I’m 17 and my jaw has been hurting, right at the hinge on the right side.
My mom has crowded teeth. My dad has gaps. I must have gotten a little of both because my teeth are straight and even. Good thing, because I’m in high school and braces would dissolve what small nuggets of game I have.
‘Well!’ declares the dentist as he emerges from my mouth. He pulls off his glove and I close my jaw. There’s a pop that could have come from either.
‘The thing is that the two halves of your face didn’t grow at the same rate. Here, take a look.’ He holds up a mirror and I see my disfiguration for the first time. The right side of my jaw is a little crooked. My nose on that side is angled, my eyelid is a slightly different shape.
‘Oh wow…’
I am shocked and embarrassed. I touch my face. I had no idea.
‘So, do I need braces?’
‘No, but your bite is a bit off. Fractions of a millimeter here and there.’ His own teeth strobe out from between his lips as he talks. They rival the overhead lamp for xenon brilliance, accentuated by his deeply tanned skin.
‘You’ll want to get it corrected or you could end up wearing your teeth down. I can do it today if you’re up for it?’
‘I’m not sure…what about my jaw?’
‘Oh it will make that better actually. Your jaw will slot right into place after this. No more sliding around to find the right bite.’
‘Are you sure? Because I really don’t—’
‘If you were my son, I would say the same thing.’
‘OK,’ I say, ‘Let’s do it.’
Tooth reshaping was a euphemism. Voluntary torture would have been more accurate. My teeth fit together better alright. But they are shorter now, and that makes the impingement of my jaw into the right socket worse.
Fucking guy. Never going there again. That hygienist was pretty though…mom-pretty because she was like 28, but still.
I wish I had never done it. But hey, at least I didn’t have to get braces.
I’m 20, in Florida. My face is still warm from the radiation bath the ancient x-ray machine gave me. It is a tall, forbidding machine that would have at least a dozen skulls painted on its nose cone if it was a fighter plane. The office is a couple rooms in an office building basement. The hygienist is out for another back surgery and the front desk lady is sick. So the sweaty old dentist is doing it all himself today.
‘Well no cavities,’ he murmurs, looking at the pictures. The good news momentarily lifts the weary folds at the edge of his mouth but the smile does not reach his sad eyes.
‘Great,’ I say. I expected no less. I am 20 after all, and I will live forever.
‘But looks like you’ve started to grind your teeth. And you say the jaw hurts?’
‘Grind my teeth? I don’t think so.’ I run my tongue along the inside of my teeth.
‘Well, it happens when you’re asleep so you don’t notice.’
Yeah whatever pal.
‘Anything we can do about the jaw?’
‘Well, I can make you a splint. That’ll help both issues. It’s like a retainer that your front teeth rest on. It allows them to glide a few millimeters above the others so you don’t grind. And it will probably allow your jaw to relax.’
‘Is it hard to sleep with?’
‘Not really once you get used to it. I just made one for my daughter.’
Seems easy enough.
‘OK. Let’s do it.’
I’m 22, and living in Utah. The splint was great but I’ve lost it and I haven’t had a cleaning in two years. I looked up the top-rated dentist on Google and now I’m walking into my appointment.
I open the door and squint into the shining plasticky sleekness. ‘Hello and welcome!’ beams a beautiful girl with flowing blonde hair and red lips. She sits in a Herman Miller chair behind a white marble countertop. The lights are bright and fancy green wallpaper accents one wall. The office air is chilly, fancy chilly, the kind of chilly that says ‘we don’t care how much electricity costs, as long as you’re comfortable.’
‘Spa water?’
‘Oh wow, sure, thanks.’
The hygienist that does my cleaning is also beautiful, about my age. Ring on though…my sister was a hygienist for a while and wore a fake ring to keep the men at bay. 22 and married? This is Utah, so probably legit.
When did they start cutting scrubs to make them sexy?
Another girl takes my x-rays on a new machine the size of a small ottoman. She is also beautiful and also wearing form-fitting scrubs that somehow leave a lot and a little to the imagination at the same time.
Dentist comes in. She’s an attractive blond that paid for about 50% of her looks. Mom-attractive though, because she’s like 38. She looks me full in the face and leans forward.
‘Good news. I can make you a new night guard. You said your last dentist made you a splint?’
‘Yes it worked really well. My jaw never felt better.’
‘Well splints aren’t good because your top teeth need your bottom teeth to strike against. Without that pressure they move around and eventually loosen and fall out.’
‘Oh jeez. Well, it felt great…’
‘I’m sure it did.’ She gives me a pitying smile. Her teeth are so white and her skin is so tan. If you smile while lying in a tanning bed does it bleach your teeth while it’s darkening your skin?
‘Now I have some bad news: you have twelve cavities.’
