More Than a Mouthful: Adventures of a Dentist

MORE THAN A MOUTHFUL

Adventures of a Dentist

DR SANDESH MAYEKAR

WITH A FOREWORD BY

LATA MANGESHKAR

This book is for my Aaie who selflessly shaped me and made me who I am today

Contents

Foreword

Introduction

1. Suicide on His Mind!

2. Every Breath You Take

3. Four Wise Teeth

4. The Case of the Missing Tooth

5. Supermodel Smiles!

6. The Hole Story

7. Secret Roots and Canals

8. Mind the Gap

9. Extreme Dentistry: All about Implants

10. Yeh Hai Right Choice!

11. Caring for Two

12. Habits That Your Teeth Hate

13. Sixty Going on Ninety

14. Systemic Diseases

15. For Want of a Tooth

16. Aesthetic Dentistry

Epilogue

Acknowledgements

About the Author

Advance Praise

Copyright

Introduction

‘Why don’t you write a book, Doctor?’

How many times have I heard that question?

Each time I would think: A book on dentistry? Who would want to read it?

Young dentists perhaps. They were the ones repeatedly asking me to write a book.

I asked them each time they told me to write a book: Why is it important that I write? You have heard my lectures, you already know everything you need to know. What more can you learn if I write a book?

They told me it was not the subject but the manner in which I handled situations and people that they wanted to understand. The manner of communicating with a patient, listening and understanding the problem he or she faced explaining to them the treatment plan ... My juniors said, ‘No textbook gives us these details, and listening to you we realize that dentistry is as much about doctor-patient communication as it is about oral health. Which is why we want you to write a book.’

My patients come to me with questions. They want to know how cavities form. Why teeth hurt. Why a root canal is necessary. Pretty young patients ask me to mend a crooked tooth, hide their gums when they show through their smile, or give them a Hollywood-style smile.

Perhaps, I told myself, if I could demystify the medical aspects and explain how I create aesthetically pleasant looks by correcting nature’s lapses, the book I write will be readable and meaningful.

So here it is. Everything a dentist should tell you about your oral hygiene: from simple everyday habits that can affect your teeth adversely to serious procedures like implants and surgeries and the situations in which either would become necessary.

I have used stories from my experience to reveal dental secrets and procedures. There are funny stories, sad stories and some that end on a happy note. I like my stories to end on a happy note. It means I have done my job well.

To my dentist students who want to learn how to become what they say I am—a celebrity dentist—I say: Just help your patients. Read my stories beyond the procedures you know about, and understand how I try at every point to bring not just professionalism, but empathy and care to every job I do. Being a dentist is also being an advisor and friend to your patients, and ensuring that they smile brightly as long as they are in your care.

To all the others who pick up this book wondering if they should turn the page and start reading, I say: Here in these pages are real stories, stories that no dentist will tell you, and they could be relevant to you some day. Being aware of what your teeth can suffer or what you might inflict on them, being aware of new technical advancements that can make dental procedures smooth and painless is worth the time spent reading.

Your teeth are precious. They are used all through your life, many times a day. And ideally they should not hurt, or fall off, or break. Not if you know how to care for them.

So here’s to a bright, happy smile. Yours!

1

Suicide on His Mind!

‘A call for you, Doctor—he says it’s urgent.’

I looked up, frowning. Involved as I was in an intricate job in a patient’s mouth, the last thing I wanted was to be disturbed.

But if I was being disturbed, there must be a good reason, I thought. I pushed down the blue mask, took off my gloves, and held my hand out for the phone.

Dr Ashish Bhumkar, the ENT surgeon from Thane, was on the line. ‘I need your help, Doctor,’ he said without any preliminary greeting. ‘I have a patient. I have been checking him for quite some time and have ruled out all ear problems. I think you need to see him. I think it is a TMD issue.’

It was a Monday morning. There were yet other cases to be handled before that particularly troublesome one. ‘Let him come on Wednesday,’ I said on the phone. ‘I am going out of town this afternoon and coming back on Tuesday.’

