Saturday, October 29, 2011

Appointment 37 and My Provisional Smile

On Monday, October 24th I had my 37th dentist appointment since January 19th. On the agenda for this appointment was my last 3 extractions of the remnants of my 3 front teeth, bone grafts and my first implant placement, and also the immediate delivery of my provisional 5-tooth denture, or "flipper" upon extraction. This would be the first time I saw myself with the appearance of all my front teeth in nearly 14 years, though it was more like 17 since I first began to be self-conscious from cavities and began tightening my lips in all conversations with the world and suppressing my smiles and laughter around 10th and 11th grade.

I can't deny that I wasn't kinda nervous going into this appointment. Many of my actually painful, bloody and intense appointments took place months ago, and though I have not forgotten them, I have been lucky to experience several visits that felt more like art classes that Dr. visits. I also knew that though exciting, seeing myself with a different face after half my life was going to be surreal and awkward and hard to process.
It was a really busy, crowded and more "formal" appointment with a doctor performing the procedures and two students assisting, so this time unfortunately I don't really have many pictures, but I will describe the process as best as I can remember. On some occasions I may be incorrect as to what was actually being done, but I am going to describe what it felt like to me.

 First up we were performing my final 3 extractions on my front teeth numbers 8, 9 and 10. Here is one last "before" picture I took on the way to my appointment:

After 3 or 4 shots, one of which made my eyes water despite my overall fear of needles, including one on the palatal side which always feels awkward, I believe a long incision was made laterally across the gums to sort of create a flap of flesh on either side of my upper jaw bone. Though in the case of my molar extractions there were many times bone had to be filed down in order to get a grip on my fractured roots, great care had to be taken in this case to preserve as much bone and tissue as possible because it is the site of the weakest bone in my mouth and also because it will be visible in my future smile. Amazingly enough, though one of which was surely buried, the first two teeth came out quite effortless and faster than expected. The final one however would introduce me to yet another of my least favorite dental tools/procedures/sensations to add to the list, a perio-tome, which if I had not asked to see it afterward, I would have swore was like 10 times larger.

From what I understand my last root was somewhat stuck, and the perio-tome was basically used like a wedge between the root and the bone in several places to help break it free. I was thinking in terms of my wood-splitting experience as this was going on however, and though I knew we were trying to preserve as much bone as possible, I was envisioning as a much wider wedge that was in fact spitting my jawbone at all 3 tooth sites so as to pry it apart on the end and pull the last root out. I never got to see if there was actually a mini dental "hammer" or what, but it most certainly felt like a nail was being driven about an inch into my skull. It didn't hurt exactly, but because of bone conduction, hearing it reverberated throughout my whole head and it was entirely freaky.

All three teeth were out in probably a half hour though and we could gladly move on!
Next up we would be inserting bone graft material at the site of all 3 extractions. Though I am tentatively scheduled according to my treatment plan to receive a 2 implant-supported FPD (fixed partial denture), the middle site is still important because over time the bone can re-absorb/recede without a tooth in the hole. We want to prevent that hopefully so there's the least amount of gap possible between the bridge and my gums at site 9.

Bone grafts are a little weird. I have never really had any kind of major injury in my life and never had to receive any part of another person's donated body. I had never really imagined even of all those people donating their organs, that a small portion of someone might end up in people's mouths or help others, OR me, smile again. My particular bone grafts came in the form of bone dust that was mixed with water (or saline maybe?) and applied into my root holes after they were fully cleaned with a syringe. It was totally painless. I asked my new student dentist assistant Elif how my living bone could somehow attach to someone else's dead bone and she described it as acting more like a supportive "scaffolding." Perhaps more like a tressle for tomato vines to grow up? A guide? I don't know. I keep making jokes however, wondering whose bone I have in my mouth. Whether it might be some hot girl's pelvis, from the femur or a runner which will make me talk even MORE, or the cranium of a brilliant mathematician or something. Haha. Whoever it is, I am grateful, and I hope their bones and my bones get along.

