it’s the tooth, the whole tooth and nothing but the tooth.

It starts back in September just days before we go on holiday.  I crack a filling.  My dentist is on holiday, so the choice is wait a few weeks or see the locum.  I choose the latter.  It’s like a scene with the mad dentist from Little Shop of Horrors.  He’s almost most standing in the chair as he drills out the old filling.  It takes a week or so for the ache in my right jaw to go.

And now it’s back.  From my ear to my chin.  Codeine does nothing to alleviate the pain and I manage to get an emergency appointment with my own dentist, who’s now looking tanned and relaxed.  It turns out to be an abscess.  There’s a dead tooth sitting above it.  The very one I had filled.  It’ll have to come out, but not yet.

The warfarin is the problem.  He wants to wait 4-5 weeks so that I can see my GP and sort out a plan for coming off the warfarin while he pulls the tooth.  I’ve never had a tooth abscess before – my sympathies to all those who have – but I have dealt with pain and discomfort before.  A dental abscess would certainly make it into my top 10 list of things to make my eyes water.  He prescribes a course of antibiotics; “once they kick in you should feel more comfortable”. 

I don’t think I’ve had a tooth out since school days – laughing gas, a nice sleep and a bloody hanky.  Now it’s local anaesthetic.  So I’ll be awake.  When I get home I google tooth extraction and immediately wish I hadn’t.  The web is full of gruesome images of bleeding gums.  So don’t search for that particular topic if you’re in anyway squeamish.

It gets worse under the heading ‘things that can go wrong’.  It can take 8 hours for the mouth to stop bleeding.  I could swallow the tooth if the dentist is clumsy and drops it.  I didn’t check if my dentist is prone to dropping things.  I give up at this stage; I just don’t want to know any more.

Next day at the gym I’m just settling down to a session on the exercise bike when one of the nurses asks how I am.  I mention the toothache.  She looks at me as if I’ve done something very rude in a place where you shouldn’t do rude things.  Before I know it, I’m off the bike and sitting on a chair in the middle of the room.  People are watching.  I think she’s going to give me a detention, but she gives me a cup of tea instead.  It turns out that exercise and dental abscesses do not mix (especially while on antibiotics).  Exercise increases pressure on the abscess (through various nerve pathways running up from the abdomen) and there’s a risk that the abscess will spread from the jawbone to other part of the skull and ultimately, the brain.

Assuming the antibiotics kill off the infection I can come back next week.  Oh no I can’t.  I’m having a flu jab a few hours before the next gym class.  Flu jab and exercise is also a no-no.  The needle can damage the tendons in the upper arm so they need to heal for 24 hours before being put under any pressure.  It’s frustrating but it is also reassuring.  These people have my interests at heart.

I visit my GP for a plan of action; he looks up from his computer screen when I enter the consulting room.  “I haven’t seen you since you went to Australia.  How are you?”  I can’t imagine many GPs remembering that one of their patients went on holiday 6 months ago.  I explain about the abscess.  There’s a sucking of teeth and a hint of a frown;  “It’s very difficult to stop bleeding from the mouth.”  My INR is currently 3.1; “It needs to be 1”.  INR gives a measure of how quickly or slowly blood clots.  A normal person (i.e. someone not taking warfarin, or any other anti-coagulants) will have an INR of 1.  My current reading suggests my blood will take 3.1 times longer to clot than the norm, which is not ideal when having a tooth out.

Tooth day is eventually scheduled for 4th December.  I can stop taking warfarin 5 days before that.  My GP suggests a blood test on the morning of the appointment, before I see the dentist, just to make sure that my INR has indeed dropped enough to make the tooth removal safe.  He also prescribes another course of antibiotics;  “you’ve got a long wait.  We don’t want it tuning nasty.”  No – we don’t.  I just want the tooth out and whatever it is they do to abscesses, done.  I do not want it going walkabout.  A visit from the tooth fairy would be in order though.  I don’t know what the going rate for tooth fairy visits is these days, but I’m sure someone will enlighten me.

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