Things moved slowly and now they are going pretty damn fast. Saw a big medical team last Friday, the prosthodontist again on Tuesday and I’m going to Greenlane for the big jaw x-ray tomorrow. See the oral surgeon and prosthodontist again on July 9th.
Plan now is not to remove all teeth surgically, just the bottom ones. Leave the top ones as is for the time being. I’ll have to have the dreaded awake intubation via the nose again but I’m up for it. Third time lucky. They might give me more sedation this time.
Friday was good but weird. There were 8 people in the room: my son and I, a prosthodontist, an oral surgeon, a head and neck surgeon, a Fellow and two nurses. We discussed the options for my mouth but they were mainly a foregone conclusion as above. To my great surprise all of them favoured that nuclear option of taking the teeth out under surgery and inserting a couple of implants just on the edge of and a bit out of the zone of radiation. A plate to be fitted on top of the implants would stop me biting on my bottom left gum. I’d still have my top plate so I wouldn’t look any different while I waited six months for the gum to heal before making a plate.
The risk of getting osteoradionecrosis is low they said. 2 – 3 percent said someone but corrected it later. It would be higher than that but still a low percentage risk. My bottom teeth are SO bad said the oral surgeon that they posed a risk in themselves. Broken and decaying, they are causing inflammation in the gum and could lead to osteonecrosis by themselves.
Friday was intense. Not like having a cancer check up but still overwhelming. On a Friday they have a multi-disciplinary meeting and that had just finished with some new patients still there in the clinic rooms. I felt acutely aware of that. I felt I should let them get back to their work. I was very touched and grateful about their concern for me and thrilled with the positive attitude to surgery. But it was tiring and even my big strong son said he felt shattered when we left. I don’t know what the psychological phenomenon is here but it’s something to do with being the intense focus of a lot of very “elite” people when you are not used to it.
Then on Tuesday after a big effort to get to South Auckland from North Auckland by 8.30 am, I saw the prosthodontist again. He came into the room with a big fat file, saying he had been reading my hospital notes. This is serious – they don’t usually do this – the services are pretty siloed. Maybe I’m a guinea pig for “putting implants into the radiated jaw of a 74 year old woman who has had recurrent cancer”. He had a good look at my mouth, teeth and dynamics of the plate and horror of horrors found a calloused patch on my good side that was probably rubbing on the hook of my dental plate. He took a photo to send to the head and neck surgeon in case it was cancer “with my history”.
I was determined not to blow this out of proportion and when the appointments started to come in thick and fast for further preparation I relaxed more and now I really am in the zen state of “leave it in the lap of the gods”.
This is a big thing for me. For years I’ve been told I couldn’t have an implant to support my limp left lower lip but now here I am on an implant journey. As a keen observer of the health system, one who tries to be objective, I don’t know exactly why and it would seem indelicate to ask. The reasons I can think of are: changing attitudes to implants after radiotherapy; more funding for the max fax and dental department; the clout of a super-specialist I was referred to; special treatment because of my part in our HNC charity.
The prosthodontist implied that I was getting this treatment because the state of my mouth demanded it. It doesn’t really matter because as long as the tissue in my mouth is healthy I’ll be going on a trip into a new world of dental opportunities and whether it works out or not, I’m grateful for the chance.