‘What!? Twelve cavities?’
I am shocked and embarrassed. I put my hand to my mouth. My oral hygiene isn’t that bad, is it? Jesus…I had no idea.
‘How could that be? Two years ago I had none. Do they grow that fast?’
‘They can!’ She brings up the x-ray on the sleek Dell x-ray viewer. ‘See the smudge between these teeth? That’s a cavity.’
I lean forward. ‘I don’t really see it…’
‘Well you can’t because you’re not a dentist. But I can. That’s the worst one. And you have eleven more.’
‘Oh gosh…’
I imagine great painful pits in my teeth, crumbling molars, my grandfather’s champing gums.
‘The good news is I can fill five of them today.’
‘Shoot, I would but I have to get back to work. I’ll reschedule.’
‘Well do it soon. There’s no cure for a cavity you know, and they’ll just get worse!’
Back at work I tell the guys the shocking news and urge them all to brush more often.
‘Wait,’ says Petey. ‘You said you went to Dr. Greene?’ Petey’s a quiet young Mormon guy, but now he gets heated.
‘That freaking dentist…she is the worst, the absolute worst. She said I had fifteen cavities! I was so darn scared. I had her fill the first few but she drilled too deep and I got an abscess and almost freaking died. Whatever you do, don’t go back to her. She’s just out to milk her patients. How do you think she affords that nice office?’
‘It was a nice office…’
‘Plus they give people discounts if they leave a 5-star review.’
‘Oh yeah…they had like 200 reviews and an exactly 5.0 star rating. That’s sketchy.’
‘Yeah man. Here’s the number to Dr. Frank, the dentist that fixed me.’
***
Dr. Frank’s office has a low drop ceiling with yellowing panels, peeling wallpaper, stacks of files along the back wall, busted-ass waiting room chairs. The fax machine is running loud and hot in the corner. The woman at the desk has normal, baggy scrubs. She calls me ‘hun’.
Dr. Frank is a wide man with a confident grip and a straightforward manner that lives up to his name.
‘I reviewed those x-rays from Dr. Greene. Let’s just say I’m not a fan of her work. She showed you these shadows right? Well I like to call that “trolling for dollars”. They may be cavities. They may not be. It will be years before we can say for sure.’
‘So I don’t have twelve cavities?’
‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
‘Really? Because she said—’
‘Oh yeah, I’ve seen it happen. Look, if you were my kid I’d say don’t go drilling anything right now. Don’t let her scare you into doing something you don’t need to do.’
I’m 26, living in Burbank, California. Back in a dental chair with my mouth open. The place isn’t exactly dingy, but it isn’t exactly nice either. I’ve learned my lesson about nice offices. The waiting couch sags, the receptionist reminds me of my second-grade teacher and the hygienist has such veiny, muscular forearms that I wonder if she’s there to restrain patients as well as clean their teeth.
Dr. Hong is calling numbers out from inside my mouth to the hygienist who types them into a chunky old Lenovo laptop. Dr. Hong snaps off the yellowing overhead light and gives an exasperated sigh.
‘You need wear night guard. Your teeth terrible. Grinding and clenching all night.’
Damn it. I never got a new one.
‘Hahhyeah I han hegetha nother un hut eely herk?’
He takes the dam out of my mouth and hand-cranks the chair upright.
‘Yes night guard work. But only if you wear it.’
‘But—’
He waves me silent and drops his bombshell.
‘You have to wear night guard. You have teeth of 50-year-old!’
‘What?! The teeth of a 50-year-old!?’
I’m shocked and embarrassed. I run my tongue along the inside of my molars. I mean, I knew I should be wearing the night guard but, god… I had no idea I did such damage.
‘Oh yes, you have old teeth. Very terrible. But night guard only $250. I can take impressions for it today.’
‘But they’re hard to keep in all the time. And there’s my jaw...’
‘Too bad. You need to get used to it. If you my grandson I tell you wear it or you lose your teeth! And hurry up because I retire soon. I will refer you to TMJ guy for jaw.’
‘OK…let’s do it.’
I’m so cowed he could have charged me $1,000 and I still would have paid.
The night guard does not help my jaw. And it pushes a couple teeth out of line so now they strike wrong. Dr. Hong retired and I’m moving soon. I don’t have time to get it adjusted. Plus, is it really doing anything? I don’t think I’m really grinding. It was that stupid tooth reshaping when I was 17…
Eventually I get in with the TMJ specialist, and he refers me to an oral surgeon. ‘Best guy in town for a jaw like yours.’
It seems this surgeon is dental royalty because his dad founded the big university dental school. Junior is a hotshot surgeon but he’s retiring soon so I should get in with him as soon as I can.
