When you choose to become an expat and work in the international schools, changing schools every handful of years, one of the big things you give up is consistency with healthcare. Not only do you not always have access to excellent first-world services, you also lose that doctor or dentist who has known you for most of your life and knows your health history.
Of course, for the most part, we all hope not to actually need any sort of advanced healthcare, but sometimes things happen and you do, and you hope it doesn’t happen when you are in the wrong place. I think of Ashley Judd breaking her leg while visiting the gorillas in Congo, and almost dying from the challenges of evacuation. Had she had the exact same injury at her home in the US, it wouldn’t even had made the news, but as it happened in the remote jungle at Virunga Park (a place I know), the ordeal was definitely as harrowing as the reports make it.
And this inconsistency isn’t only about extreme events, it’s also about the mundane…like getting your teeth cleaned. In some countries, they have the most modern techniques and well-trained dental techs, and in others they are very basic and still use old equipment. It’s a bit of the luck of the draw.
I had a very unfortunate run in with this just recently, but it is the tail end of a long history with my teeth.
When I was young, I had a slightly twisted front tooth and probably should have had braces, but I have no idea why my parents didn’t pursue that. Dad was in the military, so it was probably free (or cheap), but both my brothers had good teeth and I think he just felt it wasn’t really necessary. Besides, my bottom teeth were perfectly straight so it didn’t seem like a big issue.
When I went to college, my wisdom teeth started to come in and while the two top ones came in normally, the bottom two were impacted, growing sideways below the gum toward the front of my mouth. I was paying my own way through college and was, as were many of my friends, that ‘poor college kid’, so I could only afford to have the top ones pulled, something a dentist friend recommended as a stopgap as they had nothing to bite against below them and were going to cause problems. I delayed getting the bottom ones out for a couple years, during which time they pushed my bottom teeth so far forward that it really wrecked the alignment of all my teeth. When I finally bit the bullet (pun intended) and had the bottom ones out, the damage was done and I was left with the craggy misaligned smile and overbite I have now.
Despite the snaggleteeth, however, my teeth have always been strong and healthy. I always have them cleaned 3-4 times a year…in college, I made use of the services of the dental students who had weekly clinics where they would practice their skills. In addition to regular cleanings, I would often volunteer for the more technical services, like root planing (where they actually go down along the root below the gumline and scrape the surface so your gums adhere more strongly to your teeth) as I figured they needed the practice, and I could benefit from the free services.
So during my senior year in college, I was taking a final exam for a statistics class and while I was deep in 
thought, I was vigorously chewing on the cap of a Bic pen when I heard something go ‘ping’. I spit out the pen cap, along with what looked like half a tooth! Running my tongue along my teeth, it was clear that I had broken something inside there. Grimly, I had to finish the final exam with this on my mind (and yes, I got 100%), then I rushed off to a friend who was dentist to see what I had done. He said I had broken off a cusp, like chipping the handle off a coffeecup, and I needed a crown. I certainly could not afford that, but he said he could just put a massive filling on that spot to preserve the tooth and I should get a crown as soon as I was working for a living and could afford it. He did this for $20, paid with a barter for a bag of something I could get for him (use your imagination) so I had that done with the admonition that it would only last maybe 3-5 years, tops.
Well, it never gave me any problems and 20 years later I was teaching school in Israel and decided that probably it was time to have that crown put in. I went to an excellent dentist who had immigrated from the US and got a nice metal crown and went on my way. In addition, he mentioned that my lower left molar (the one below the crown) had a small crack forming, and while it was too small to worry about now, to be careful not to chew hard things on that side of my mouth so that I could delay needing another crown and could preserve that tooth.
Since then, I get them cleaned regularly with whatever level of local services are available. In places like Thailand, you can just stop at any dentist’s office and get them cleaned for $5. In other places, like Latvia, you have to make an appointment but you get a high frequency sonar device that cleans them quickly without even touching your teeth! And when I lived in places like Burkina Faso where there really weren’t any dentists, I found a dental hygienist in the US who would clean them for a reasonable rate, so I went to her each summer for several years.
