THE DENTAL TANGO

"Life is a shipwreck but we must not to
forget to sing in the life boats"

-- Voltaire

The dance between the dentist and the patient is unpredictable. Each person's style requires a unique choreography. Some take the Two-Step, others require the Waltz, but with Tanya it was definitely the Tango.

She lay reclined in a motorized wheelchair; bellowing cheeks, bright eyes, curly, muddy-red-blond hair, huge lips, exaggerated make-up, no neck, hands that appeared to be plastic and a dress wrapped around a small ovoid body. A mouth stick was attached to the wheelchair near her chin as she gasped rhythmically for air.

Polio had affected Tanya's spinal column at a level of C-3 at a young age in the 1950s. Her lungs were not involved, but the intercostals muscles of her chest, abdomen and diaphragm were paralyzed.

Most people in this condition are confined to an iron lung, but Tanya was an exception. She skilled herself in getting people to do what she couldn’t. And for routine dental care without hospitalization, she taught me to perform the "Dental Tango."

Our procedure worked between Tanya's breathing for air and my brief invasive interruptions. Tanya would gulp, gulp, gulp, then I would drill for five seconds and get out. Gulp, gulp, gulp. Drill five seconds. Get out. The routine became second nature. Sometimes she would speak between gulps, and the pattern continued for the whole time she was in the chair. I was particularly proud of myself when we restored a maxillary second molar. On prior visits I feared that Tanya become overly dependant on our office for her care, ironically I now realized that Tanya had just trained me well.

Sometimes I'd go to her high-rise condo in downtown St. Paul to clean her teeth with a portable hand piece and conduct a limited visual exam. She was on state assistance but the high technical quality of her home was surprising. Her iron lung had a life-depending back-up generator, and this was not the easiest item to locate in the housing market.

Tanya also required a personal attendant to feed, bath, move her and perform all daily activities, and it was apparent their special relationship was built on intimate trust.

Tanya was a dictator. She learned early that if she did not demand the care she needed, she would not survive. She was driven to manipulate, insist, coerce and just plain bully. She did not exclude herself.

Tanya's body was forced into a new form. Her cheeks were huge because she bellowed them to swallow the maximum amount of air. Her neck was wide allowing an expanded airway from base of her skull to her shoulders. The shape of her head was altered by the face masks and elastics to maintain an air-tight seal. Her mouth had developed a big anterior open bite from the wooden mouth stick to operate her computer.

The lack of a working diaphragm and chest muscles affected her ability to clear her lungs. The secretions can act as glue preventing the lungs from proper inflation and causing collapse (atelectasia) resulting in upper respiratory infections and pneumonia. Several doctors told her that she would not survive this condition, but she outlived many of them.

She miraculously learned to mentally control her epiglottis because a ventilator hook-up would have limited her mobility. Fewer than twenty people in the world have learned the art of "pharyngeal breathing."

Tanya was personally affected by the meddling of the legislature over benefits and program cuts. She lobbied successfully on behalf of the disabled, and she was elected ‘Miss Wheelchair Minnesota.’

Tanya was our dental patient for more than fifteen years and she never had a bad day. She was a fighter who showed us that attitude can do it all. If we can’t control what knocks us down, we can choose how we react to it.

For Tanya, it was the dance.


--Patrick J. Foy, DDS, Minneapolis

CHOOSING TO LIVE

"If standard of living is your major objective,
quality of life almost never improves; but if quality of life is
your number one objective, your standard of living
almost always improves.”

-- Zig Ziglar, Author and Motivational Speaker


"I used to eat sheet rock,” the patient confessed, "They call it pica.”

He was a small Hispanic man whose boyish, olive-brown face was coarsely scarred and framed with neatly-trimmed jet-black hair. As I filled out his medical history forms, he peered at me with jaundiced eyes, hoping to catch my response.

“I suffered from severe depression and almost died several times,” he said, as if he had often shared this story. “But now I’m trying to get my act together for a kidney transplant. I want to live."

He resided in a nursing home; his kidneys had shut down and he was dependent on dialysis three times a week. Blood chemistry issues also compromised his ability to heal. The downward spiral of mental health had left his general health in shambles.

The patient had been referred by "Donated Dental Service," a volunteer program to treat people who are medically compromised. This man had destroyed most of his dentition with a combination of depression, neglect and the assault of chewing abrasive sheet rock.

The name pica comes from the Latin word for Magpie, a bird that will eat almost anything. The condition is world-wide, but because of patient’s shame and low incidence, pica often goes undetected. Causes may be cultural, physical (malnutrition and mineral deficiencies), and mental (developmental and psychological).

The erosion to this man’s maxillary anterior teeth was remarkable; they were worn down to the alveolar bone exposing unprotected nerves and dentin. His mouth was riddled with worn, fractured, decayed and abscessed teeth. Paired with poor oral hygiene, his dental state was catastrophic. A treatment plan was challenging because pica relapse is not uncommon. His fervent will to live became our motivator in helping him.

Many of his teeth were extracted and replaced with removable upper and lower dental prosthetics. Now he could eat and speak properly, and with his body rid of future dental infection risks, he was a better candidate for a kidney transplant to help satisfy his goal.

He said, "Everybody has been complimenting me on my new smile. I’ve never had straight teeth before. I can’t believe it."

It would be a pleasure to report that this man has received his kidney transplant, but he is not there yet. Despite several setbacks requiring hospitalization, he is slowly improving.

The interconnection of dental, mental and medical problems was clearly apparent in this extreme case of pica. However, these relationships cannot be as neatly separated as we formerly believed.

Medical pathology needs to be evaluated with a differential of possible mental health causes. People tend to ignore their dental health from stress, depression, low self-esteem, physical pain and other conditions. Anti-cholinergic medications, poor diets, poor hygiene and lack of preventive dental services also contribute.

"I want to live."

That was the mantra for our dedicated response.


-- Patrick J Foy, DDS