What the dentists said

I have a dentist in Nogales, Sonora, Mexico who takes care of my teeth during the six months we're in Tucson each year. And I have a dentist in Lynnwood, Washington who I see the other six months. I see the Mexican dentist in November and March each year (very good and much cheaper, but 95 minutes away by car.) I see the American dentist in June or July. Three cleanings a year, carefully scheduled.

In March I was at the Mexican dentist and I was told that one of my top right midway-to-the back teeth, previously fitted with a crown, needed to be extracted and replaced with an implant and another crown. I decided to wait until next season because there was a three-month lag between the extraction and the implant, and I was leaving before three months. The tooth was a little loose sometimes but I figured if I paid attention I could keep in my mouth for six more months.

In May when I returned to Washington, I learned that I need to have my hip replaced. I am scheduled for August 18. One of the pre-surgical requirements is a release from my dentist that I don't have any infections in my mouth. I decided to use my summer appointment for cleaning and a signoff by the dentist.

Yesterday I went for my checkup. The dentist looked at my mouth and said there was no infection, but my iffy tooth was a little wiggly and he was concerned that  when I was intubated during my hip replacement the tooth could break and I could aspirate it. He recommended removing the crown and filling what remained of the tooth so it would be stable for the hip surgery. Then I could have the implant done next fall in Mexico, and get the crown in Mexico in the winter. One advantage would be I could have the work done in two different calendar years, which would make better use of my dental insurance. 

We decided I would come back today for my cleaning and that tomorrow he would do the filling.

I arrived at noon today for my cleaning and there had been a cancellation right after my appointment, so the dentist asked if I would like to have him do the filling today so I wouldn't have to come back tomorrow. I said yes. 

He removed the crown and saw immediately that there wasn't enough tooth left to fill. The tooth would need to be pulled as soon as possible. My hip replacement is in about six weeks, so I only had a couple of weeks to get the extraction to have enough recovery time before the surgery. 

He said he'd give me a referral to an oral surgeon, or he could do the extraction today. It looked like a pretty simple job to him.

I said do it today. 

He asked if I wanted to have a bone graft. I asked why and he said it would increase the odds for the implant to work, since there would be a difference of several months between the extraction and the implant, and the remaining teeth start to shift after an extraction. He said it would cost $400 and that insurance wouldn't cover it. I asked where the graft would come from. He said a cadaver or a cow.

I said do the bone graft. If the implant didn't work I'd have to have a bridge and  I don't want that.

I got moved from the cleaning room to the extraction room. I got several numbing shots. The dentist and his assistant worked on my tooth for 45 minutes. The remaining half inch of root - which had had a previous root canal - gave up after a lengthy struggle. The dentist said, "I'm not going to charge you for the bone graft. This took much longer than I led you to believe."

I got stitched up and, with gauze pressed into my mouth, I left to have the antibiotic prescription filled. I looked weird with gauze sticking out of my mouth but I had a mask on so no one noticed. I go back in ten days to have the stitches removed. The dentist will make sure I don't have an infection and then he'll sign off on the dental exam part for my hip replacement.

That's the plan, anyway.