AKA – How to survive a subepithelial connective tissue graft with apologies if the details are too gory...
The day I had been dreading since last February arrived Monday. At 2:40 in the afternoon I entered the periodontist's office for a dental procedure called a subepithelial connective tissue graft. This is a very technical term for the barbaric necessity of having gum tissue removed from the roof of my mouth and grafted over gum recessed and root-exposed teeth in another part of my mouth.
The procedure is a preventative measure, to prevent infection, loss of tooth and/or bone and to avoid an even more painfully barbaric procedure called scaling and root planing, in which the periodontist removes bacterial plaque from below the gumline with a serious of instruments that would not be considered out of place in a medieval torture chamber. My mother was forced to have this procedure done and swore that she would let her teeth fall out before going through it again.
As I had to have a graft done on both sides of my mouth (lower right and upper left), I was given the option of splitting the procedure over two visits. I elected to get it over with all at once, afraid that the experience would be so bad the first time that I would not want to come back again.
The first step in the graft was the administration of 7.5 milligrams of Valium to ease my very quiet, but very real panic and the taking of an impression of the roof of my mouth to create a wax stent. As I waited for the Valium to take effect, the dental assistant talked me through the rest of the process, sent J out to get the prescriptions I would need and compared notes with me on migraines.
After twenty minutes, she carefully guided me to a second room and handed me over to a second assistant. Assistant number 2, covered my eyes with protective glasses, my body with protective paper and numbed the hell of ¾ of my mouth with a topical Novocaine solution, so the injections would not hurt as much. She waited five minutes, then numbed the surface of my gums again.
After an additional five minutes, the periodontist, an oddly charming and cheerful old Jewish man named Dr. Baumhammer began injecting Novocaine into my lower right and upper left gumline and midway between the hard and soft palate on the roof of my mouth.
(This particular injection, into the palate, is something I experienced at the age of twelve when I had four molars removed and stands out as one of the singularly most painful experiences of my life. I clearly recall, as heavily sedated as I was then, the oral surgeon saying “This will hurt and you will remember this one for the rest of your life”. Correct on both accounts).
After the first round of injections, Dr. Baumhammer stopped for five minutes. He explained that it takes approximately five minutes for Novocaine to reach its full effectiveness and he would be administer a second round of shots. Based on my reaction to the second round he would either start the procedure or wait longer and give me a third round of injections. At any point, if I felt the slightest bit of discomfort, I was supposed to signal him to stop by raising my left arm.
Aside from the injections, the procedure was close to painless. The only sensation I felt was of the surgical thread running against my lip as he stitched the grafted tissue into place and the donor site closed. The upper tooth was more difficult and he had to stop multiple times to give me more Novocaine (I lost track after the sixth shot), as I could feel the scalpel blade (no pain, just the blade) against my gum.
Finally he finished stitching up my poor mouth, covered the grafts with surgical packing and the donor site with the hard wax stent. I discovered that 7.5 milligrams of Valium was not enough to keep the tension out of my body, as I had to physically force my legs to relax. The assistant helped me sit up in the chair and sent J ahead to get the car.
While we waited, she prepared a small brown paper bag, into which she dropped after care instructions, an envelope with a prescription for an antibiotic, some gauze pads to staunch bleeding and some ibuprofen for pain relief. She escorted me down the elevator to the alley behind the building and handed me off to J.
I spent Tuesday and Wednesday “working” from home. Between Monday and today my face swelled up, I learned that Vicodin is an excellent painkiller, ibuprofen is equally excellent, baby food is absolutely disgusting and being restricted to soft foods only gets old quickly. My diet has consisted primarily of applesauce, chocolate milkshake, eggs (scrambled and poached), whipped potatoes and cream soups.
I also have an enormous blue bruise on the lower left side of my check and a small purple bruise under my left eye. I looked like I was punched. Hard. The bruises are the relic of the six plus shots of Novocaine into the upper left gumline. It has been interesting to see how people react when they see my face. More than one woman has winced and looked at me with pity and J says a couple of men gave him rather unfriendly looks.
The stitches come out on Monday.
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