Thursday, March 7, 2013

'Customer Is Always Right'

“I want to make a new denture.”
“You already have one?”
“Yes. But I want a new one.”
“Is the old one broken?”
“Does not fit?”
“It fits ok”
“Are you not able to eat with it?”
“No, I can eat”
“Then why do you want a new one?”
“This denture is small”
 “Yes. It is small. I want a bigger tooth. “
“Why do you want a bigger tooth?”
“My cheek has gone in after my tooth was removed. Even after putting this denture there is no change. I want a bigger one which can make the cheek look full.”

This is something which I come across quite often in my job. It is true that the cheeks look hollow after a few teeth are removed (gives an ‘aged’ look) and people feel that by replacing the teeth they can get back the original, younger look. But sadly, that does not happen. The hollowness in the cheek is because of the wearing out (resorption) of a part of the jaw bone around the teeth (alveolar bone) and also the loss in muscle tone brought about by the lack of support from the teeth. Placing an artificial tooth does not always bring back the original look.

This man had two teeth missing in the upper jaw - one on the right and one on the left - and similarly two in the lower jaw. This had not actually altered his looks. But he felt that his cheek had gone in and that the denture he was wearing made no difference. Now he hoped that putting a denture with a bigger tooth would improve things.

I told him that he looked fine and that there was no need for another denture. I explained that we can make the tooth just as big as the gap between the natural teeth permits. I also mentioned that even if I somehow managed to make a bigger tooth/denture it was not going to alter the look of his cheeks.

“Still, I want a new denture and as big a tooth as possible.”

He had a fixation for a bigger tooth and was not going to give up.

I did not want him to have false hopes and so I said that I would make one with wax, put it in his mouth and show him. (It is one of the stages in making a denture and we call it a ‘trial’) If he is happy with it, I said I would make a similar denture. He agreed and I started the process.

I called him for the trial. The old denture had a tooth which was worn a bit and I thought that a new ‘bigger looking’ (but not really bigger) tooth would satisfy the person. He did the usual circus in front of the mirror and viewed himself from different angles, mouth closed and mouth open, poking his cheek repeatedly.

“This is OK but feels a little flat. Can you please make it bulging towards the cheek”

I added some extra wax on the part of the denture that touches the cheek.

“This feels better but if you can make it even bigger......."

The placement of the teeth in a partial denture (where one or a few teeth are replaced) is bound by the size of the gums and the natural teeth present in the mouth. They determine the size and position of the artificial tooth. Like a missing brick in the center of a wall. The new brick should fit in the existing space. It is just not possible to put a bigger tooth just because I feel like making it big. I explained this to the fellow. I showed him his model and my compound wall - which is yet to be plastered - to make my point clear.

“That is Ok but please, little bit bigger, covering that space completely” he inserted his finger between the tooth and the cheek to indicate that there was some space left.

I pushed the tooth completely out of alignment and towards the cheek. It was not coming in contact with his lower teeth at all. It was of no use for chewing whatsoever. And the denture would not be very stable even. But the tooth could be felt pressing against the cheek.

“Ah, this is fine. That is how I wanted it.”

I told him the problems that he may face with this ‘out of the ordinary’ denture but he wanted it made that way.

I made the denture and told him not to tell anyone that I had made it. I had my reputation to take care off. But he was very much pleased and went away happily. You may see the denture in the photograph of the model of his upper teeth. I have marked it with a pen but I would have preferred to hide it.

He was back after six months. I expected trouble. But no. He was very happy with what I had done and wanted a similar one in place of an existing lower denture.

Now I knew what he wanted and made one just as bad as the upper one. Again, he was very happy.
See the picture below? The second denture is incorporated in this model of his lower teeth. I have again marked around the tooth, the second one from the top, left side. Sticking out.

He came once again last week and wanted yet another one made. The missing tooth on the other side of the lower jaw. Once again, he has a normal denture there but wants an abnormal one. Now it was routine for me. I told him that I could make it as he wants and can place both the lower teeth on a single denture base. He would have one lower denture replacing both the missing lower teeth and one upper denture. He need not juggle three pieces in his mouth.

“No, No, just make a separate one. Make it as you have made the one on the other side.”

The red thing that you see in the picture is the wax model of his third denture. The trial is over and he has approved my work, much worse than the previous - as far as the guidelines governing making of artificial teeth are concerned.

I had kept this case hidden from my son. He has specialized in replacement of missing teeth and he is a stickler for rules. He would not approve such atrocious work. This case was about to go to the lab and my assistant had left it on the working table. My son saw it.

“What case is that?”
“Oh, that. One of my old patients.”
“Which lab did you send it to? Whoever set that tooth must have been either fully drunk or absolutely ignorant about setting teeth”.
“It is neither”
“How are you sure?"
“Because I did it”
“You set this? But appa, why? What is wrong with you?”

“Nothing wrong with me. It is just that the ‘Customer is always right’!”


Raghu said...

Hey! good one Raghu,LOL.

rs said...

haha.. tht was a good one. have been reading your blog for quite some time and it has been a pleasure to read them.

John Moran said...

Hey! it was really funny. I enjoyed it.
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