This article contains some graphic dental and medical references that some readers may find upsetting.
There I was, with my finger up this young woman’s bottom thinking “God, I love being a dentist!”.
Actually, I was a dental student. And it was harmless enough – she had a suppository to insert but was nervous. And under undergraduate rules, a dental student was “medical” so I had been commandeered to do the (in)decent thing and help out.
Dentists are almost medics
Of course, this idea that dentists were almost medics played both ways. It was a role assigned to us by the crowd. But at times it suited us, to extend our remit beyond an anatomical area. And we easily fell into the trap of spinning out our expertise way beyond its current extent.
Indeed, there is a dangerous period in the education of every healthcare professional when he knows almost nothing but has yet to discover this.
For dental students, it arrives remarkably early.
You enter dental school as an ordinary person who cannot reliably identify anything in the human mouth beyond teeth, tongue and, in moments of exceptional confidence, tonsils. Then somebody gives you a white coat, teaches you six anatomical terms and shows you how to hold a dental mirror, and within days you find yourself regarding the general public as an enormous collection of undiagnosed conditions.
The transformation is extraordinary.
You have not actually treated anybody yet. That comes much later. But you possess Knowledge, and naturally you are desperate to use it.
Dental education progresses cautiously, for understandable reasons. They don’t begin by handing you a drill and saying, “See what you can do with Mrs Thompson”. You start with simple things. You learn how to examine a mouth. You learn where everything is. And, in my day, one of the first useful clinical skills we were taught was how to remove a set of full dentures.
There is, surprisingly, a technique to this.
Removing dentures
You cannot simply grab a pair of dentures and pull. They are wider at the back than the front, so they have to be rotated carefully as they come out. Otherwise, I gathered, the patient’s lips would have to expand to dimensions not normally encountered outside cartoons. And they would vibrate harmoniously when running.
I became rather good at it, whipping out false teeth from an edentulous mouth.
Admittedly, I had performed the manoeuvre only under supervision and in circumstances where everyone knew what was going to happen. Nevertheless, I felt that denture removal was now essentially a conquered field of medicine.
Then, one lunchtime, destiny called.
And in real life
As was my wont, I used the town-centre location of the dental school to explore during lunchbreak. I was walking past a bank when I noticed a crowd gathered on the pavement. Being young, inquisitive and recently equipped with medical knowledge, I pushed through to investigate.
An elderly woman was lying unconscious on the ground. Her shopping basket had overturned beside her and its contents were scattered across the pavement. Here, at last, was an emergency.
More importantly, it was an emergency with an audience. I surveyed the scene with what I hoped was an expression of grave clinical authority. “I think we need to take her teeth out” I announced. This produced a gratifying silence. “Why?” somebody asked.
This was an excellent question and one that, ideally, I would have considered before making the announcement. “In case she chokes on them,” I said. There were murmurs of approval. This was enormously encouraging. In the space of perhaps twenty seconds I had gone from dental undergraduate to senior consultant in pavement dentistry.
I knelt beside the patient.
Unfortunately, I knelt on an egg.
There was a soft crunch followed by the unmistakable sensation of something cold and viscous spreading through my trouser leg. This was unsettling, but by now I had a crowd and a professional reputation to maintain.
I opened the woman’s mouth. There they were: false teeth. Excellent. I was on home territory. I reached in, grasped them and pulled.
Nothing happened. I pulled harder. Still nothing. This was puzzling. At dental school dentures had behaved impeccably. They came out when asked. These appeared to have been installed using welding. I pulled again.
The woman’s head moved towards me. I pushed it back and pulled once more. Her head came forward again.
Soon I had established a kind of rhythm in which I pulled the teeth and the entire patient followed them. Her head rocked backwards and forwards while I became increasingly conscious of the crowd watching a procedure that was taking rather longer than advertised.
Then the woman opened her eyes.
There can be few more disconcerting experiences in medicine than discovering that the unconscious patient whose mouth you are rummaging around in is now conscious and watching you do it.
She looked first surprised, then alarmed, and finally furious. Then she bit me. I withdrew my fingers and uttered something not normally included in the dental curriculum.
This disappointed the crowd. There were audible tuts. Apparently, they had been willing to overlook my assaulting an unconscious pensioner, but bad language was another matter entirely. I should, of course, have stopped.
Instead, wounded professionally as well as physically, I became more determined. Those teeth were coming out.
I took hold again and pulled. And pulled. And pulled.
Suddenly, with horrifying ease, they came free. I staggered backwards and stood up triumphantly, holding the dentures aloft like a victorious big-game hunter.
Oddly, nobody applauded. Instead, they stared at my hand. I looked up. The dentures were not full dentures. They were partial dentures.
There is an important difference. Full dentures are removable. Partial dentures may be attached to remaining natural teeth. These were. Several of the old lady’s real teeth were still attached to the denture in my hand. Blood ran down my wrist.
My patient, meanwhile, was now very much conscious and attempting to get to her feet with blood and foam coming from her mouth and the unmistakable expression of someone who wished to discuss my treatment plan.
At this point my clinical instincts told me there was only one sensible course of action. I ran.
I was almost at the corner when a voice from the crowd called after me: “And I hope you’re not going to be a dentist! ““Or a gynaecologist” added another. It was a cruel remark. But educationally, probably the most useful thing anyone taught me that year.
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