After this to help guide the tissue to grow back in a more pronounced and uniform way across the formerly sunken in sites of my gums, a collagen membrane was applied covering the holes. It basically looked like a little inch-long piece of scotch tape. This felt particularly weird because Rakhee was using like, a little "spatula" thing to hold all that flesh away from my jawbone while the doctor was applying it. I'm not sure sometimes if my powers of visualization freak me out more that I would be if I was actually watching these procedures done on someone else or what. Upon completion, I received several stitches, and we moved on.

We tried my provisional denture in for the first time to see how it fit and determined that it would need to be modified slightly in order to not interfere with the healing tissue of the extraction sites before the day was over. Then we went to take my 3rd I-cat X-ray thus far to get a better picture of how my bone has healed over the past several months at my extraction sites before beginning my first implant.

The implant actually also went quicker than I thought, though there was one slight snag: my mouth is too small! We would only have time for one implant today, once again beginning the process with an incision at the site of tooth 30--my bottom right first molar. The Dr. then filed down the rounded bone slightly to create more of a broad surface to begin the first of several pilot holes, increasing in size. I asked to see the implant, which was 4.7mms in diameter and 13mms long, or about a half an inch. We continued on with more holes of increasing diameter, I think 3 in all, with the students confirming the angle and "perpendicularity" of the drill from their more advantageous perspectives. We took more X-rays to confirm with some other metal  piece in the hole as a reference, one of which happening to be my least favorite angled X-ray because in order to bite down on it hard enough to hold it in place it supremely cuts into the bottom of my tongue, this time from the taste I think making it bleed. During the final pass with the largest drillbit it was virtually impossible to get started at the correct angle because try as I might I could not open my mouth any further to begin the hole more perpendicular. The implant was screwed in very slowly with a cute little mini-rachet until it was flush with the surface of my jawbone, with each turn making a hard click that also reverberated through my skull. Upon the final X-ray it appears because of my small mouth it went in at a hair less than the ideal angle, but the roots of the adjacent tooth were also a little curved and it seemed actually perfectly in line with tooth 28. It was however, no big deal and will just require a custom abutment, or the joining part between the implant and the crown. More stitches to cover the implant with my gum tissue, my appointment was finally almost over! Today was a total MESS of tools and blood, and this wasn't even all of them used:
6 full carpules of Lidocaine, (3 for upper and 3 for lower) and 3 1/2 hours later, I was almost ready to go home. Rakhee made the modification to my partial and explained I needed to keep it in for 3 days in case of swelling it might not fit again. When it was first put in my mouth I think my tongue was so confused I could barely seem to make the sound of any consonants. It was incredibly disorienting, and I hadn't even seen it yet!

Being under orders not to lift or exercise for a week and under strict dietary limitations so as not to cause complications with the sensitive bone graft sites, I took the next few days off of work to rest and try to get accustomed to the sight of my mouth full of teeth again. This is, in fact, quite harder than it seems most people think. I've spent a lot of time in the mirror just looking at my mouth and making faces and taking pictures and trying to fight my perpetual urge for years of keeping my lips as narrow as possible in all conversation. I have come a long way over the past several months at opening my mouth, both to friends and strangers, wearing my story on my sleeve in regards to what was "missing" from my mouth. It feels like a different story altogether however finding comfort in teeth being put back IN. I posted a few pictures on facebook before I began to awkwardly make my new public debut of this new transitional smile.
A few hours after surgery.

I think some people may have felt that these pictures represented my "big finish" or something at first, and in order to clarify I wanted to also share the following few pictures I did not post on facebook. The teeth in the above pictures are part of a temporary partial denture, kind of like a retainer that just sorta pops in.

I think it kind of looks like an elephant!
It is not what my final smile will look like, and in fact I still have probably 6-8 months and about $12,000 worth of appointments to go. The purpose of this denture is to provide support to my other teeth throughout that time so they do not collapse. I'm sure it also will help to ease the transition in my brain, and also help me eat better once my sutures heal.

I have been wearing this crazy thing for five days now. Though it is getting a little bit more bearable in general, it is still very hard to overcome my public resistance towards speaking with perky enthusiasm and unleashing big smiles. I feel that some people are disappointed in me that I don't outwardly seem "excited enough" yet, but trust me when I say it is not that easy, and that I am working on it.

I have taken a few other pictures after resting and sitting with this new plastic friend for a couple of days that I feel look a little bit more natural to me, or just being playful. Here they are:
This is probably my favorite thus far.

