Complicate and treat?

“Naa re shaanya (no, no, dear) doctor is not giving you any injection. No. he will not remove your tooth. He will just see it and give you some sweet medicine. Or, he will put some medicine in your tooth and the pain will go away”.
I could hear Mr. Patil trying his best to coax his son Akhil, into the clinic and knew that I was in for trouble.

Patil had called me earlier, saying that the boy was complaining of tooth ache, and had taken an appointment. I knew that I will have to do at least a ‘pulpotomy’ (removing part of the soft tissue in side the tooth- which also contains the nerves) or even an extraction. I had told Patil, very clearly, to inform the boy, what to expect. I had suggested that he explain to the child, as sweetly as possible, that whatever is to be done to cure the toothache, will be done and if necessary, I may give an injection or even remove the tooth. I had told him to prepare the boy for treatment by stressing on the fact that while there may be a wee bit of pain, none of it is going to hurt much. And I had specifically asked him to abstain from telling ‘sweet lies’.
Now I was hearing exactly the opposite. To make his job of depositing the boy in my chair, easy, Patil was putting forward an imaginary and strawberry flavoured dental treatment, which always made my unpleasant task doubly difficult.
From the Sanskrit saying “satyam brooyaat- priyam brooyaat- na brooyaat satyamapriyam” (tell the truth- tell what one loves to hear- don’t tell the truth if it is not liked.) the parents always select the later two, and the inconvenient one – to tell the truth (and work it) - is left for me to handle!

I like children, their innocent ways, and their curious questions. I like to listen to their un inhibited talk and see their pranks. But I declare that, as patients they are a pain and apart from the un explicable fears of childhood, what makes my job worse is the fears and mistrust a child develops because of the wrong attitude of the parents towards our profession and overt expression of false fears and anxieties.
Even though I hate to have children in the chair, I do attend to their needs and have been reasonably successful in getting the expected results in majority of the cases. But I always have to brace myself and offer a silent prayer before starting on a child patient.

I began with the text book suggestion of putting the correct picture before Akhil. I took time to explain to him why his tooth was paining and what needs to be done. I showed him the instruments and explained their use. I smilingly pricked my finger with a needle, to demonstrate that it does not hurt much. He appeared to understand and subjected himself to treatment. Initially he was quite co operative. He sat through the first few minutes when I was working near the surface of the tooth and as I moved deeper, he started squirming in the chair. It was obvious that the ‘truth’ was being felt. I still had a long way to go, and it was time for injecting a local anaesthetic. I applied a bit of ointment to make the surface of the gums numb and surreptitiously injected some local anaesthetic. I was hoping that the injection would be fully effective but my luck was not agreeing with my hope. Few more millimeters in to the tooth and he was not comfortable any more. He started shaking his head and wriggling his body. The injection was only partly effective. I tried other tricks to make the tooth numb and failed. Now the only option was to give what we call a ‘nerve block’, a deeper injection, which can be made ‘almost painles’ if we have full co operation of the patient. Even as I was explaining this to his father, Akhil covered his mouth tight with his hands indicating that no co operation is forthcoming. When his father very sportingly but foolishly offered to hold his son’s hands and legs tight and restrain him, Akhil just jumped out of the chair and ran out. All our single and joint efforts involving all sorts of explanations, coaxing, rewards and threats failed to bring him back. He steadfastly refused to come in and be treated. In the end, I had to go out of the clinic with both my hands raised, holding only a bit of cotton as a white flag and a sign of surrender, and convince the boy to come near me and just allow me to pack his cavity with cotton.

I dispatched them, offered a prayer and kept my fingers crossed hoping for some miracle to ‘make the pain go away’ or at least not to make things worse. But my prayers were just as effective as my treatment. After three days Mr. Patil called to say that a painful swelling has developed over the jaw. The situation had got worse. From a deep cavity with an inflamed pulp (nerves) it was now an abscess (pus in and around the roots of the tooth). Almost in all cases, an untreated infected tooth, naturally leads to an abscess, but in the present instance after my meddling with the tooth, the accusing finger was fixed firmly in my direction even though not mentioned.

I told Mr Patil that there is nothing much I could do other than removing the tooth under general anaesthesia. But something had to be done immediately to reduce the suffering of the boy. I asked him to bring his son again to the clinic.
I swore on all the known gods that I will not be giving an injection and convinced the boy to occupy the chair. Now, the child was more concerned with the swelling and pain on the jaw and allowed me to touch the tooth. I thought that I would at least wash the cavity with an antiseptic and gingerly tried to remove the cotton dressing that I had placed. The child was calm. There was no pain. I probed a bit deeper. Still no pain. I used the air drill to clean the cavity further. Fine. I went deeper and deeper and almost reached the roots. There was no sign of any distress!
Another millimeter and I had drilled through. I could see a drop of pus seeping into the cavity from the roots. Once the pus was drained out, the boy felt much better and allowed me to proceed with the RCT (root canal treatment) and the rest of the treatment went like a dream. Two more sittings and the procedure had been completed to everybody’s satisfaction.

When I had tried to work on the tooth the first time, the nerves were inflamed and extra sensitive. In the later stage they were fully infected, ‘dead’ and degenerated. So there was no sensation at all!
I failed miserably trying to treat pulpitis (initial inflammation of the soft tissue present in side the tooth) but could successfully treat an abscess, which is a complication arising out of untreated pupitis!!

I had read this joke long back and had thought it was a joke. Not any more!

ಬಹಳ ನೆಗಡಿ ಡಾಕ್ಟರೆ ( I have severe cold, doctor)
ದಿನಾ ನಾಕು ಸರ್ತಿ ತಣ್ಣೀರು ಸ್ನಾನ ಮಾಡಿ ಎದೆ ಮೇಲೆ ಒದ್ದೆ ಬಟ್ಟೆ ಹಾಕಿಕೊಂಡು ನೆಲದಮೇಲೆ ಮಲಗಿಕೊಳ್ಳಿ. (Have a cold water bath four times a day, spread a wet cloth on your chest and lie on the floor.)
ಅಯ್ಯೋ ನೆಗಡಿ ಹೆಚ್ಚಾಗಿ ನ್ಯುಮೋನಿಯಾ ಆಗಲ್ವಾ ಡಾಕ್ಟರೆ ? (won't my cold turn into pneumonia?)
ಅದಕ್ಕೆರೀ ಹೇಳ್ತಾ ಇರೋದು . ನನಗೆ ನ್ಯುಮೊನಿಯಾಗೆ ಔಷಧಿ ಗೊತ್ತು. ನೆಗಡಿಗೆ ಗೊತ್ತಿಲ್ಲ. (That’s why I told you that. I know to treat pneaumonia. Not common cold! )