I arrive at the swanky building off Wilshire Blvd. Elevator to the 30th floor. Doors open right into the office and I’m greeted by a bored, curvy little blonde with light brown eyes that flash up from her Apple laptop. She instantly catalogs me from under her elegant mascara. No ring. But it’s clear from the wince she passes off as a smile that I wouldn’t have a chance anyway. The office is nice in an old money sort of way: stiff leather chairs, thick wool carpet, muted red and white and gold, immaculately clean.
‘Spa water?’
‘Sure, thanks.’
Dentist is a large tanned man with a quarterback’s hands. He doesn’t use them to shake mine. He has pictures of dead African big game as his Macbook Pro screensaver. He touches his gold-rimmed glasses and pulls up my x-rays.
‘You have what we call a large skeletal anomaly. Essentially your face is deformed. The only way — the only way — to solve it is to saw your jaw apart, graft bone, cut off your gums and move the whole thing over fractions of a millimeter with posts and pins and glue made from your own powdered bone.’
A chill runs up my spine.
‘Plus you have some gum recession which we can take care of at the same time. It is a coordinated care plan that involves four different specialists. It takes about 9 months in total. It will cost about $100,000. Maybe $150,000. But I am confident we can probably help you.’
‘But what about—’
‘It is the only way. Nothing else is really worth getting into.’
‘But—’
‘Look, if you want things to keep getting worse, live your life. But if it was me, I’d bite the bullet and get it over with.’
‘In terms of a second opinion, I think his recommendation was way too drastic,’ says my neighborhood strip mall orthodontist. She’s in her early thirties, still paying off her student loans but not trying to pay them off tomorrow. Office is modest and her assistant is a niece with bad skin.
‘I guess there’s a skeletal anomaly but it’s not bad at all. About 6 months with some gentle Invisalign and you’d be all set. Your jaw will not be perfect, but I can promise that you’ll have a better bite.’
This should make me feel better. But all I feel is exasperation.
‘That’s great. But I don’t know what to think. I got him saying $150k and 9 months, and I got you telling me 6 months of light correction. Who do I believe?’
She shrugs. ‘Well, he’s a surgeon. Maybe every mouth looks like a nail he should hammer.’
I wince at the thought.
‘How could I have prevented this?’
‘Oh well you should have gotten braces when you were young. And a palate expander. But after about 21 your bones are hard and set. No changing them unless you do those crazy surgeries he was talking about.’
‘Damn. So just a little Invisalign?’
‘Yep.’
‘Would you need to do any tooth reshaping or anything like that afterwards?’
‘Oh sure. But that’s nothing. Just fractions of a millimeter. I can take your impressions today if you want to get started?’
‘No thanks. I need to think about it.’
I’m 33, just moved back home to Austin. I never got the Invisalign. Jaw still hurts from time to time. I haven’t had a cleaning in two years. And my tooth sensitivity from the gum recession is getting worse. I can’t drink cold water without pain. My teeth aren’t as sharp as they used to be either. I have not been wearing a night guard. Both my parents have recently gotten root canals and explained the process in graphic detail. They wish they had taken better care of their teeth.
It is time to get my shit together. But first I need to find a good dentist.
‘You should see mine,’ says my sister over tacos. ‘She’s cool and pretty. I call her Hottie Doc. It’s a super nice office.’
‘Hottie Doc? Nice office? No thank you.’
‘Oh trust me, I understand, but they really do good work and they don’t try to upsell you on shit all the time.’
She would know. She was a hygienist after all.
‘OK, well I don’t have any other recommendations and I don’t trust Google so… I guess I’ll give them a shot.’
Spa water. Beautiful hygienist. Cold office. New handheld x-ray machine. Form-fitting scrubs.
‘Well you have 6 cavities,’ says Hottie Doc. Her perfectly bronzed skin glows in the afternoon sun coming in through the floor to ceiling window. ‘See these shadows between the teeth?’
At least I see the shadows now, because they’re bigger. And those were some of the same teeth Dr. Greene said I had cavities in ten years ago. It’s time.
‘OK fine. And what about the gum recession?’
‘Yeah your recession is pretty bad. For that I’ll get you in with the periodontist. It's worth a consult and he’s great.’
‘And the jaw thing?’
‘Well you need a night guard for sure. I’ll make you something called a splint.’
‘Oh no, I’ve tried those before and another dentist said—’
‘Well, you’re not meant to wear them for a long time. A few weeks to allow your jaw to relax so we can see where it wants to go. Then we get you a proper night guard made in that shape, so all night your jaw is relaxed and happy. Your bite will feel off but in the morning it will just go back to where it normally does when you chew.’
‘OK, I guess that makes sense.’
‘And then we’ll refer you to the best ortho in town, Dr. Trudy. She’ll tell you what you need. Are you ready to take care of these cavities? I can do your left side today.’