And here is a pic, in case you are wondering, or maybe just because Halloween is around the corner and I have gore on the brain from watching zombie movies, of what is healing slowly behind this surreal new plastic smile:
That's all for now! I have a post-op appointment on November 7th and at that point hope to schedule my next 3 implants for early December providing everything looks good and the implant doctor is available, but now things are kind of a waiting game for me to heal and to raise the remaining $9K for the remaining implants and subsequent crowns to be mounted on them. So I guess it will be nice to have a break from so many appointments and stress over finding rides, though I am honestly going to miss my dentist. I'm sure that sounds crazy to some people! I am going to redirect my energies toward more fundraising events and catching up on a great deal of things I wish to write about in this blog I have been neglecting. Thank you for reading along, though I understand if some of the detail of procedures like in this entry may be monotonous, I am trying to be as thorough as possible in reporting all I remember, all I feel and experience to provide the truest account that I can for all of you wishing to know the story of this transformation. Thanks, as always, for all of your continued support and kind words. It is far from over. I hope to give you more to read really soon! Goodnight.

Sunday, October 23, 2011

Reflections of the past year on the verge of my first implants & the "home stretch"

There has been a lot on my mind lately. My 5th and most recent fundraiser on October 24th was the one year anniversary of the day that my 3rd front tooth, #8, broke in half while in Trinidad, California on a 6 week bicycle tour down the Pacific Coast with my best friend at the time and former partner, Pinar.
October 24th, 2010. Trinidad, California.
 In some ways it felt like the worst day of my life. It was certainly the key toward letting go, releasing nearly 20 years of pain, alienation and isolation and my first step toward moving forward and changing my life, even if in that moment I had no idea how to even remotely begin that journey.

I could barely speak to or look at anyone for days. It continued to create distance between us for the remainder of the bike tour. On our last night together before the drive from San Luis Obispo back to Phoenix an also the eve of my 33rd birthday on November 10th, I found myself with a horrible toothaches, awake most of the night listening to songs I recorded 5 years prior during my final months in New York. My voice has changed a lot since I left the humidity of my forest upbringing and Lake Ontario, partially I think due to allergies and the pollution of cities, the dry heat of the desert and continuing decay of my teeth. Listening to me screaming lyrics felt like hearing the voice of a friend from beyond the grave, a voice I felt I would never hear again.

It was hard to come back to Phoenix. When I left 2 months earlier I had dreamed I would find a new place to start over in and in a way returning felt like just one more thing to be "ashamed" of even though we had successfully completed our 1,100 mile adventure. This was further complicated by not all of our memories being as perfect as I may have hoped, by knowing that our dynamic as partners and friends would be different than it once was, by knowing that I had never opened up to anyone but Pinar about my secret, and that I had no idea how to begin. How do you come back "home" after that when no one really knows shit about how you are feeling and all you have been through in the 2 most intensely beautiful yet tragic, life-changing months of your life? How do you put on a fake smile (when you don't even smile to begin with) to reply to all your friends questions, "Yeah, it was SOOO awesome!" when you are also totally fucking scared to even look at them?

I returned to Phoenix with about $3-400 to my name, homeless again, broken-hearted and completely unsure how to even begin to tackle the road that lay ahead if I were to finally begin to fix my mouth. (I did however, have the strongest legs of my life!) Pinar left to continue her own healing journey alone in Peru, I moved in with my friend Robyn temporarily and tried to figure out what was next for me. It was around this time that I wrote my "Ask for Help" note on facebook and stenciled a shirt, began trying to make money bartering bike repair services, and worked part time cooking and baking vegan food at the downtown collective and hangout space, Conspire.

I tried searching the internet for dental resources, but found little hope or answers. I began to talk a little about my secret with a few close friends. Everywhere I tried to call, from non-profits with once a month dental lotteries, resources for the homeless and a few random private practices, none seemed to have any answers or guidance for someone like me or were over a $100 just to even look in my mouth.

