It was the week before final exams at the end of my first year in medical school when the pain in my back lower left molar finally reached a point where it could no longer be ignored. And I had ignored my teeth for some time.
My dentist growing up had been, shall we say sub-optimal. I didn’t know it wasn’t normal to have bleeding, or be unable to chew without pain, for 48 hours after every appointment, so after I graduated from high school - and parental management of my health - I simply stopped getting dental care. (I learned years later that my parents knew there was a problem, but remained patients out of loyalty, because felt sorry for him, knowing that he became depressed after his wife ran off with another woman.) Five years later I was to pay a price. Life being what it is, I was also to learn a lesson.
The tooth had been sending intermittent warning signals for months. I had learned to chew on the other side, avoid ice cream, and always have tylenol on hand, and I got by. But over several days the pain became both more constant and more severe until it took over. There was no way I could study for exams, let alone sleep or eat. So, with great reluctance bordering on dread, I hauled myself down to the dental clinic associated with the medical school, where students and other indigents could get free care and dentists could get post graduate training.
Once the requisite intake work was done and papers signed, I was escorted to a chair and met a skinny, serious, and soft spoken dentist whom I estimated to be about my father’s age. He introduced himself, and listened carefully to my tale of dental neglect culminating in localized sever and constant pain. “Well” he said, “Let’s take us a little look, shall we?” There was a short pause while he looked around, moving his mirror and periodically scraping or probing with one of the hooked shiny instruments that look so threatening as they approach your mouth. Then came the softly spoken words that seemed to stop time: “My goodness. Who’s been mucking about in here?” He looked up and summoned someone I understood to be his faculty advisor or instructor who looked only briefly before he remarked: “Everyone has to see this. It’s a great example to learn from.” And over the next 10 minutes about 4 dentists looked in my mouth, probed at various increasingly unhappy places, and pronounced various versions of amazement.
It turned out that the quality of the work was inferior in many ways: cavities incompletely excavated before poorly constructed fillings of the wrong material were sloppily put in and not well shaped on the surface. A number were cracked.
My dentist took everything out of my mouth, sat the chair up, and gently explained that the tooth that was bothering me was beyond repair and needed to be pulled. That could be done today with local or he could give me some pain medication for the night and I could return tomorrow morning on an empty stomach for ‘more complete anesthesia’ if I chose. That would deal with my presenting problem, but he also recommended 4 sessions, one for each quadrant, to remove and replace all the fillings to prevent multiple future recurrences of a dying tooth.
Because I desperately wanted to avoid medication that would impair alertness and interfere with studying or testing, because I overestimated my tolerance for pain, and it turns out because I underestimated the power of Murphy’s Law, I opted for local and extraction, on the spot. I think I was also a little afraid that I wouldn’t have the courage to come back the next day if he gave me pain medication for the night.
He injected local anesthetic in several places on the inner and outer margin of the jaw near the angry tooth, a new experience for me, something my old dentist had rarely bothered with. He said that I should report when the pain resolved as a sign that the nerve to the tooth was asleep. The pain persisted and the faculty advisor was summonsed/ He determined I likely had an aberrant nerve and that the only option other than delaying for general anesthesia the next day was to inject directly into the root through the defective center of the tooth, which he said would hurt a great deal for just an instant, after which the tooth would be numb. He would show his student if i were game. I was game. He got a specially angled needle, moved into position, and as the needle entered my tooth, I can only explain what I felt as an explosion of colors in my head accompanied by a loud noise of screaming. As the colors receded I realized the screaming was him demanding that I open my mouth and release his hand and the now shattered syringe. He needed a stitch and my tooth was as angry as ever.
By this time I was desperate to have the tooth out, and they adamantly refused to use general on someone so soon after a big breakfast. We were at an impasse. “How about hypnosis?” one of the other dentists asked. The faculty advisor’s face lit up.”Great suggestion,” he said, “this is a perfect opportunity.” Before I could object that medicine was a science and that my pain was real - not psychological - and that I didn’t want to screw around with some weird, out-there, snake-oil remedy, he turned to me and explained that hypnosis had been shown to be extremely effective for pain control, including dental pain and burns, but that no one really understood why it worked in some settings but not others. They had a research project going to address this and other issues, and would love to enroll me to see if it would be successful for me. It would cost me nothing, it was completely safe, it had not side effects, and if it worked, it would solve the problem.
Fifteen minutes later, exuding skepticism from every pore, I was in the office of a psychiatrist on R wing. After listening to my request for a painless extraction so I could continue to study and take exams, he gave a brief explanation of what he was going to do, and then had me focus on a small piece of abstract sculpture on his desk, take several deep breaths, and listen carefully to what he said, trying to remember every word, but erasing words that were unimportant to make room for more words, letting my eyes close only if they wanted to or needed to, never losing my focus on the piece of strangely melted metal on his desk, and relaxing deeply, deeply, as completely as I needed...My memory of what happened after is incomplete, but I know he had me drain the pain out of my face through a long, long tube into a deep, deep hole, that I walked back with him to the dental clinic where he talked to me some more while they prepared, that I kept wanting to say there was something wrong because my tooth didn’t hurts so I should just leave, and that they extracted my tooth in two pieces. I remember him saying that the pain would not bother me at all through the next days of studying and exams, that I would sleep well and be relaxed during the day, and able to focus clearly.
They gave me a prescription, I think it was for codeine, but I never filled it. I had no pain during the next several days of studying and exams, but as I walked out of the room having completed my last exam, I became aware of a dull throbbing in my jaw. Nothing bad, nothing to take even tylenol for, but I immediately remembered him saying that I would have no pain until my exams were done. It was four years before I saw hypnosis used in medicine again during my residency, and 15 years of practice before I decided to learn how and when to use it in my practice.
The price I paid? Four long sessions of reparative dental work. The lesson I learned? Just because I don’t understand something, or because I have no explanation for it, doesn’t make it false, unscientific, useless or untrue.