So about 3 years ago, I was working in the Dominican Republic where there are a LOT of dentists, and I don’t really know why because, either due to genetics, diet or good hygiene, people there have fantastic teeth! And in keeping with my usual practice of getting regular cleanings, I went to a dentist’s office in a mall near my house. That particular day I was exhausted from trying to communicate with people in Spanish, so I asked for a hygienist who spoke english. They scratched their heads, then commented that there was this one lady who did, and they would arrange for her to do my cleaning.
A few minutes later, I was brought back into the room and this roly-poly gushing younger woman came in. She was exhaustingly chatty, and only wanted to talk about America and how much she loved America and why was I in the DR instead of America and so on. After about 20 minutes, tired of being polite and cordial, I asked if she was going to clean my teeth, and she said “Oh yes, of course!” and proceeded to do the fastest cleaning I have ever had. Something about all this just didn’t sit right, but at least I was getting them cleaned. Then she mentioned how one of my molars (top right side) had a small cavity and she could quickly fill that while I was there. I thought about it for a second, then agreed because hey, I was already in the chair and I didn’t want it to become a problem later.
So she had me sign some forms (not sure why) and proceeded to get set up to drill. Then she drilled…and drilled, and drilled and drilled. It was apparent that she was a little out of her element and I was thinking (other than wow, this hurt!) that it seemed like an inordinate amount of drilling for ‘a tiny cavity’. Finally she announced that it was gone, and she started packing the hole with amalgam. When she was done, I could not bite closed so she ground down a bit of the amalgam. I still could not bite closed, but I told her it was fine as I wanted to get the hell out of there, as my jaw and tooth was killing me.
For the next week, my tooth ached like never before. Hot, cold, pressure, even just breathing through my mouth made it ache. I made an appointment with a different dentist, and when he got me in the chair he said he had never seen such a massive filling. I told him the story, and he informed me that those ‘dentists’ at those walk-in clinics are all dental students who just clean teeth for practice, and are not supposed to do fillings. The form I had signed was probably a release form and I might have been the first filling she had ever done, in her exuberance to make this ‘American’ feel pampered.
He filed down the filling a little more, but said if he did any more than that, it would just fall out as there was so little of the crown of the tooth left on the top. He advised me that the pain would probably subside over the next few weeks as the pulp became desensitized, but in the meantime I must chew on the left side of my mouth…where that cracked tooth is.
So sometime during that next week, as I was eating some fruit (I think maybe it was a guava, with little tiny seeds), chewing on the left side…I heard a familiar ‘ping’ sound. Hoping against hope that I had only cracked an old filling, I feared that I had cracked that tooth. Fortunately summer break was coming and I had an appointment with my technician in Maine in a month, so I waited for that.
When she got me in her chair, she said it didn’t really LOOK like a crack, but she did ascertain that it was definitely becoming sensitive to cold and I should see a dentist to have it x-rayed and examined. She also told me that, according to my records, I never had a cavity in that top tooth! I had been suckered by that dental student for her to practice on!
Unfortunately I didn’t have a dentist in the US and didnt know any who were taking new patients, so I decided to wait until my next teaching job (with dental care) and have it dealt with then. Well, that didn’t happen for a couple years, during which time that tooth hurt more and more. It was obviously cracked (eventually even I could see it) and between the pain of that cracked tooth and the pain of the tooth the dental student had mangled on the other side, chewing was becoming a real issue.
Once I got here to China, one of the first things I did was see a local dentist who said the left tooth was cracked so badly (two places, both below the gumline) that I needed it extracted and an implant put in. So I had her pull the tooth…because it was so damaged, it took over 3 hours in the chair and she had to break it into small bits and pull them out one by one. Some of the deep roots resisted extraction so much that she needed to have a bigger colleague come in and do it…I think all those root planings I had done in college paid off. Once it was done, my jaw hurt like I had been kicked by a mule, and now I have a big gaping hole in my mouth. Worse yet, while I wait 3 months to get my implant, I have to chew on the right side where that mangled tooth is and it’s getting more and more sore, so tomorrow I go in and have it ground down and fitted for a crown.
So the moral of the story is…you can take care of your teeth in all sorts of situations for your entire life, but just one overeager dental student with a drill can set off a three-year journey of agony that ends with massive dental work to save your teeth.
Sucks.
The Wandering Sole 