After talking to a friend who is an ER Doctor it was suggested I pursue a dental university as a possible cheaper option, but after calling around I could not be seen for over a month at the closest one. I tried again at A.T. Still University in Mesa and finally made my first appointment in 20 years for early February.
I still had a lot I was trying to process about the past several months of my life, and was repeatedly dissapointed upon Pinar's return that I could not find the time I felt was needed to work through all our experiences before she would leave for college. The night before she left, at the end of my rope, I wrote what would be the first attempt at an autobiographical narrative trying to put into perspective what the fuck happened in my childhood to make me this way and somehow put into words what it was that I felt happened to me to make me stop brushing my teeth. I wrote the majority of it in one sitting with virtually no editing, and cried several times reading it aloud on the phone to my former partner as she drove further and further from my life toward her own new journey to begin. It was the first time in my life I felt any of it even made sense or registered to me, like the first step away from over 15 years of denial was finally over. Shortly after I posted my secret to about 40 of my closest friends on facebook, and after such an overwhelmingly supportive and positive response from friends and acquaintances alike, a few days later took a deep breath and posted it to the world.

What followed in the months to come is hard to even put into words. I am still struggling every day to understand all that has changed in my life as documented in this blog, struggling to find enough time alone with myself and my thoughts and my mouth to really take it all in and realize how far I have come. I got a call mid-January from the dental school saying that my appointment had been moved up a few weeks and on that fateful day I would meet a very special dentist that would change my life, with each appointment helping me to find the strength to face my fears and little by little rebuild something I thought I had lost forever.

In the past 9 months and 36 appointments I have suffered through 13 extractions, 12 fillings, 2 root canals, 2 crowns, probably a 100 shots, dozens of X-rays, like 15 impressions without gagging, and have managed to find almost 2,000 miles worth of rides from friends and strangers to my Mesa appointments without ever missing one, with the exception of my grandmother's funeral. My blog has been viewed over 45,000 times in over 75 countries, and between it and the 5 fundraisers I have hosted I have raised nearly five grand from all over the US to make my grand total just over $12,000 counting the $1,000 my insurance covered and my savings. My autobiographical narrative, largely summing up what for years felt like the only "life story" I could see yet never speak of alone has been viewed 17,000 times. In a way, it feels like I have sold like 500 copies of a $10 book to the world. It feels like for once my writing actually really is making a difference and having a positive effect on others around the globe.

I now have 17 healthy, finished teeth out of final 24 I will have, am no longer in any pain, and can most of the time feel comfortable even opening my mouth to total strangers, now wearing my story on my sleeve everywhere I go. I am slowly relearning to eat foods I have long since avoided and/or forgotten, and trying to visualize myself with a real smile on my face again, even if my face oesn't quite yet seem to naturally contort into one correctly.

Tomorrow morning at 8:30AM will be the most expensive and intense appointment I have ever had, at over $3,000, and I am paying cash. After never really finding the discipline to save over maybe $1,500 at once my whole life and always being in debt, it is truly empowering to know that for once I have been able to pull out all the stops and make lots of daily sacrifices for the greater good of myself, to be able to confidently KNOW and say that in a year and a half I will have found a way to raise 22 thousand dollars. After that, I hope that as predicted, it will truly feel that anything is possible. I can't even begin to imagine how in addition to all I have learned and grown and healed and overcome, what new doors being able to smile again will open for me, what doors I have kept locked for so many years that I will now choose to open.

Tomorrow I will finally get my last eyesore of a tooth that you can still see extracted, #8, along with its 2 nearby friends buried deep beneath the gumline that I lost when I was 20 and 25. I will probably have bone grafts at those sites to help regenerate supporting bone for future implants, and will also be getting my first two mandibularly molar implants at sites 19 and 30. On top of all of this, I will be fitted with a provisional denture for my top 5 missing teeth to wear for the next several months mostly for cosmetic reasons but also to restore some function and stop my other teeth from collapsing. I am frankly not quite sure which one of these makes me more anxious! Though they will look somewhat different from the finished product months from now, tomorrow afternoon will be the first time I have seen myself with this many of my upper teeth in nearly 14 years. It is going to be a trip, and I am sure probably going to somewhat freak me the hell out and be really weird to get used to. I am really curious how it will effect my voice, and what it will be like to begin chewing everywhere after my extraction sites heal. I am actually kinda scared for the most in quite a while, but definitely still excited. I am not supposed to exercise for 5 days, and plan on staying in bed watching movies for most of the week, and all of my readers out there have ever been thinking about sending a "get well" card, this is most certainly the one! My birthday is also coming up on November 10th, wink wink.

