I enjoyed nearly 2 hours of being poked, prodded, and x-rayed by a very friendly and thorough dental student… whose diagnosis is what we already knew: Root Canal Molar needs a root canal – apparently it’s dead but worth keeping around because I can use it to chew – and we don’t know what’s wrong with Endangered Molar. It could also need a root canal – that’s what he suspects – and/or I might need to see a periodontist. I think it’s a bit telling that I feel more confident about his assessment of the situation than my primary dentist’s – mostly because he listened to me and took my concerns and feedback seriously (and had the agreement of his professor). He was even willing to use unconventional means to get the best picture of my molars possible – resulting in the clearest x-ray of that area I’ve ever seen! I especially appreciate that he’s addressing the problems of both teeth.

The x-ray of Endangered Molar looks even more ominous than the one taken 6 weeks ago. There’s a giant dark area that shouldn’t be there. It suggests to me that there is something very seriously wrong with the tooth and its roots, but my responses during the examination suggest that it – unlike Root Canal Molar – is still vital. Quite the enigma. The dental professor said it may be something as simple as a piece of food that got stuck up there and needs to be cleaned out by a periodontist. (Good luck getting a referral…)

Despite my readiness to pull the teeth and get the whole thing over with, I’m going with the dental student’s decision to treat and attempt to save the teeth. He gave a much better argument than “I don’t want to feel guilty.” The last x-ray clearly shows that both affected molars meet the ones below them and are therefore functional for chewing – definitely worth saving. I’m convinced that I’ll be better off receiving treatment for them and not “giving up so easily,” as the dental student put it. If nothing else, having those teeth will help me make a better case for treating the ones below them, should it ever become necessary. I hadn’t thought of that before…

The person in the endodontist department verified that the school was submitting a referral for both teeth to receive root canals, gave me her card, and said, “if you don’t hear from me in four weeks, call me. If you have any problems with your teeth in the meantime, call me and I’ll try to get it expedited.” I liked that she took ownership of the situation and expressed willingness to advocate for me. It was a nice personal touch.

Everyone I interacted with helped me feel like a fellow human whose well-being was important. I’m going to see about changing it so the dental school is my primary dental facility. In addition to having more competent dentists, it’s in a better location for me and has a far more pleasant atmosphere. They even included “transgender” as an option on the patient registration form!

Mom accompanied me and was patient and supportive through the whole process. She seemed more upset than I was about, well, everything. I took it to mean she was concerned about me and that felt good. I treated her to a casual dinner as thanks. It wasn’t an ideal bonding experience, but it gave us time to talk and connect with each other and I found that to be meaningful.

I never thought I’d call a day that involved going to the dentist a good day, but it kinda was. Chew on that…

To Save a Tooth

“How can someone so young and healthy have such a serious problem with their teeth?”

The endodontist (root canal specialist) actually asked this during our meeting today – after I’d described a previous dentist’s theory that over a decade of grinding my teeth had caused a cavity to form inside one of my molars. It had decayed from the inside out, to the point where I almost needed a root canal when the cavity was finally detected about a year ago. I thought the dentist had fully treated it, but he only inserted a temporary filling. Some miscommunication must have occurred because I didn’t realize any follow-up was necessary.

Now my gum is badly swollen from an infection – that came back worse after I’d finished the antibiotics I was prescribed four weeks ago. It’s actually less painful now, but still very uncomfortable and so sensitive to the touch I can’t brush my teeth the way I’m used to. I feel like I have a bean wedged between my gum and cheek, and my jaw is sore on that side. I really miss being able to chew on both sides of my mouth and I’m concerned about how a gum infection might affect my overall health.

The endodontist couldn’t have performed the root canal with the infection there anyway, but he pointed out a bigger problem. I’m in danger of losing the molar next to the one that was supposed to receive the root canal because it’s the one that is infected. Ironically, the endangered molar is the one I thought needed treatment; my only complaint about Root Canal Molar is that it feels weird when I touch it with my tongue because it’s the very back tooth and I think half of it is missing. No pain; food gets stuck back there sometimes but I get it out with floss, everything’s fine. Apparently it might actually need a root canal or I could lose it, but again, there’s a much bigger problem.

My poor Endangered Molar has been assaulted by an alien civilization for at least the past two months! In addition to the gum infection, there is evidence of significant decay in the roots, possibly bone? I am in serious trouble. I really need to receive treatment for this … well, apparently, about a year ago.

The endodontist is not qualified to deal with gum infections, and is not authorized to give referrals to see a periodontist (gum doctor) or oral surgeon. So, I had to go back to my primary dentist in order to take further action. I was so furious, I was ready to start destroying things. When we got home I saw that Dog had gotten into my kitchen garbage! I was so angry, I told Mom to take him upstairs so I wouldn’t kill or seriously injure him. It was terrifying and so frustrating because I didn’t have a safe, socially acceptable way to express my rage!!!

I called my primary dentist and learned she could see me if I arrived within the hour. Within about 5 minutes Mom was driving me there; we arrived just in time. She asked questions and took X-rays and said I had two options: I could go to the periodontist to try and save the tooth, or I could go to an oral surgeon to get it pulled.