There was a long pause at the other end of the line. Then, in a lower tone, he said, ‘I don’t know about waiting so long, Doc. Last weekend, he was talking about committing suicide.’

There was nothing else to be done. ‘Send him right away,’ I said, and I informed my family that I would not be home till after lunch time.

I had first met Dr Bhumkar as a patient. A nodule in my throat had prevented me from delivering my lectures, causing hoarseness and discomfort. I had been to a couple of ENT specialists before, but Dr Bhumkar had explained the treatment plan to my satisfaction. Somehow, as doctor to doctor, we had got talking, discussing the relationship between the ear, nose and throat and teeth. Our discussions convinced us that dentistry and ENT found a common meeting point in problems related to the Temporo Mandibular Joint (TMJ), which is related to the jaw. And TMD or Temporo Mandibular Disorder is one condition that could need both medical and dental attention.

But what, I wondered now, even as I worked on the job at hand, could drive a man to suicide? The answer presented itself soon enough.

The patient came in, accompanied by his wife. Looking at them, one could not easily make out who the patient was. They both looked distraught and close to breakdown.

The man’s clothes were a mess. He wore a beige shirt untidily tucked in, and dark trousers that needed a belt. It made me think he had lost weight recently. He was fair skinned, but his face was mottled with lack of sleep, the eyes behind the lenses were tired. I wondered what he did for a living. Looking at the silk sari his wife was draped in and the jewellery she wore, they should be doing pretty well, I thought.

But what was most noticeable about him was the wild look in his eyes. Haunted was the word that came to my mind as I ushered him into the dental chair. Yes, I could well imagine him contemplating suicide!

Usually, patients who come in to my clinic for the first time look around. The soft lilac and white walls of my treatment room usually evict a favourable comment about the soothing ambience. The colours are meant to relax the patient and remove the fear of the dentist’s clinic. But Satish, as I would like to call the patient, hardly paid any attention to his surroundings. He sank heavily into the chair, and sat there, as if transfixed. Something occupied his attention completely; it was as if an inner demon was tormenting him.

I have learnt in my years as a dentist that the fear of visiting a dental clinic can seize the bravest hearts. Even Napoleon was scared of dentists! Many prefer the operation theatre in a hospital and the oblivion of general anaesthesia that accompanies a surgery for say appendicitis or tonsillitis to sitting defenceless, fully conscious, in a dentist’s chair, with an open mouth into which what look like instruments of torture will be introduced. Devising my own technique to put my patients at ease, I usually embark on a line of conversation that distracts them from the reason they are there.

But Satish, I realized, was not likely to be thus engaged. I asked him gently what the matter was.

‘I have a problem in my left ear,’ he said, turning to look in my direction.’ When I turn my head, or if there is any movement in my lower jaw, there is a continuous clicking sound in both my ears for sixteen hours a day. It is driving me mad, Doctor,’ he said. ‘I just want to die!’

He sank back into the chair, his expression intent as if he was listening to something. I bade him open his mouth, and examined his teeth. They were in good health, but something in his mouth made me alert.

‘Have you had anything done to your front teeth?’ I asked.

He replied that he had broken his front teeth in an accident some years earlier, and had replaced them with fixed artificial teeth in the form of a bridge.

‘Do you wake up tired?’

‘Yes,’ he responded, looking somewhat surprised.

‘Do you have a pain in the neck ... a stiff shoulder? Do you have lower back pain?’

He sat up, his eyes focused now. ‘Why are you asking me these questions?’ he countered.

But I needed to know more. ‘Tell me the history of your accident,’ I said. ‘When the bridge was made, did it sit properly?’

Satish sighed. ‘Not at first,’ he replied, ‘but after a while it adjusted.’

I knew I had the problem firmly in hand. My suspicion was confirmed when I examined his mouth further. His jaw was closing badly, shifting every time he shut his mouth.

I straightened his chair back and locked his gaze with my eyes. ‘I want to explain your problem to you,’ I said.