I hope that you all have enjoyed and found meaning in my story, and I am eternally grateful to have found so many compassionate and supportive listeners also eagerly awaiting to see the new and improved me. You all help me to continue to find the strength to move forward and to strive to find a focus and balance in my life as never before. I hope you will think of me tomorrow morning and send me as much positive energy as you can spare. It is probably going to be my longest appointment yet. For now, I will bid you goodnight, and leave you all to wait in suspense of my tomorrow's pictures! Thanks, as always, for reading...

Sunday, October 9, 2011

Crossing my first bridge toward better chewing.

My last few appointments have been a scheduling nightmare. Every appointment I make basically has to be approved by like 20-30 people's schedules, between my dentist's schedule and her faculty of other doctors depending upon what procedure we are doing, then my schedule and that of my co-workers so we can not be short-staffed, and then if I make it through all of that first wave of hurdles, I have a list of like 20 possible people who help give me rides to the dental school about 26 miles away. Every appointment is tied to the next and if there are any complications it messes up several future appointments as well. In this case, a slight modification needed for my bridge needed more time from the lab, which in turn pushed back tentative date for my final extractions and first implants 20 days. It has been hard to be patient sometimes when I have suffered through all of this for so many years, and harder still when I actually have a ton of money saved that covers my next several appointments. I am however, trying my best to remain sane and focused and trust in the journey and my dentist and not get discouraged. Everything happens for a reason, right? Everything is all still going "according to the plan." Slow and steady wins the "face," as I often joke.

Here is a picture of my first bridge after the porcelain was added before trying it on.
It's weird how discolored it looks in comparison to the white plastic container it is it while technically still matching my teeth. I know that my teeth certainly aren't the brightest and artificially-whitest in the world, but it doesn't seem like this would possibly match when compared to something that's actually white.

So we tried on my new Snap-On teeth and went through the same ritual as before every time any big change is made to the crown of a tooth to check its occlusion, or basically how well these 3 teeth get along with the 3 that live in the apartments below them, but also how their party compares to the chewing party across the courtyard with the only teeth that really make contact well, #s 13 and #20. We went several rounds with articulating paper, "tap-tap-tapping" and "grinding all around" and rechecking for marks and slight modifications to the bridge to achieve the correct fit and try to get contact on all 6 upper and lower teeth without effecting the contact on my left side also, alternating tests with shim tape as well until it would no longer slide through my teeth. After more X-rays that were some of the most challenging ever due to location and angle and my missing teeth, and searching for an elusive bit of glue to remove, my bridge was finally after like 6 appointments seated and finished and ready to scrutinize!

This would be the first time I have seen myself with my first premolar (tooth #5) in years--I frankly don't even know when I lost both my maxillary premolars--and the most teeth I have seen on that side of my mouth in general, let alone that were actually healthy, in who knows how long. For the past several months I have been doing virtually all my chewing with my two premolars on my left side, and I was really curious how this would effect my ability to eat. The color seemed perfect, something Rakhee prides herself on, informing me once that there are actually some color blind students too. I have been comparing prices of dental procedures in my mind lately to different things. It began when I realized that for me to fly to visit a friend was roughly the same cost as my root canal on my front tooth, and it was strange to think about in terms of how we prescribe value to things. Is a weekend with one of your closest friends more important or meaningful than a root canal? I guess depending on the circumstances, it is hard to say. This bridge cost me about as much as my bike is worth, which is my most valuable and arguably most important possession that I have traveled over 4,000 miles with through 4 states in the past 15 months. In many ways, my bike feels like my new best friend I can always trust in any circumstances to get me through. It has very rarely ever failed. When compared to my bike, it is weird to wonder if 3 teeth are capable of "adding up," but nonetheless despite hating them for years, I am still grateful to now have them. It is just something I think about. The more I learn about my teeth, the more questions I have, the more I think about them, the more I make analogies and metaphors, and the more I remember from my past and my relationship to them and how they have always effected me as well.
I went home that night, and tried my hardest to imagine what I might look like when this journey is all over next year. I took a bunch of pictures trying to smile, trying to cover up the teeth that were still missing and pretend my mouth was complete. I must admit it still looks incredibly strange to me, but it is most certainly a huge improvement. This is what I think is the best and most "natural" I took in that series, and the most recent picture of all of my progress and what my teeth and smile looks like as of today. I will write about my new adventures in chewing very soon!

