Periodontal Quest: Surgery 1

*Warning: this post contains slightly graphic descriptions of surgery. Do not read while eating.*

Well, the day finally came. After weeks of taking impressions and radiographs (x-rays) and making and changing appointments, my first periodontal bone-grafting surgery is finally behind me. It was quite the experience.

I received a phone call from my dentist Fatema on Thursday afternoon asking if I could come in earlier on Friday (10:00am) to take a couple more impressions and one last radiograph. Apparently all the work we did last time wasn't good enough. That's terribly frustrating, since making the impressions last time was such a pain. This time it actually went much more smoothly. Two on top and two on the bottom, all came out well and we were done. Amazing. Why couldn't that have happened at the last appointment? Having deep enough trays really makes a difference. And before that we did the radiograph. We had already taken shots of my entire mouth piece by piece, but this was a 360 degree scan. I had this done before, when my braces were taken off, and I think when I had my wisdom teeth out. I love how quickly it goes--just stand still and watch a machine circle around my head.

After the impressions they asked me to wait in the lobby while they prepared a stint to take a few measurements. But that took too long, so eventually Fatema came out and said I should just go get lunch. She led me through the complex to a cafeteria where Tufts students eat, so I had my last normal meal surrounded by future dentists.

The surgery took place in a small room just off the large room where all the cubicle-style dental chairs are. There was a large window to my right, and an inspirational poster about teamwork with a picture of a sailboat on the wall in front of me. Before anything else, Fatema took my blood pressure and had me take extra-strength pain relievers. It was an electronic blood pressure cuff that went around my wrist--very high tech and impressive. Not surprisingly, my pulse was a bit fast, since I was nervous at the beginning of this whole process. Then they had to draw some blood, to mix with the bone powder to make the graft material. I don't remember whether I've had blood drawn before, but I was surprised how little it hurt. They actually tried twice on my right arm and finally got the four vials they needed from my left, so now my multiple holes make me look like a drug user. But on the bright side, they only used two of the vials, so they probably won't have to draw any blood for the next surgery.

There were a lot of people in the room throughout this process. It took 3 dentists to draw my blood, plus a couple others running around making sure we had all the supplies we needed. Colette was very nice and talked to me to keep me calm while I waited between steps. Next came the measurements. We had to recheck the depth of recession, plus take a whole new set of measurements using plastic stints molded from the impressions taken earlier. They measured the thickness of my gum tissue by measuring how many millimeters away from the plastic stint it was, and then comparing that to the distance to the bone once it was uncovered.

But now I'm getting ahead of myself.

They didn't give me anything to make me loopy, so I was aware of what was going on the whole time. I was, however, completely numbed and couldn't feel a thing. Fatema and Michael, the assisting dental student, were impressed by the fact that I didn't even flinch when they injected the anesthetic. Once I was all numbed, we only had to wait for Dr. Griffen to arrive to conduct the surgery. Dr. Griffen wears glasses, so I was able to watch the entire process in the reflection.

Have you seen the advertisements for the show House MD, or any other medical drama? They always have a picture of the cast peering down over the camera as if they were examining a patient. Well, now I know what that feels like. I had Dr. Griffen doing the surgery, Fatema and Michael assisting, and 2-3 other dental students observing. They were also filming the procedure and taking photographs throughout.

The first step was to cut my gum tissue away from the teeth and bone. Dr. Griffen gave a lecture on his favorite tool and how to use it as he worked, cutting and peeling the very thin tissue. Once the flap was cut away, Fatema used a scaling tool to clean the plaque and remaining fragments of tissue off the bone so that the bone graft would be able to stick effectively. They also put the plastic stint back on and took new measurements. While this was going on, one of the other students was mixing my centirfuged blood platelets with bone powder to create the grafting material. Dr. Griffen used a tweezer shaped implement to put this gelatinous material into the areas where my bone had receded. Over this they placed a membrane that looked remarkably like tissue paper. This membrane had to be stitched together to keep the bone graft stable, along with another layer of a material I can't spell. The thread used was rather yellowish. The thread used next to hold the gum tissue back in place over the graft was purplish.

This description reads far too quickly. The whole process took from 1:00pm until after 5:00pm. Between the stages I had to be reminded to relax my jaw, I got so used to holding it open. But by the end I could barely hold still for the stitches, I had been lying there so long.

The surgery reminded me of book binding and manuscript repair, oddly enough. The membrane used to cover the bone graft looked like the Japanese paper used to repair torn manuscripts, and the skin flaps were stitched together much the same way the text block of a book is created. These are the thoughts that ran through my mind as I watched Dr. Griffen put these foreign materials in my mouth to strengthen my tissue. Not being able to feel what was being done, I had a disconnected interest in the reflection, imagining it was someone else's mouth being cut into and messed around with. At least until the end. As Dr. Griffen was putting in the very last stitch I started to get some feeling back. It didn't so much hurt, but the feeling of thread moving through my gum tissue was bizarre to say the least. They gave me another shot before tying it off.

Christina came to meet me at the clinic and brought me home on the T by way of a CVS to get my prescriptions filled. My orders were to keep ice on it and eat only cold, soft foods. This meant, of course, that my dinner consisted entirely of ice cream. That was the best part of the whole experience.

I was still partly numb when I finally went to bed, and the pain meds they gave me have been keeping things under control. It's hard to eat--I mostly have to drink my nutrition, though I can chew on the left side. I expected there to be more pain, but thus far I only have a very dull ache when I near the 8 hour interval between doses of the meds they gave me. Perhaps I just have a high pain tolerance, or it could just be that I heal quickly. Tierney has decided to call me Wolverine, because of the bone grafting. It's beginning to seem more appropriate, and the experience is giving me story ideas. At least something will come out of the experience.

-Kim