Tooth Extraction and Dental Implant

I did it. I survived. Wouldn’t have been possible without my husband. Literally and figuratively.

Wyoming is a very sparsely populated state. It’s the least populated state in the United States and the tenth largest. Alaska (the largest state in our nation) has more people than Wyoming. A long time ago, we lived in California. It is the third largest state and has the highest population. As of April 2020, there were 39, 538,223 people living in California (one of the reasons we left) and there are only 576,851 people in all of Wyoming (one of the reasons we moved here and no we don’t hate people, we just hate congestion).

So it should come as no surprise that the small town we live in (Riverton, about 11,000 people) has no oral surgeon. And the second largest city in Wyoming (Casper, about 59,000 people) has only one oral surgeon’s office. Yes, there are two doctors there, but it is only one office. And the doctors are related.

Casper is 120 miles from Riverton. So when my dentist told me I had to go to Casper to have my tooth removed and an implant placed, I wasn’t sanguine about the idea. Add in my absolute terror of dentists and dental procedures and … well, it wasn’t pretty at our house for a few days.

The oral surgeon, when I finally met him, was a bit aloof and, well, doctorish in the way that doctors are. It’s my theory that they all have to sort of be egoists because they have to be self-assured enough to make decisions regarding people’s health and act on them. I don’t think I could do that.

Also, it probably did not help that I insisted they break from their usual policy with me. I probably could have been more diplomatic, maybe a little bit ingratiating even when the front desk person I talked with on the phone told me that first I would have to come in for a consultation and then make an appointment for the procedure. I basically said, “No. Do you have any idea how far Riverton is from Casper!” And that exclamation point was in my voice when I said it.

In my defense, I had just arrived home from the appointment with my dentist here in Riverton. I was a mess emotionally but thought I’d better make the call to Casper before I lost my nerve altogether. Possibly, I should have waited. No, probably. Sigh.

Anyway, she paused and then said that they could make an exception and she gave me a date and time. Then I settled in for the long wait. It was going to be almost two weeks before I could get that broken molar out of my mouth. The only thing that made the wait possible is that it had a root canal several years ago and I had no feeling in it. It did make kind of a sick feeling in my mouth, though, every time I accidentally moved it a little. I tried very hard never to do that. And I worried a bit about the whole thing coming apart before my appointment.

The day finally came and we left a lot earlier than we needed to because my hubby was concerned about the distance and unknown problems along the way. Insurance actuaries know this well, the farther you go, the more likely you are to have some sort of trouble. So we arrived over and hour early and thought we would check in at the oral surgeon’s and then maybe toodle around Casper a bit. But they said they could get started with me in a little bit. So I had a seat in the waiting area with my heart just thumping in my chest.

My hubby went out to the car to get Maddie, our dog, out for a walk. We couldn’t leave her home alone because we would be gone too long. And no one would be there to let her in and out of the house or give her lunch. She loves her lunches. And … she has a fair amount of separation anxiety.

After a short wait that felt like forever, Bernd and I went into the consultation room. We talked a bit with the doctor’s assistant. Got some facts squared away and then she took me to get a CT scan of my mouth. After that processed, the doctor came into the room and we got down to the nitty gritty. Possibly, I shouldn’t have been as assertive as I was. I have a history of irritating doctors.

I’m very proactive about my health. I don’t take anyone’s word for anything, not even a doctor’s, without due consideration. I’d done my homework beforehand and thought I had the whole thing pretty well mapped out in my mind. Later I said to myself, “Well, there you go thinking again.”

I dictated a few terms (maybe it wasn’t quite as harsh as that sounds, maybe). No saline solution because of my Meniere’s Syndrome. No epinephrine in the local because it makes my heart go crazy. And when the doctor mentioned antibiotics I blurted out, “Great. That will mess up my intestines for six months.” Egad. Keep in mind I’m never at my best emotionally when I’m sitting in front of a doctor. I know, excuses, excuses.

I think he thought I was a little nuts when I said I don’t take pain medications. Hubby piped up and told the doctor that even for the last tooth extraction I didn’t take the pain med the dentist prescribed. It’s not a philosophical thing and it’s not because I’m a former addict. I’m not. It’s because, they all give me what is called a rebound headache. And that rebound headache often turns into a migraine headache and relieving the pain usually isn’t worth a migraine headache. Usually. Might have to rethink that.

The doctor left the room shortly after that and when he came back I had reconsidered my terms, spoken with the PA and my poor hubby, and had some compromises worked out.