‘Sure, better now than later right? But god I hate getting my teeth drilled! Every few years I read some promising article about how scientists are working on lab-grown organs and stuff. It’s always like 10 years away from actually being ready. When are we going to be able to just regrow teeth in the lab from our own stem cells or something?’
She guffaws. ‘I don’t know! Ask Elon Musk! OK now lean back and open your mouth.’
Poor form. A good dentist should have more professional curiosity than this. Further thoughts are drowned out by the screaming whine of the dental drill.
On the way out the pretty little hygienist hands me two referrals. At 19, she’s too young for me and probably too young for these scrubs that show so much deep cleavage.
‘This one is for Dr. Trudy the ortho. She is just the best. That’s who my parents took me to.’ Her teeth are wide and white and straight. She has no skeletal anomaly. ‘And here is the referral to the periodontist Dr. Gupta.’
‘Thanks,’ I slur through Novocaine lips. ‘Guess I shouldn’t have been brushing so hard all these years.’
‘Oh that’s been totally disproven as a cause of recession,’ says Hottie Doc, appearing behind the counter. ‘It's caused by grinding and by genetics. Brush as hard as you want. I’ve seen gums grow back after wearing a good night guard.’
‘Oh really? I thought that once gum tissue was gone it was gone forever.’
She shrugs. ‘I’ve seen it. Bye bye now. See you next week for the other side!’
‘Yes, you have some light recession,’ says the periodontist Dr. Gupta. He pops in a mint and sits down onto a fancy swivel chair. Unlike other dentists, Dr. Gupta came by his dark complexion the old-fashioned way. His office is nice but I’m not sure if the same rule about niceness applies to a gum specialist.
‘It’s really not too bad. See all this tissue here? I’d say you’re fine.’
‘Well, that’s good to hear.’
‘The main thing is to manage the sensitivity and not brush too hard.’
‘Wait, I thought hard brushing was disproven?’
‘Not really. Who told you that?’
I feel a surge of anger. Good lord. Do any of these dentists actually know what they’re doing?
‘OK, well I’m getting this night guard which my dentist says will help with the recession.’ He gives a noncommittal head bobble. ‘I’m pretty excited about it because she’s making one that will help my jaw go back to where it wants to be.’
He frowns and squints at my jaw. ‘Hmm, yes. Look, just make sure it’s a flat one, and doesn’t pull your jaw out of alignment. Those sideways ones might feel good while you’re sleeping but then your teeth don’t fit together right. If it's off by fractions of a millimeter you could end up doing serious damage to your teeth and maybe worsening the recession.’
‘Oh. Well I already paid for it. I was really going to do it right this time…’
‘Well if I was your father, I’d say stay away from those types of night guards.’
‘Oh…’
‘As for the recession, if the sensitivity is really bothering you we can do a gum graft. That’s where I scrape tissue off the roof of your mouth, cut into your gums so they lift up in flaps, and then I paint the scraped tissue back on around your teeth and reattach your gums. It costs about $10,000.’
A shiver shoots up my spine.
‘Oh boy. Isn’t that just a stopgap though? Without really knowing what caused it, how do I know the recession won’t keep getting worse?’
‘We don’t. You know, if I were you, I would wait. We’re only a few years away from being able to culture gum tissue from your own stem cells and reapply it painlessly to your teeth.’
‘Really?! Now that’s what I like to hear! And who knows, maybe with light brushing and wearing the night guard, some of it will grow back on its own.’
Dr. Gupta scoffs. ‘That’s a myth. Once gum tissue is gone, it’s gone forever. Who told you that?’
‘My dentist…’
He chuckles. ‘Well, she’s not a perio.’
I catch the unmistakable odor of stale tobacco under the mint on his breath. I notice the outline of a pack of smokes in his scrubs pocket. For Christ’s sake, isn’t smoking a major cause of gum recession?
‘One last question. I saw Dr. Trudy for ortho before I came to you. If I do get the gum treatment, she said I should do the ortho first. Is that right?’
‘Oh, no no no! You do perio first and then the ortho. Moving your teeth around, even fractions of a millimeter without gum coverage, is a good way to lose even more. Listen, Dr. Trudy is…well, let’s just say I am not a fan of her work.’
‘You aren’t?’ I ask weakly. A gray swirl of frustration and confusion and hopelessness wells up inside me.
‘No. In fact, I’m glad she’s retiring. You know, I’ve seen a few cases like yours over the years.’
‘You have?’
‘Yes and with coordinated care, we could really correct your entire mouth. But the first thing you need to do is see an oral surgeon.’
He spins on the little chair and calls to the tall, raven-haired stunner at the front desk.
‘Hey Crystal, who was that really good oral surgeon out in California?’