And below is my updated Dentrix diagram of my mouth, with all the work that has been completed in blue. Not too much red left! I will have to post some side by side comparisons of things so far once I get some of the new pictures Rakhee took at my last appointment with those mouth spreading contraptions in my mouth. Get ready!

Saturday, October 8, 2011

On Building Bridges: A brief overview many of my past several appointments

I believe since I last left off I was on the verge of receiving my final crown on tooth #3 and beginning my bridge on numbers 4-6. I don't have pictures of all of this and some of the details have escaped me over the past few months, but I will share with you the bits and pieces of the story I managed to capture.
Here is a picture from my 28th appointment showing the prep on teeth #4 and #6 at the start of the huge number of steps necessary for the completion of my first bridge which my student dentist was using for one of her numerous needed competencies.
Basically the outer surface of the teeth are removed to leave a "peg" of sorts which i kind of think of like a Lego that the final 3-tooth porcelain and metal bridge can be cemented onto. Note my FINALLY finished crown, post last-minute emergency root canal on my first (and only) molar behind them, tooth #3.
Here is a pic of the temporary crown Rakhee made and fitted that day to cover the exposed and sensitive inner tooth surface of my canine.
At my next appointment upon a consultation with my dentist's advising doctors, it was decided to slightly refine the prep on those teeth and drop the margin of tooth #6, or basically remove the surface of the tooth slightly deeper than the gumline so on the finished bridge you would have less of a chance to see the edges where the fake tooth meets the real tooth since it was in a more visible location.

Thank god today would also be one of the last times I would ever have to endure one of my biggest dental pet peaves, PACKING CORD, as you can see above in the blue lines of cord stuffed into the margins on teeth #4 and #6.
 Today we needed to take impressions again so the lab could have a record of the modifications made to my teeth in order to prep my final bridge, including the inner metal support that would first need to be tried in before the porcelain could be added around it.
In a weird way impressions always feel like 5-minute head hugs of sorts. A speechless internal reflection on all of mine and Rakhee's time together and how far we have come, like we just reached another landing in the skyscraper of babysteps we climb every day and at every appointment toward my finished smile. Every impression is a record of a new and improved me that she has created, and I adore she has like, a whole "shoebox" of models of my mouth. After spending much of my life always thinking that if I were to die in a flaming wreck that I would probably never be identified because I had no dental records, that is most certainly no longer the case.

After impressions I received a temporary bridge. Though a far cry from what my finished bridge could look like, this would be the first time I would see my mouth with a first premolar on the upper right side in years, and I couldn't help be be a little freaked out in once again seeing myself with one more tooth in my mouth after so many years without so many of them, and certainly so many others I was ashamed to look at.

Today's appointment also came a few days after my dentist's birthday, and I was up half the night before creating her present and card, which in the spirit of the open honest ways I am documenting most every aspect of this experience for the world to see, I wanted to share those words as well. I gave her a flash drive full of the nearly 4 gigs of pictures and videos I have taken since the beginning of this story from all my appointments, fundraisers and all aspects of my story that has, quite arguably, become her story as much as mine in my opinion. Here is my floss-shaped "card" I made her:

Over the next few appointments, X-rays, consultations and scheduling of MORE appointments, I was prescribed an extra strong toothpaste and encouraged to also use Listerine to help strengthen my roots and enamel. It occurred to me later while looking at my arsenal of tools and prescriptions I have used in relation to my mouth in comparison to the crappy old folding travel toothbrush and Tom's of Maine toothpaste I was using a year ago, that I have come a LOOONG way in how much care I try to take of my teeth.
At my 31st appointment I had my metal try-in of the internal support for my bridge. I couldn't help be be amused and feel like a cyborg. I am still wondering to what extent having implants may complicate my ability to pass through airport security when my teeth are finally finished.
I'm going to end this entry here and keep you in suspense to see my finished bridge I received on October 4th and read about how it has effected my life. More updates real soon!