Saturday, February 8, 2014

Dental Damn.

Primary Care Center, Same Day Sick Clinic

Chief complaint: "Tooth pain."

"Good morning, sir. I'm Dr. Manning."

"Hello, doctor. Good to meet you."

"Likewise, sir. I see that you are here for. . . a toothache?"

"Yes, ma'am. Aaaarrrgghh. My tooth is killing me."

When he said that he slipped his tongue over the affected molar and squeezed his eyes shut. I hadn't personally had that kind of toothache before but I certainly knew enough about dental issues to know that there's nothing worse than an urgent one.

Now. Before you ask me what on earth a patient is doing coming to me, a general internist, with a complaint of a toothache--I'll explain. In Atlanta, if a person is uninsured and has any kind of complaint requiring some sort of health care intervention, Grady is the destination. And for most of those issues we can do plenty.

But not necessarily all of them. At least, not immediately.

See, this man clearly hadn't been without dental care in the way that many people with limited incomes often are. Either it was that or that God had just somehow protected his dentition. But regardless of his history, he mostly had nice teeth. Whitish in color with pink gums and no fractures or obvious decay in the smile line. When he opened his mouth, I saw a few scattered metal amalgams that confirmed my initial impression. This man had previously been under a dentist's care.


"Do you have a dentist?" I asked.

"I used to. But when I got laid off my insurance did, too. So now I can't afford it. Or much of anything for that matter."

"Oh, okay." It was clear that he had a story. But the "same day sick" session didn't afford me the time to go on the exploration that I wanted. I pushed my curiosity aside and stuck to business.

Slipping on a glove, I gently opened his mouth and palpated the gum line with my finger. There was no obvious abscess or pus collection but there was definitely pain when I tapped the tooth with the wooden tongue depressor.


I immediately backed off. "Sorry."

"It's okay. Just do what you have to do."

I pulled off the gloves and gestured for him to come down off of the examining table. "Well. I don't see anything requiring immediate evaluation by an oral surgeon. But I can give you something for pain until they can see you in the next few days. Is that okay?"

"That'd be great. I just hope I don't need a root canal." He shuddered.

And you know what? I did, too.

Not because of the mention of a root canal (which I DO know about personally.) But because a root canal isn't usually what our oral surgeons do in these instances. Unfortunately for him, the term "oral surgeon" means just that.

"Ummm," I said, "I think they will likely want to just pull your tooth."

"Pull it?"

"Yes, sir."

His eyes narrowed when I said that. He wasn't a person who found his teeth more of a hassle than anything else. At least, not yet. I quickly thought of the many times I'd heard forty and fifty-somethings request to have not just one but all of their teeth pulled to be fit for dentures. But this man was like most people and wanted to keep his teeth. And I didn't blame him.

"If they pull this tooth you'll see it when I smile." He wrinkled his face and chuckled; I could tell he was trying to get me to cosign with him on how ridiculous this suggestion was.

"We don't have restorative dentistry at Grady. Just oral maxillofacial surgeons. But we do work with several community dentists who've agreed to assist our patients with things like fillings, dentures, and root canals for a reasonable price."

"Wow." He let out a sarcastic laugh and shook his head.

I felt bad. I mean, I know what a great service our OMFS guys do for our patients with dental and oral health issues. I do. But I also knew that we simply didn't have what he was asking for. And his teeth hadn't gotten to the point of "just wanting them gone.

"I can circle the clinics that are closest to your address."

"Will anyone see me today?" he asked.

"Actually, we give you the list with the numbers and you can call to see what time you can get in."


"There's a lot of great dentists on that list."

"Yeah. But a lot of people are waiting for them and none of them have money to pay."

"Yeah." My voice was tiny. I had nothing witty or helpful to say.

After wrapping up the visit, I rose to walk to the door.

"You know what, doctor?" he asked.

I removed my hand from the door handle and turned back around to face him.

"On second thought? Go ahead on and refer me to the oral surgeon."

I furrowed my brow and started to speak but couldn't.

"I'd rather just not have to worry about it, you know? And who in that shelter is really going to care about my smile having a hole in it? I don't want my tooth to hurt. So I'll just let them pull it. Fuck it."

I winced at the unexpected f-bomb. "But. . . I thought. . .why don't you just call the dentists and see first?"

"Naaah. I know if they pull it out it can't bother me anymore."

He'd made up his mind. I slid back onto the edge of the chair and entered the referral into the computer. I clicked the "sign" button on the referral and offered him a half-hearted smile. "All set. And you can always call and cancel if the dentists can see you instead."

We shook hands and once again, I prepared to leave. Before I could, he spoke.

"One more thing, doctor."

I raised my eyebrows.

"Whatever you do? Don't become poor. I mean it. Everything is harder when you're poor. And extra fucked up."


"In addition to their own oral hygiene practices, a key component of maintaining the oral health of midlife Americans is the availability of dental benefits."

~ The National Institutes of Health

Happy Saturday. I guess.

Now playing on my mental iPod. . . if only it were as simple as this 1970's  PSA.


  1. Knowing in my heart that we are all just a moment away...I have a small fortune in my mouth and I know exactly how that man feels.

  2. As a dental hygienist working in public health, I see this all the time. Working with kids, this breaks my heart daily. We have a few more options to offer people, but not many. My heart goes out to this man!


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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