I told the doctor that since I opted for complete sedation that my heart rate would be depressed anyway so if the epinephrine in the lidocaine would make his job easier (it prolongs the effectiveness of the anesthetic) then that would be fine. He told me that the procedure would be short and that should not be a problem.

Then we discussed the antibiotic some more. I told him of my experiences as succinctly as I could and by now, dear reader, you know that I have a great deal of trouble being succinct. So he asked if I thought I could tolerate taking the Clindamycin for five days (it wreaks havoc with my stomach and esophagus as well as what all antibiotics do to the intestines). I said I thought I could do that. He reiterated that there is some risk of infection, though generally small, because they do a really good job of cleaning the implant area. But if infection were to occur, it could cause the implant to fail. I did not want that. I did not think that I could dredge up the courage needed to do this again if I had to.  And I really need a tooth right there. It will be the only molar I have on the lower right side. So we went with a five day course of antibiotic.

Then we just had the saline issue to get through. The doctor said, with a little animosity coming through in his voice, that either I could do the whole thing … extraction and implantation while awake (and the extraction would be a bit complex because the crown of my tooth had come loose of the roots) or I could be asleep and have the saline IV. My choice. They had no Ringer’s Lactate and the saline drip is the way they administer the sedative.  Possibly, If I had done the consultation first and then set the appointment route, they could have acquired some Ringer’s Lactate. Oh well.

I’ve had teeth pulled while awake. It’s no damn fun, but I’ve done it. However … I was pretty sure I didn’t want to be awake for the bone graft and placement of the implant. So they said they would adjust the drip to the barest minimum.

Once we had all that settled we paid for it all and they set up the operating room. I didn’t have long to wait and it was time. I walked into the room under my own power. I climbed into the chair under my own power. I freaked out a bit inside (don’t know if it showed on the outside of me) when they strapped my arms down after inserting the IV needle (which was very expertly done and didn’t leave even a slight bruise). They put a blood pressure cuff on my left arm and an oxygen saturation monitor on my right index finger. They stuck an oxygen cannula in my nose. And the last thing I remember from that OR is the doctor saying, “Okay.” Next thing I knew I was sitting in the Jeep, buckled up and ready to head home.

In the car, my hubby handed me an ice pack and I pressed it against my jaw. I remember looking over at him and he said something like, “Okay. Here we go.” The car started moving and we were on the road. I might have nodded off a couple of times. I have no memory of leaving Casper. Somehow he found the way back to the main road home without the help of my superior navigating skills.

At some point, I discovered I had a baggie in my lap. It had gauze in it and some lip balm and instructions for after care. My hubby told me it was time to change the gauze in my mouth and I realized there was a big mass of something in my right cheek. Until then, quite literally, I had not been aware of it.

I spit it out. Luckily he had pulled over for this procedure and had a bag ready for me to put it in. I put the new gauze in place myself and congratulated myself for a job well done. I was still feeling pretty funky and that felt like a big deal; a great accomplishment.

I was a little more awake after that and started asking my hubby some questions. Turned out they had wheeled me out to our car in a wheelchair, but I had gotten right out of the chair and climbed into the car under my own power without any difficulty at all. Then I buckled my seatbelt without any prompting or difficulty. I have no memory of that whatsoever but I thought that was pretty impressive, but then I was still kind of under the influence of the sedative when I had that thought. I’m not sure it didn’t actually wear off completely until sometime after we got home two hours later.

He told me that the whole thing took only about half an hour. They told him they had used hardly any saline at all. And they said they had put a cap on the implant and I wouldn’t have to worry about dry socket. Dry socket, in case you’ve never had a tooth pulled, is when the blood clot comes out of the extraction site and the bone of your jaw is exposed. It is said to be extremely painful. So for my other tooth extractions, there was always some anxiety about dry socket. Not this time though.

Shortly after we got home and he got me situated comfortably in my recliner, he left to pick up the antibiotic prescription. When he got home he told me that the prescription was for a normal ten-day course compressed into five days. I was going to have to take twice the normal dosage three times a day. I may have gone a bit pale at that news.

Revenge prescribing? You tell me.

So I have a constant strange taste in my mouth. Maddie thinks I smell weird. My stomach is a mess. And my intestines … well we won’t even talk about that.

And the pain has been crazy bad. Way worse than a simple extraction. I have had to take a few acetaminophen caplets. Just one at a time. It does seem to help a little. But I have a nasty headache and am a bit worried about developing a migraine headache.

But hey, in four months they’ll do a torque test on the implant and then I will have my dentist here in Riverton set the abutment on the implant and then a bright, shiny new tooth will take up residence in my mouth.

Ain’t modern medicine amazing.