Sunday, April 10, 2011

Thrills! Chills! Taiwanese dentistry!

So, right on the heels of this post (yeah, I know, I'm linking it but it's right below, whatevs) I started to feel a vague ache in my jaw. I figured, as usual, it was a wisdom tooth coming in and so it'd hurt a bit for a few days and then go away, just like with the other ones, which came in normally.

By the end of Brendan's birthday party it was a bit more serious, but I'd had three cocktails and could still eat, though it was hard to open my mouth fully, so I figured I'd sleep on it (not that I had much choice; by that time there were no realistic medical options beyond an emergency room run for prescription pain medication). Deep down I knew that this was more serious, but didn't really want to admit it. I'm the author of this old Lonely Planet classic from 2003 and as a result of that experience I'm a bit wary of dentistry generally, at least when it involves more than a filling.

This morning it was worse, and by 2pm I was seeking out a dentist, with a growing fear in my heart that this would not end well. And it didn't: I did have an impacted tooth, I did need it removed, and the pain wouldn't go away until it was removed. So I had it taken out. Once again, I didn't have much choice: it was so bad I could barely eat, and if I wanted the full general anesthetic I'd have to make an appointment and go to the hospital, which would have to wait until Monday at the earliest.

This brought me in touch with yet another aspect of Taiwan's health care, so I figured I'd write about it here.

The bad parts were (mostly) not the fault of the Taiwanese system or the dentist:

- I had it done with just Novocaine (or whatever they use now), not general anesthesia. Apparently that's normal for fully erupted wisdom teeth. I'd assumed that one got put under because, hey, it's a pretty medieval procedure when you think about it. It's basically the same thing as Ye Olde Tooth-Puller, except more sterile and with local anesthetic instead of local moonshine. This surprises me - if I ever have to get this done again, goshdarnit, I'm going under! Waking up from general anesthesia is not as horrible as being fully conscious when they do...that...that...twisting forcep thing to you.

- My tooth was more firmly embedded than most, so it took longer and was more painful than it normally would be.

- The ginormous forceps. The pressure. The blood. That crunching sound as they widened the socket and maneuvered the tooth out - I admit that I started sobbing. I'm not even embarrassed about that. It was thoroughly horrifying. (I have kind of a fear of crunching bone and have never had to face it, as I've never had a broken bone, so there's that too). Why don't people go under for this?

- I had to do it all in Chinese. My regular English-speaking dentist closes at noon on Saturdays so I went to the first dentist I could find, and he didn't really speak English. Considering the circumstances I think I did pretty well. With a wad of bloody gauze in my mouth, I managed to say "給我你們最強的藥。鴉片,大媽 - 都可以!"

- The horror of the procedure was kind of low-balled, in my opinion. I was told "It's OK to get it without general anesthesia. It's a little uncomfortable but I promise it doesn't hurt". Yeah, uh, it's true that it's not "painful" but they clearly have a different threshhold of what constitutes acceptable discomfort! I thought "OK, maybe that means the tooth just comes out" but no, it means "we get to squish your skull and move the tooth around in the socket, which causes bone trauma, before extracting it with the biggest forceps you've ever seen, and you'll feel it in your EYEBALLS".

- I do feel that partly because of the language barrier, I wasn't given enough prep on what to do afterwards. For example, they didn't tell me not to drink from a straw, so I started out doing that (then found out I wasn't supposed to, and stopped). They told me not to spit, but they didn't tell me how to properly brush my teeth and rinse. They didn't tell me about the importance of not dislodging the blood clot. They didn't tell me to avoid solid foods for two days (although I kind of assumed that). They did say "only eat food you feel you can comfortably eat. If you feel wary, don't eat it", but that's it.

- The painkillers they gave me? Yeah, so not strong enough. I've been supplementing with Panadol.

...but there were some good parts, too - somewhat attributable to the Taiwanese healthcare system.

- The entire thing cost three US dollars. Yes, $3. US. No missing zeroes. Fo' shizzle, to steal an outdated '90s slang term. A friend of mine broke her ankle in January and it's not healing, and has to have surgery. She is currently waiting for insurance approval to have the procedure and is living a very limited existence while that approval goes through. She'll still be in the bag for several hundred, if not thousand, after it's approved (which it had better be). I walk into the dentist, no appointment, pay THREE DOLLARS, and get a wisdom tooth out. It really throws the two systems into stark relief, when you put it that way, and it's clear which system comes out on top.

- General anesthesia is a covered option: I'd have to go and stay in a hospital and it would be delayed and take longer generally, as well as cost me a bit more, but it is a possibility. I'm hoping there's no next time, but if there is, I'll take this option. No way will I be conscious if those terrifying tongs of terror come near me ever again. Not every American insurance plan offers that for an erupted tooth.

- I was able to make a follow-up appointment for Monday. Not all American dentists do that - if you think you're healing fine they don't worry about checking on you a few days later. You only go back if there's a problem. In Taiwan, I'll go back on Monday, pay another $3 and get checked to make sure it's healing smoothly, which is a good way to help prevent possible dry socket, something I'm at elevated risk for.

- No appointment necessary! Try THAT in the USA without a severe emergency (mine was an emergency in that I couldn't eat, but not so severe that an American dentist wouldn't have minded if I'd shown up without calling first).