To be completely honest, if money weren’t an issue I’d say pull the fucking tooth, clean out the infection, and give me an implant. But implants aren’t covered by insurance and can cost up to $3,000. That’s more than my wedding dress! I could get the tooth pulled and not get an implant; this might be what I end up needing to do, anyway. I don’t think a bridge would be an option due to the location of the tooth; the dentist didn’t mention it as one.

But everyone – by which I mean the dentist and my mom – seems hung up on “but you’re so young!” and “it’s really better to keep your own teeth.” There’s a chance a periodontist might be able to help me, so it’s best to take that chance and get the tooth pulled only if it doesn’t work. I expressed some uncertainty, so the dentist made the decision for me: we’ll try the periodontist first. This way the dentist doesn’t have to feel guilty (I don’t think I’d feel any guilt, sorry Endangered Tooth – regret maybe if I then experience problems, but not guilt) and I might get to keep my tooth until I’m old enough for extraction and replacement to be okay. I’d need to wait for the antibiotics I’m now on (again) to kick in and (hopefully) clear the infection before I could go to an oral surgeon, anyway.

Here’s the really fun part. I could get an emergency referral to see an oral surgeon, but my insurance doesn’t see gum infections as requiring emergency treatment. They wouldn’t approve the emergency periodontist referral over the phone; there’s a chance they might not approve it at all! I have to wait 2 to 3 weeks before I’ll even know if I can see the periodontist, never mind then having to make an appointment! The infection will probably come back and/or get worse in that time, and who knows? Maybe more of my teeth will be in danger.

The receptionist said I have to wait for the referral to come in the mail, but if I had X Better Insurance she could write a referral and hand it to me.

Pissed doesn’t even begin to cover it.

You might be wondering, what do dental issues have to do with mental health? Well, let’s see.

1) “How can someone so young and healthy have such serious problems with their teeth?” Well, sir, perhaps my health issues are not readily apparent because they aren’t medical, in the sense most people are used to. I have mental health issues, which impact physical health as well. In my case, they clearly affect my dental health! For example, I GRIND MY TEETH!!! due to chronic tension from repressed anger and overwhelming anxiety.

2) I’m not working because my mental health issues are severe enough that I can’t even follow through with a job interview. I don’t trust my mood to be stable enough for me to show up for work consistently, and my anxiety levels to be low enough to function once I get there – assuming I can manage to be on time. Wakana would say I’m being too hard on myself and I should focus on the times I have been punctual and consistent. But I don’t have to do it every day; when I have had to do it every day I’ve struggled. I need help getting to the point where I can try it again.

Anyways, not working means no income means I can’t afford better insurance or to just pull the fucking tooth already and give me a titanium implant.

3) It’s really hard to do things like stand up for yourself to make sure you get the best possible care, drag yourself to the dentist and wait Spock knows how long hoping you’ll get seen as an emergency patient even though you don’t have an appointment, and deal with the stress of going to the fucking mall to see an overbooked dentist with staff that is probably overworked and underpaid and sick of being the person patients get angry at when their insurance is being sadistic. It’s even harder when you have mental health issues (especially being more attuned to other people’s needs and emotional states than your own). I would rather pull my own tooth without so much as taking ibuprofen first, than deal with the headache that is going to the dentist!

Hmm…

4) When you have a mental illness(es), you start to rely more on other people’s judgment; sometimes you trust it more than your own. “Maybe I thought he was being a jerk because I was wearing depression goggles.” “Maybe the chest pain I’m experiencing is from anxiety.” “Maybe I’m having these symptoms because I read that they’re potential side effects of the medication I’m taking.”

I know I can’t always trust my thoughts and feelings because they tell me things like “nobody loves me” and “I can’t do anything useful” and much, much worse. I rely on people reminding me that those things aren’t true and encouraging me to think about situations from other, more creative, and generally more positive perspectives.

So if you’re in a situation like I was last week, when the hygienist who did my cleaning said the pain I was experiencing from my infection was “normal,” it can seem a bit “crazy” and “excessive” to insist on seeing the dentist anyway. They were busy, I was feeling overwhelmed, I didn’t want to be on antibiotics again anyway, and I’d just been told that my problem was no big deal. So I left. If I’d stood my ground (or had someone advocate for me like my mom did today) my gum might not be swollen. I don’t know if my teeth would be in any better shape, but at least I could brush them!

5) Extremely frustrating situations like this can trigger all sorts of painful, unhealthy, and outright dangerous thoughts. It’s even worse when the people who are supposed to help me when I have a serious health concern like this either don’t seem to care or care but can’t do anything because of bureaucratic red tape. I’m fortunate that I’m in a place where my primary concern is protecting my health, and that my mom was able to support me in expressing my anger – probably because she was angry and worried too.

I’m furious to think that I can’t get the help I need because of a rule my insurance company made up, that someone who has never even met me has to review my information, make a decision with more concern about the company’s bottom line than my health, and use fucking snail mail to communicate with me. It can be all to easy to internalize that ruthless capitalistic complete and utter lack of compassion, to absorb the message that I am worth less than someone who can afford to pay for a better insurance plan (or worse, unworthy of medical interventions, period). So for now I’m clinging to my anger like a life preserver; the hard part is doing that while keeping it directed away from myself.