One-day-dentist

 “Do something and take it out…I cannot deal with this anymore. It is such a nuisance...” she yelled as she entered the clinic. Mrs. V , a 72 year old lady, lives alone in the nearby village. There have been many ways to start a clinic. Some days start lazy, I sit with a book, or with a notebook reading or writing for some time before the first patient comes. Many days, there is a quiet queue of patients waiting outside and they come in one by one in an orderly manner. It is later in the day that people become impatient and peep inside or barge inside even as the previous patient is still sitting with me. But this was a strange start. Mrs. V stormed inside, yelled and planted herself firmly in the chair in front of me. She is a thin built lady with a slouched back. There are more wrinkles on her face than a piece of dried grapes. She must have been a beautiful woman in her prime, the vestiges of which are lingering on her weatherbeaten skin and face. The frown on her forehead was accentuated by the crinkles. It did not seem like Mrs. V was in much pain. But she was definitely angry and frustrated.

“This last tooth on the upper jaw has been loose and dangling for more than a week now. It is just not falling. Do something and take it out” she said. 

 

I examined her mouth and noticed the right upper molar, the first one, loosely hanging on to the palate. One firm tug and it should come out. Mrs. V could have easily tugged it out. But that is the thing with nature and its self-defense mechanisms. We are programmed to not do anything that could potentially cause us pain. So Mrs. V could not get herself to pull out her tooth. 

 

“Let us go to the treatment room and see what we can do about it”, I said and escorted her out of the consultation room to the treatment room. The treatment room is a cozy little space, cozy for me, but quite a nightmare for people who have had their wounds dressed, abscesses cut open, cuts sutured, and injections given. It has a big bright window with a curtain that is always drawn open. Through the window we can see the little garden that is carefully maintained by our dear gardener. The garden has a big hibiscus plant which is one of the most fertile plants I have seen. It throws out new flowers every single day of the year, irrespective of weather. The bright red blooms sometimes cover every inch of the bush that one can barely see any green leaves in between. Immediately after completing a procedure, I love to hang out near the window watching the hibiscus bush proudly announcing its beauty and majesty to the world. 

 

The dressing couch is a raised flat bed with a soft cushion and plastic sheet laid over it so that cleaning the surface is easy. Today they had changed the plastic sheet and is was sky blue in colour. It seemed to reflect the bright sunny sky just outside the window. There is a small foot stool near it to help the patients climb over it and either sit on it or lie down. The couch is positioned right next to the big window. To the left of the couch is a hand washing sink with tap and liquid soap dispenser. To the right of the couch, at arm’s reach distance, is a dressing table with all sterile material and equipment required to perform minor procedures. There is a huge difference in a dressing room that is maintained by a dedicated and committed staff nurse and one that is maintained by a nurse who is not. This treatment room is run by a great one. You can see that because the supplies are perfectly re-stocked and arranged in a manner that is accessible. It is so meticulously thought out and planned. For example, the staff nurse knows that the person doing the dressing will first require saline solution for washing the wound, so that is placed first, following this there is a betadine solution bottle. Then the sterile bin with cotton and gauze in it, and right adjacent to it the antiseptic solution with the Cheatle’s forceps (the tongs which are used to pick up sterile equipment and materials without contamination by the hand). I work in two such small clinics, while this one is perfectly and meticulously maintained and re-stocked, in the other one, it is a major ordeal to even prepare for a minor dressing, having to go helter-skelter looking for things and restocking them myself. That is why this difference is so obvious to me. 

 

“Please get up and sit down on this table. I will check your tooth and see what we can do?” I said and helped Mrs. V up the couch.

 

I donned my gloves and with a torch shining light into Mrs. V’s mouth, I put my right index finger inside her mouth and gently touched the tooth. It was very loose. I carefully examined the area around the tooth. There was no evidence of any infection, swelling, bleeding or wounds. I called out to the staff nurse who was in the next room dispensing medicines to patients,

 

“Sister, could you please give me a sterile artery forceps?” 

 

I thought I could use the forceps and gently pry out the tooth. I am not a dentist and have not done this before. But common sense told me that when the tooth is so loose, it could have fallen on its own or could have been pulled out by the person themselves, if they had some fortitude. My finger was still on the loose tooth. The staff nurse replied that she will return with the forceps. Even before she could come back the gentle nudge of the index finger dislodged the loose tooth and the dislodged tooth gracefully glided on my index finger and landed on my palm. 

 

Even before I realized what had happened, Mrs. V had already felt the loose tooth fall and the bright smile spread out all through her face. It was her smile that announced to me that the task was accomplished. Then I pulled my hand out and saw the tooth in my palm. Teeth are supposed to be ivory colored, but this one was coal black. Years of poor dental hygiene, betel leaf and nut chewing and constant chewing of tobacco had completely discolored her tooth. I placed it on the tray nearby and examined her mouth again with the light. There was no bleeding. But to be on the safe side, I dipped some cotton in antiseptic solution and pressed it on the empty space left by the fallen tooth and asked her to bite it into place. 

 

“Show me the irritating thing. I want to see it” Mrs. V asked. I showed the tooth to her. “It looks so big and majestic. It looks like a rock!!” said Mrs. V and she had a very proud note in her voice as she did this. She gently touched me on my shoulder in a gesture of gratitude and slowly got down from the dressing couch and walked out. The staff nurse was shocked. “Doctor, are you sure you did a dental procedure here?” I just shrugged and smiled at her. I wouldn’t call this a dental procedure. It was a commonsense household procedure. My dentist friends and colleagues might even call this the work of a ’quack’! 

The story of how ‘dental procedures’ are conducted in the clinic started spreading far and wide and all kinds of people with tooth problems started coming. There were some with pus in their gums, some with deep cavities in their teeth. None of these I could fully treat as a non-dentist. I had to refer them all to dentist colleagues. But word started spreading that I was showing favouritism to some patients and giving them dental treatments. It took quite some time for the ‘dental treatment’ requests to stop coming. 

 

The life of a primary care physician is exciting! It is a human enterprise with all kinds of interesting stories and anecdotes taking place daily. This was a small story of how I had become a ‘one-day-dentist’ by pulling out a tooth that was just hanging by a loose thread!