Then I gave him an example he would understand: of a car. ‘Whatever the car may be, an Ambassador or a Porsche, if you change the car without changing the wheels, the machine will go haywire. That is because the balance in the wheels has been lost.

‘The muscles in your face are the wheels. The teeth

are the equivalent of the car’s body. If the muscles get out of alignment, they send the jaw out of alignment as a result.’

The vacant, preoccupied look had left him. He was listening. I had his complete attention. I continued further.

‘The upper teeth are fixed to the skull, the lower move up and down,’ I said, moving my own mouth to explain it visually. ‘By nature, the lower teeth attempt to meet the upper teeth, and in that effort the jaw moves any which way just to accommodate the meeting of the two sets of teeth. In this process, the alignment is disturbed and the muscles are strained.’

There are three sets of facial muscles that work the mouth. The first opens the mouth, the second closes it. The third positions the teeth and jaw. That is the one that causes problems. It was what was causing my patient’s problem too, and because the muscles from the top of the head to the toe are interrelated, the strained muscles were also causing his stiff neck and back pain, and resulting in the poor quality of his sleep.

It was, I explained, like the ripples that are caused when a table cloth is pulled strongly from one end. The ripples will go all around the table.

Satish listened to me till I finished my explanation. Then he sank back into the chair, shaking his head. The movement obviously disturbed him a lot; the look returned to his eyes. I could see he was not convinced. Nothing I said had explained the reason for the clicking sound he heard consistently, and which was driving him crazy.

I told him to relax, while I readied for his treatment. He waited in the outer room, and I could see how tense he was, sitting there, often holding his head in his hands, sometimes wringing them in utter despair. His wife sat beside him, trying to soothe him, but every movement he made started a reaction in her ... I could see she was on edge too—the muscles of her face were tense, her hands were clenched as she sat watching him.

My staff had meanwhile been taking down the patient’s background details. He was a chartered accountant with a thriving business, which in the past month and a half had seen much neglect. In the past weeks, he had entirely stopped attending office. I could well imagine the tension that the entire family must be under as he tried to cope with his invisible but very tangible problem.

It took just about an hour for me to start his treatment. With the help of a German machine I had bought just for this purpose, I created a splint or bite plate to fit into his mouth. I fixed the plate in such a way that the jaw would now move to touch the splint in a manner that would relax his muscles. I told him to wear the bite plate through the night.

He took it, but his tense eyes and face told me he was not at all convinced that I had found the remedy for his problem. In fact, I thought his jaw was more clenched now than when he had first come in ... And it was at least for the moment compounding his problem. Looking at this, as he left, I told him to start wearing the plate right away. ‘Wear it for twenty-four hours,’ I told him, and told his wife to ensure he did so. That way, even if he continued to clench his jaw, the plate would help relax his muscles.

I left for Nashik that afternoon. I was chief guest at a dental college annual day function and had persuaded my wife to accompany me. It was my way of getting time with my family. But before leaving, I gave the man’s wife my associate’s phone number. Knowing his tendency to think of suicide, it was a necessary precaution. My associate being a Gujarati like Satish, I told him also to call and check on Satish, and pamper him.

As my car sped through the beautiful rocky landscape that connects Mumbai to Nashik, I sat back to relax and take in the sights spread out on either side. Green fields gave way to rocky patches, and in the distance the mountains created a splendorous border as they reached into the sky. Just a few hours out of the bustling metropolis of Mumbai and nature was able to lay out such a visual feast!

My mind returned to Satish. Poor man, he must indeed have gone through hell. I knew something of his pain; I had been a sufferer myself. Only chance had solved my own problem.

Lucky Discovery

It was in 1999. I was visiting Tufts University in the US. It had been my practice since 1982 to visit dental institutions whenever my work took me to America, to check on new techniques and advances in dentistry.

In 1999, I was to meet Dr N. Mehta, head of the GELB Orofacial Pain department, to talk to him about collaborating with our educational institutions in India.

While waiting for him to be free, I could not help noticing that most of his patients were those with neck pain, and other signs of what was commonly thought to be spondylosis. I had undergone traction myself, so I