STORIES FROM STIR

LEAD FILLINGS

So it seems like the interesting patients always come in on Saturdays. This is not to say that all the patients are not interesting, but on Saturdays we get the guys who have spent a lot of time on another planet, or maybe even in another universe.

One Saturday morning, there was an emergency patient on the schedule. His appointment request stated that he had a tooth that was killing him and he needed to have it "yanked out". He was seated and he started a long involved diatribe that he had "lead fillings" that were causing him to have violent headaches. In fact, he said the headaches were so bad that he had pried out the ones in the teeth that were causing the most pain.

I informed him that in the prison clinic, filings in molar teeth were dental amalgam, not the tooth colored fillings, which meant his teeth would be restored with the same material he said he had pried out of his teeth. I went on to explain that lead was not used as a filling material for multiple reasons. Among those were the toxicity of lead and the softness of the metal which made in unable to  withstand chewing forces. He then told me his metal fillings were lead and he did not want the teeth restored, he wanted them out.

At that point, I began his examination. The first thing I noticed was he had no teeth that were missing restorations. Next I noticed a large caries lesion into the pulp of a mandibular molar with significant mobility of it and the adjacent molar. An x-ray showed a pulpal access of one molar, and a periodontal abscess of the tooth next to it. He was wrong about the lead, but he was right about the need to have the teeth "yanked out".

Then he wanted to know why his fillings caused him to have headaches (since he was abut six years old) if they were not lead. I told him I could not say why he had headaches, but it wasn't from lead in his teeth.

While he was getting numb, the patient in the next chair was concerned about an abscessed front tooth that needed root canal therapy, or extraction. The patient was in his early 20s and did not want to lose a front tooth. As I was explaining what a root canal was, Mr. Lead Fillings called out "You don't want no root canal! I've had them and they don't work. The take the roots out of your teeth and that makes them fall out." I told the both of them that this was not the case. That the dental pulp was removed from the tooth root, and then the root was filled.

Mr. Lead Filling said he didn't think so. The other patient said he would live with the pain and think about it. I told him he should at least reschedule for a cleaning an fluoride treatment. Mr. Lead Filling couldn't leave that one alone either.

"Fluoride is a deadly poison and the government wants you to take it because it will lower your resistance and it will be easier for them to control your mind. I've done a lot of research on the computer and the Italians did this in World War II. Don't take no fluoride! If it don;t kill you it will make you a robot under government control". I told both of them that this was not the case. No cleaning and fluoride treatment was scheduled either.

I then extracted Mr. Lead Filling's affected mandibular molars. By then I was half sorry that he was so well anesthetized, because he felt no pain, but he sure had caused pain for me. I showed him the x-rays and the teeth. No lead. No amalgam. No portion of the tooth prepared to accept any type of filling.

He just smiled at me and said that was because he had pried the lead out himself. 

Dentistry in the Big House

Not the prison where I work

DENTISTRY IN THE BIG HOUSE

I have been seeing inmates for their dental care for about 10 months. It is an interesting gig, nothing at all like dentistry in the world (that's on the outside to the uninitiated). 

Patients in the MDOC come in several different categories:

1. Green and white striped pants: these are the inmates who are on the best behavior and close to discharge (two years or less to go). They have stayed out of trouble at the correctional facility, and are eligible for Trusty status (there are no Trusty Guards in the MDOC. They were replaced by corrections officers in 1972 prison reform). They are allowed to intermingle with the next category below them.
2. Black and white striped pants: these inmates are similar to the green and whites, but are not close to their release date, if they have a release date at all. Many are lifers, but have been on good behavior.
3. Red and white striped pants: these inmates are separated from the rest of the population. They can have no contact with inmates other than their fellow red and whites. There status might be a result of behavior issues, or other circumstances.
4. Jumpsuits (orange, yellow): This category usually shows up in manacles. They also have no contact with the general population.

It is important to remember that these persons are entitled to being treated with dignity. They are human beings who managed to be in the wrong place, at the wrong time, while experiencing a significant error in judgement. They have already been judged, the healthcare team is there to help them, not judge or punish them. All are entitled to respect as humans, but some do their best to make that difficult. Most are grateful for the dental care they receive, but they all seem to want more. Corrections dentistry provides basics only; fillings, extractions, partials, dentures, and cleanings. Emergencies and acute pain take priority, restorative is next. Unfortunately, cleanings and preventive services are the bottom of the triage list. Cosmetic work, crown and bridge, dental implants, and most root canals are not going to be done in the slammer.

More to come.

Stories From Stir

Picture from internet images

STORIES FROM STIR

I get interesting comments from the inmates who come in for treatment in the prison clinic. "Stories From Stir" are little interactions that I find amusing. I hope you do too.

This one took place this past April after performing a "2 Year Dental Exam".

Inmate: When I get out I'm going to get a new grill, you know...so I got a question to ask you. Which kind is better, a snatch-out or a glue in? Wanna look good, but I don't wanna hurt my teefs

Me: If it is removable, if you don't take it out several times a day to clean teeth where the grill touches them, your teeth will decay to the point that they might have to come out. If it is cemented in place, the teeth will have to be cut down, or prepared, and an impression or mould made for a lab to ensure a good fit is obtained. If there are gaps in the fit, the cement will wash out and the teeth will decay under the grill.

Inmate: Thanks Doc, I guess I'll get the snatch-out and do a lot of brushing.

Me: Just be sure to take it out and clean it and your teeth in the morning, at bedtime, and after any meal or snack.

So now I'm wondering if I should start calling removable partials and complete dentures "snatch-out teeth"? Kind of has a ring to it doesn't it? Just saying'.