- My sweet and wonderful husband, who came immediately out to the dentist's when I texted him with the news, was there when I started sobbing (which I did - that crunching bone sound really freaks me out and I think I'm going to have nightmares about those massive glinting forceps), went out to buy me more gauze, soft food and Panadol, made me a smoothie and has generally taken great care of me.

- Millions of people suffer from far worse pain than this and have chronic conditions, or can't afford treatment (ahem USA....ahem), or have no access to treatment (much of the Third World). I have led a relatively pain-free life with the one exception of my severe slipped disc, and really, I'm quite lucky. So please don't take this post as pure complaining.

Anyway, my advice: no matter whether the tooth has erupted or not, go ahead and get general anesthesia. This is one heck of a traumatic procedure when you're conscious.


Anonymous said...

By general anesthesia, do you mean sedation? Because technically that's not anasthesia, that's just making you unconscious so that you don't remember the pain (or anything else).

I got all of my wisdom teeth pulled when I was 17. Even though standard procedure in the USA is to sedate, I chose to have nothing but lidocaine because of the following reasons:

1) If an earthquake happened in the middle of the operation (and since there were 4 teeth to be pulled, it was an operation of some length) I wanted to be conscious
2) My aunt is allergic to sedatives - I don't know whether I share the allergy, but I didn't want to find out the hard way (I wonder if there is an easy way to test for this ... maybe I should look into this)
3) Cheaper
4) And the most important reason is, if you're messing with my body, I want to watch what you're doing.

My case was very different in that none of my wisdom teeth had erupted at the time of the operation. They were all removed because they would have all, eventually, become impacted, and there was no point in waiting for them to become a problem. Personally, I found it about as pleasant as the average dental operation, which is to say unpleasant, but bearable.

I was very lucky in that I didn't need painkillers after the operation. They gave me a bundle when I left, and I never touched them. When I had the follow-up they said that I didn't need painkillers because they did such a good job ... don't know whether that's true or not.

If the tooth yanked was a lower tooth, there is something else you need to watch out for. For a few months food would get stuck in the gaping holes where my lower wisdoms once were, and I had to delicately clean them out. Carrots, for some reason, were particularly prone to getting stick in those holes. Eventually, the holes closed. Of course, since your tooth was erupted, that might not be a problem.


Cahleen @ The Alt Story said...

Ouch! I hope you never have to relive that experience. I had my bottom two, still in the gum, taken out while sedated in the States. I woke up and was in all kinds of pain! So far I've had one erupted wisdom tooth from the top (the other one will probably have to come out eventually but so far not a problem) taken out in Taiwan with just lidocaine and I actually didn't think it was that bad at all. For me it was just kind of weird and freaky to feel them twisting that tooth around (the roots were pretty curved so it took awhile), but I didn't feel any pain so I didn't really care. Then I just hopped on my scooter and drove home. I don't think I even had to take any pain pills after. Anyway, I hope I don't have an experience like yours when I get that last one out!

Anonymous said...

I had my wisdom tooth (not impacted) removed under the same conditions as yours but my reaction was totally different.

First there was the injection. All I thought was "Cool."

Then he said "You're going to feel me using force but it won't hurt."

Then he started pulling and I thought "Wow he's using a lot of force but it's not hurting! Amazing! And the damage he must be causing to the tooth itself ... if this kind of manhandling happened to one of my other teeth I'd be so worried but I want this tooth out so it's OK!" And as they sucked the blood out of my mouth I remember being impressed with their efficiency.

Oh and when I finally saw the tooth I was impressed by its size.

All in all it was somewhat pleasant.

Anonymous said...

Hi, which dentist did you go to in Taipei? I need a good recommendation.

Jenna Lynn Cody said...

Michael's Dental (Michael Li) on Keelung Road. If you walk up from Heping it's on the left in the shops just beyond the gas station. He speaks English and studied abroad.

Unknown said...

Hello Lao Ren Cha! I'm also an American currently living in Taipei and have just gotten my NHI (whoo!). I've been experiencing tooth aches for a while and have been wanting to get my wisdom teeth out here in Taipei because it's just SO much cheaper. Can you recommend me to a dentist? Preferably an English speaking one because I don't think I'll manage to get by with Chinese :P Thank you so much!


Jenna Lynn Cody said...

Christal - see above. Michael's Dental on Keelung Road. It's on the left if you walk up from Heping, just past the gas station.

Bohling said...

I myself do not trust dentists. Not here, not anywhere. That said...

I have heard 2 sides of the GA debate. One side says GA is not available here. The other sides says it is, but not covered by NHI and is NT$10,000.

This creates a quandary for me, since I need to have my final wisdom tooth (quite compacted, at least coming in sideways) removed, along with another tooth that is slowly rotting away for 15 years. When I had my first set of wisdom teeth yanked, the doctor shot me 6 or 8 times with novocaine. I still felt it. He said it was pressure, I said it was pain. So, he knocked me out. Badabing, I woke up as the sutures were going in.

Laughing gas is useless, and I would guess novocaine would be lethal at some point. Is there GA here? Otherwise, I guess I am happy to live with pain until the infections deliver me into the warm sweet embrace of death.

Great article, though.