Rewards Beyond Money

 After writing "Careers and a Hobby", I kept remembering the special patients and unique situations that made my dental career so rewarding.  In the US military, dental/medical care is not determined by rank or cost, the question is whether the patient needs and deserves the treatment considered.  I asked three things of my patients: 1) Will you practice good hygiene to maintain the results?  2) Will you show up for all needed appointments?  3)  Will you be assigned at this base long enough to complete required treatment?

Question number one was most critical.  I will not waste my time or the taxpayer's money.  Number two could be impaired by frequent deployments.  Number three is important because partially completed treatment can leave a patient in worse condition than no treatment all.

What follows is a story of one of many patients for whom care provided was life changing, and I will never forget. 

When Dawn suggested that I apply to dental school, instead of medical school, her consideration was that it would allow more regular hours, more time available for family activities.  My reply was, “Dentistry sounds boring.”; I had very limited understanding of dental procedures at that time.

However, I did take time to interview a dentist, with an engineering background, and was introduced to the broader span of dental procedures.  Certainly, the technical complexity and creativity needed in dental treatment, individualized for each patient, made dental practice seem interesting.  After working with patients for some time, the procedures became more routine (still challenging and tedious), and the personalities and experiences of my patients became the central aspect that made my practice rewarding.

The opportunity to apply for a military scholarship was attractive to us, both for financial support and a chance for future travel.  In dental school, some of my classmates derided the thought of practice in the US military, saying that such a practice would mainly consist of tooth extractions on patients with low appreciation for dental health, but that was the voice of ignorance.  I knew from previous enlisted military experience, that such patients could appreciate good care.

Our military service members come from a wide span of backgrounds, including hardship and foreign-born (mainly third world), but their commitment and necessary discipline come from a desire for achievement, improving their lot in life.  They have interesting stories from their personal backgrounds as well as military assignments worldwide.  When military recruitment is difficult, the US Army is forced to accept less qualified candidates for recruitment to meet quotas.

I was serving at Fort Drum, in northern New York State, when one of our dental hygienists called me over to meet a young, enlisted arrival, who had been treatment-planned for full dentures at his initial dental examination elsewhere.  I could easily see why he had been marked for such drastic treatment.

His hygiene was garbage; plaque, food debris, and inflamed gingival tissue everywhere, and every tooth had visible caries, the front teeth looking like apple cores, with the contacts between adjacent teeth rotted away.  The only reason he was scheduled to see a hygienist was that, even when surgery is planned, oral hygiene needs to be at an acceptable level to avoid surgical complications (i.e., excessive bleeding) and post-surgery infections.

Much of the bone in our jaws is there to support our teeth; once the teeth are gone, the surrounding bone atrophies.  Dentures at an early age may mean that later in life there will not be enough jawbone remaining to support dentures.  I have seen it happen.  He obviously came from a sad dysfunctional background.  Did I want to commit him to a toothless future?  Change is difficult.

I try never to judge a person by first impressions (although they are often accurate).  This was what his previous life had given him, but, now with his military life, he had a chance for a new future.  Would he be up to the challenge of changing his habits and accepting responsibility to achieve drastic improvement?

I sat with him and clearly explained why the previous dentist had recommended full dentures.  I explained that, with his absolute lack of effort toward hygiene, any attempt at restoration would be a waste of time.  (Something I had learned early in my career was that the patient must care as much as you, the provider, to achieve success.)  The treatment plan could change if his efforts toward dental health improved.  At this point, he had completely given up any attempt at hygiene.  He was in a world of ignorance, neglect, pain, and shame.  I left him with the hygienist for cleaning and instruction and told her to book his next appointment with me.

When I saw him next, his hygiene had improved little, if at all.  He was still stuck in a cycle of hopelessness.  He hadn’t fully comprehended the alternate future that I was offering.  Difficult oral conditions, copious debris and inflammation, were present, but I was able to isolate and restore a few of his front teeth comfortably, esthetically, and without exposing the pulp tissue while removing deep caries.  I handed him a mirror to view those few teeth which I had carefully restored to an original healthy form.  For the first time, he started to comprehend/believe what I was saying: “If you improve your oral hygiene, I can restore enough natural teeth to give you an acceptable smile.”

Every visit after that, his brushing and flossing efforts were greatly improved.  I had to improvise on many of the restorations because caries were more extensive than commonly encountered.  We had to extract (hopeless) all his molars and two lateral incisors (replaced by false teeth bonded in place), but to appearances, the result was a pleasing and healthy smile.  He told me, “Now for the first time I can go home, see my family and friends, and have a normal smile!”  Think of the significance of that…. Not just his smile, but his life had changed.

A year later I saw him again.  Excellent hygiene and not one defective restoration or new cavity.  He stated that the dental clinic was his favorite place to visit on our Army base.  What could be more professionally satisfying?  With dental treatment, I had been able to improve his entire outlook.

Encounters such as this were repeated throughout my career.  The military is a great place for encouraging change.  The goal was not just teeth but improving lives.  Dentistry is a very personal service.  I view my patients as good people who perhaps need some education, motivation, and treatment to correct faulty habits.  The satisfaction in doing that far outweighed any challenges involved in completing necessary procedures.