Saturday, August 31, 2019

My Sweet Smile

~This is the seventh chapter of my year-long exploration of 

living with Type 1 diabetes for 50 years.~

When I have a choice, I will most always try the experience I haven’t had before. Thus, in August, a very kind Doctor with a load of credentials used a Laser Assisted Peri-Implantitis Procedure (LAPIP) on my front teeth. I’m hopeful. 

I wish I could tell you that I lost my four front teeth when an oar hit me in the mouth while running a challenging rapid. In fact, it was a slow burn, a series of circumstances, a tinge of neglect, and youthful misunderstandings that led to their demise.

It’s not uncommon for diabetics to have periodontal problems. There is a two-way relationship: diabetes increases the risk of periodontal problems by as much as 30%. The inflammation elevates blood sugars and in some cases, leads to the progression of kidney disease. 

My issues started young, with a diagnosis of trench mouth and followed by orthodonture, regular cleanings all throughout my childhood, not that many cavities. But now, when dental professionals take a look at my mouth, they are impressed by the level of “work” that’s been done. Crowns, bridges, fillings, and now implants. Earlier this year, the dentist decided a crown needed to be removed to deal with a cavity and it uncovered a bigger problem. It became clear that all the options for this are expensive. I’ve held off until I resolve the issues with my front teeth. 

The extent of my dental work is a badge of class privilege, a lesson I learned early as I made my way out of my middle-class suburban upbringing and into the world. In my first job out of college, as a street-based social worker in downtown Boston, I saw the ravages of the inability to deal with dental issues over and over again. The clients had access to the free dental clinic offered by the agency I worked for, helping with the recurrence of emergencies and maintenance. As an underpaid social worker, I needed to find
 From a story in the Guardian
about the UN special rapporteur
who visited West Virginia on his tour
of poverty in America.
This guy needed root canals
on every tooth.

I found the Tufts School of Dental Medicine in Chinatown. Rows and rows of chairs on the entire second floor. Rounds of would-be dentists hovered over before moving onto the next. They determined that the gums around my front teeth were failing, and they performed osseous surgery to reduce the gaps between the tissue and bone. There were photographs, documentation, and case study. 

Shortly after, I quit my job and started traveling. I’m not sure I understood what I needed to do to maintain my teeth, perhaps the directions weren’t clear or perhaps I wasn’t listening. After a year, I began to have problems. Two large swellings appeared above my front teeth which led to more evaluation, a referral, a treatment plan, and a decision to stay in Boulder while I dealt with the realities. I lived in my sister’s friend’s place, worked three jobs to save money. I was smoking at the time as well, which didn’t help. 

I met Dr. Jacque DeLormier, who laid out the plan. He pulled the front four teeth out and gave me a partial plate to wear. I knit him a sweater for most of the bill. My sister poked fun at me a bit, joking about how my IQ instantly went down when I took my teeth out. The Alaska magazine in his waiting room was my market research for exploring tourism companies to work for. After the winter in Boulder dealing with my teeth and the spring in Big Bend working on the river, I was hired to go north. 

The dental journey continued. I continued to smoke, a very bad idea. The partial was difficult to deal with in the field and I began to have fiery irritation on the roof of my mouth. After the partial plate failed while I was in graduate school in Boston 15 years later, I found a dentist who built me a bridge, connecting across my canines. Then, finding lovely Dr. Bunhean in Cambodia, who performed two implant surgeries, affixed crowns and dental cleanings for a fraction of the cost of what it would have cost me in the states. 

These recurring problems are traumatic. In stressful times, these are the first thing that begins to freak me out, carrying on the cycle over and over again. I have recurring, nagging thoughts that something is wrong has gone awry with the LAPIP, thinking now that instead of new tissue being regenerated in these early weeks, that once again I’ve sabotaged the best-laid plan. 

In response, I’ve begun to deploy is to think positively, reassure myself that everything is healing as it should. That there is a reason why I am here in Maine at this moment in time. Like diabetes, periodontal disease will be my constant companion on the journey of life, with complications that need to be managed, diligently and with each small step of healthy choices and routine.