The Month of Oral Surgery

This summer, we found out that one of the canine teeth in Neil’s lower jaw was stuck in a horizontal position, beneath the baby teeth it was meant to push out and replace. We hired an orthodontist, who sent us to a local oral surgeon who told us he’d be able to expose and bond it in his office for $1,379 (plus his consultation fee of $94). We don’t have dental insurance, so it was a pretty painful price.

And so I paid up, and brought Neil in for the surgery on August 30. Neil was put in a chair, pumped full of sedatives with an IV, and I sat nervously in the waiting room, hoping for it to go well, and be over. When the surgeon’s assistant called me back, I assumed the worst was over, but as it turned out, it was only the beginning of a horrible month.

The surgeon had attempted to get at the impacted tooth from the front, only to find out that it was positioned towards the back of the mouth. I don’t know why he hadn’t been able to figure that out from the panoramic x-ray he’d gotten from the orthodontist, but then I’m not an expensive oral surgeon, am I? He told me to get at the tooth, we’d now have to take Neil to a hospital, where he would have an anesthesiologist stick a tube down Neil’s throat and worry about keeping Neil breathing, so he could focus on getting at that tooth. Already stinging from having paid over a thousand for needless surgery, I asked how much this new surgery would cost. He assured me my medical insurance would probably pay for the hospital and anesthesiologist, but if they didn’t, we might go to some medical center he knew in Livermore, where it could be two or three thousand dollars. Well, my medical insurance does not cover hospitals costs for dental surgery, and I didn’t have two or three thousand to spare, on top of the money I’d already spent. Naively, I asked if I still had to pay for the surgery mistake he’d just done, since it was clearly not was I’d contracted for, and the doctor said he’d oh-so-generously only charge me the $608 for the anesthesia –as my son was still attached to an IV, with an oxygen mask.

Watching Neil groggily recover from the anesthesia was a frightening experience. I’ve known him to be bright and aware his entire life, and here he was dazed, confused, and really out of it. He looked at me fuzzily, and quickly forget whatever was said. And then, as he came further out of it, and the assistant raised his chair, he started throwing up–it wasn’t much since he hadn’t eaten in a day, but it was so bad, the doctor pumped yet another drug into him to make it stop. Did I really want my son getting a tube down his throat and filled with even more of these drugs? I was happy to finally get out of there.

The doctor had been able to tell me right away what the first surgery would cost, but he took his sweet, sweet time getting me actual costs on the next one. First, he said he’d get it to me at Neil’s follow up appointment the next week, and then had conveniently forgotten to ask his staff to put that together. Two follow up calls and three days after that, his office clerk told me I’d have to pay the surgeon $608 for the surgery; another $550 for his travel time; $956 for an hour and a half of anesthesia; and $1050 for the use of the operating room and the medical center–and both of the latter could be more, if the doctor needed more time. (They wouldn’t add it up, but it comes out to $3,164,  just for starters.) Oh, and wait, while the doctor couldn’t give me a break, here was a number I could call to go hat in hand to the hospital and beg for a financial break, given I didn’t have the medical insurance to cover it–but as it turned out, the number was wrong.

Meanwhile, I called the orthodontist and asked if Neil really, really, really needed that stupid tooth exposed, because as with any medical procedure doing nothing is always an option. If I couldn’t scrape up the thousands I suddenly had to front to the doctor, nothing would be done. If I’d rather not drive 90 minutes to the butt end of Alameda county, to have a tube stuck in his throat, and heavy drugs pumped into his system, and that was the only way this would be done, nothing would be done. And doing nothing seemed like a real good choice, since it would have been a better choice that shelling out $608 for vomit-inducing drugs and unneeded gum slicing, and it was an even better choice that paying three or four thousand dollars for another round of the same. So what were the possible consequences of doing nothing? That tooth would eventually dissolve part of his jaw, and fuse to it, I was told, giving him a funky bite, which would be even worse without having a canine on that side of the mouth. The end result of not doing anything now would probably be something like dentures or more extensive oral surgery as an adult. Well, after this experience, dentures sound like a real good option, I said. The orthodonist knew a different oral surgeon, Dr. Cheng, who might have a different angle, and who might even be able to do it without having to drug Neil up to the eyeballs and beyond.

It took me weeks to get up the nerve to actually see Dr. Cheng–I’d already been burned, and badly by the first and only oral surgeon I’d trusted, and just seeing this new guy meant spending another $128. But after scheduling and cancelling, and scheduling and cancelling appointments, I confirmed that if this surgeon did exactly the same thing the first one wanted to do, he’d cost less, since he wouldn’t be hitting me up for drive time, and has prices were actually a little lower.

Well, Dr. Cheng was far more to my liking. He still need to get at the impacted tooth from the inside of Neil’s mouth, but after interviewing Neil, he said it was likely he’d be able to do it with just Novocain and laughing gas–if Neil was willing to deal with being conscious during the procedure. Neil, being his usual mild-mannered self, agreed. Plus, we could get a CB-CT scan which would tell everyone exactly where this tooth was, including how far in the gum tissue it was, and what was around it. All in all, it cost far far less, there would be at least three people helping and monitoring Neil during the surgery, and the cost of the consultation applied to the surgery.

The CB CT scan turned out to be a pleasant experience–it took all of 20 seconds. And we got a ton of information as a result–not only was that problem tooth lined up behind four teeth in front, it didn’t seem to know which end of itself was up, since the thick root end was higher than the narrow tip.

Today I took Neil in for the new surgery, and I was still a bundle of nerves. But I felt somewhat better when Neil’s orthodontist came in to advise and assist during the surgery. I was also welcome to go into the operating room with Neil and sit with him while he was being set up for the surgery. Dr. Cheng came in to greet me and he and Neil’s orthodontist went to review the CB CT scan together. They decided to pull two teeth, which was another expense, but not an outrageous one. And then, it was time to start and I had to go back to fretting in the waiting room. I couldn’t read, I couldn’t relax, but every so often someone from the back came out to tell me everything was going well.

Neil bravely managed through the surgery, without a whimper or a complaint, even though it meant having his jaw open really wide for an hour. He didn’t look terribly happy afterwards, but oral surgery is never fun, and at least this one was a success–all that needed to get done, was done, carefully and completely (which included sucking up the tip of a pulled tooth which had remained in the gum.) We went home and Neil watched some documentaries with me, and Mythbusters, while I made some soup, and later took a nap, knowing my son was finally safe and his surgery finished. The month of oral surgery is over, though it may still have the epilogue of me trying to get the failed oral surgeon to cough up the $608 he extracted from me.

Update: I sent a sternly-toned letter to the scapel-happy orthodontist. Neil was a bit blue at having had two baby teeth pulled so we went to his favorite used bookstore, Recycle Books, where he had $20 to spend on puzzle books.

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