting twists brought the tooth out cleanly, root and all, clanging it into the dish with great drama. He spat into the basin leaving a fine bloody spray across everything for a yard around him. I slipped the plastic bib round his neck and handed him some napkins. When he spat into the sink again, a bloody string looped down from the rim to the skirt of his brand-new Latimer tunic. He was no better than a patient now; anxious, dribbly, high-maintenance.

Biting on a gauze wad, he looked up at the clock, mumbling, flexing and unflexing his fingers. Then, back at the mirror, he began digging around the ragged gum line and before you could say spoon excavator the instrument fell from his hand and bounced off his plastic clog.