Have a look at this x-ray, taken right after today’s work:

This is my left jaw. To the left, mostly off-camera, is a premolar. Center-right you can see an obvious molar with some fillings. To the left of this molar is what appears to be … and in fact, for all practical purposes, is … a lag bolt. Well, technically, a lag screw, but one without a point. To the left of the screw is a dark area shaped like a cup. The location of the cup shaped area and the screw is where the roots of a molar previously located here sat.

In today’s procedure, the roots were removed. This involved cutting the root structure into two parts, then easily yanking out out the medial (to your left) roots and somewhat more cumbersomely extracting the distal (to your right) roots. There was a lot of prying and tugging but no swearing or sweating, so I guess it went OK.

The medial roots (left side) were largely rotted away, as was some nearby bone, because of an infection that festered at this location while we busied ourselves waiting for dental insurance issues to be straightened out. Because of the extra bone destruction in this area, additional work was needed (which I assume the insurance company will not be paying in full for, which kinda makes me want to sue them). This consisted of a bone tissue implant. The bone implant is actually a mushy liquid with sterilized bone tissue, which will encourage my own osteotic cells to extend their clastic/blastic activities into this cavity more quickly than they otherwise might.

The root to the right side of the photo, where the bolt now sits, were in great shape as was the surrounding bone. So, Dr. Spanish got out his tap and die set and installed a set of threads in my freakin jaw. That actually hurt a bit, and involved a machine that sounded like a cement tamper and vibrated like an L-11011 jumbo jet on a short runway.

Then he put the screw in. That was funny. It was done with a standard Sears Craftsmen ratchet wrench, and when he didn’t have the correct size bit, his assistant had to run out to her car and borrow one from her tool kit. You can never find the most common wrench sizes because they are always being used.

OK, OK, I’m kidding about the ratchet wrench, but only a little. He really did use one of those wrenches … where you turn the handle to twist the nut, then you turn it the other way to ratchet it back, then twist again, etc. etc. Crank crank crank crank. I was worried that he was going to over tighten. “Check the torque on that thing, will ya?” I was yelling, but it came out like “Ek e or o a in, eh eh?” and he said “I know. It could have been warmer, but in the sun it was nice.” Crank crank crank crank. Like a hundred times.

Anyway, when that was done, a few stitches went in, and Dr. Spanish sent me off with a fresh supply of icky mouth wash, scripts for antibiotics and pain killers, and a wadge off cotton surgical sponges to help control the bleeding.

The injected pain control liquid has now worn off, and my jaw feels like two people were standing on it for an hour. Because they were. In the end, I was very positively impressed with Dr. Spanish and his assistant. I think they did an excellent job, they worked quickly but carefully, and Dr. Spanish clearly has the touch one needs to do this kind of brutal yet finely tuned work.

In four months I go back to get a crown put on that lag bolt.

Two months ago, I fell on the ice, was taken to the hospital in an ambulance, got emergency surgery, and two/three days later was released from the hospital. The paperwork I waas handed on my release indicated that the costs to that point were $20,000 US (all covered). I estimate that this injury will cost, medically speaking only, about another ten grand, so the total cost of this injury is going to be, let’s say, $30,000.

A few weeks later, a tooth crown that I had had repaired several years ago (“This may last six months, one year tops” said the dentist) finally came flying out of my mouth at a random moment. So now, I’m getting that fixed. Associated with the tooth crown falling off of its perch on my lower left mandible was a nasty little mandibular infection.

So the dentist put me on antibiotics and we started the process of figuring out what to do next.

This tooth needs to be fixed with either an implant or a bridge. The raw cost, before insurance, of both procedures totals to about $3,500. So, about one tenth of the knee surgery. But, there is a question about what insurance will cover (they don’t like to cover implants for some reason), so we sent off a request for information along with x-rays to Delta Dental, the insurance company.

Delta Dental screwed up the paper work, so about two weeks went by and we learned nothing, and could not start on the work. So we redid the paperwork, and now another three weeks has gone by, again Delta Dentals’ fault, and not only do we still not know anything, but the infection is back, somewhat worse than it was before.

So now I’m on antibiotics again. The pisser is this: If Delta Dental covers my implant, they still would only cover part of the procedure. If they don’t cover my implant, they will still cover the new crown, because they cover crowns (to 60 percent only). A bridge requires three crowns. So, when you do all the math, the answer we will eventually get from the Delta Dental insurance company … a “yes” or a “no” on the implant … will make a difference of about $800.

A mandibular infection can be a very serious matter. I’ve got an open hole in my jaw where bits and pieces of root canal stuff occasionally falls out into my food. And the dental insurance company can’t handle the paper work to the tune of going on a month and a half of time.

There are certain contrasts that come to mind.

In the paleolithic, I probably would have lived form the knee injury, but only after a long period of painful recovery, and I undoubtedly would have lost the use of my right leg. But my fellow hominids would have brought me bits of mastodon and cooked roots, the occasional kidney from a deer, maye a dead lizzard, and so on. I would live. In fact, I might even have been able to do something useful. But, in the paleolithic, this tooth infection would likely have killed me. These things, eventually, are often fatal in the absence of dentistry and antibiotics.

Yet the surgery costs ten times what the dental work costs. Also, people tend to complain mightily about the cost of dental work. But really, given what you get (you get to live!) it is really a bargain.

And, finally, Delta Dental leaves something to be desired. Listen; If I suck on my tooth I can taste the infection inside my jaw. Thanks Delta Dental. Great work. I’ll bet your fucking CEO never had to wait this long for what amounts to emergency dental work.

I’ll update you later on how it all works out. At the moment, if you have a choice, and one of your choices is Delta Dental, I’d consider the other choice. And let this be a lesson to us all!