Not on the bucket list no.23

WARNING: Contains material that may distress dentophobics and may offend any people who still believe the UK health service is in good hands.

Damien Hirst, 'For the Love of God', https://en.wikipedia.org/wiki/For_the_Love_of_God

Moving to another country - a step into the unknown; an act of faith. Always be prepared for the unexpected.

These past eight months, we’ve had rollercoaster highs and lows, but a couple of months ago I was feeling that on some next level things were starting to settle. A shape and purpose to our lives here were starting to form clearer edges. No longer trying to force ourselves into spaces, we were allowing a more protean existence, ebbing and flowing with the tides, and generally starting to accept and enjoy life as flotsam, just passing through, bothering no-one, doing our thing. Days waking up to birdsong and sunshine, routines that we no longer felt we had to resist in some quest for renewal, wove a loose fabric around us that we wore more and more comfortably.

And then we went to our local dentist for a first check-up. Adrian was a bit reluctant - he’d had yearly check-ups back in the UK, and was a bit smug that apart from the bruxism (yep, we looked it up, even checked with our Portuguese teacher, Rita, how to say it in Portuguese! Bruxismo, if you ever need to know) he’d be reasonably fine. I was gung-ho. I’ve never really had any problems with my teeth - I was well into my twenties or even thirties before I had my first filling but I hadn’t had a dentist in the UK for five years or so before leaving, having been deregistered after missing an appointment (thanks, teaching life!) and to this day am still on a private dentist’s waiting list. I had my immigration checklist and registering with a dentist here was on it. Tick. Done.

Or that was the plan. But life, it seemed, had other ideas. At 9am one Friday morning at the end of March, our lovely local dentist, Dr M, had greeted us with smiling eyes and perfect English, and taken us into a space-age X-ray room where X-rays were duly taken, me first, then Adrian. But then I had to go back in for a CT scan. Adrian would tell me later that he’d heard the deafening thud of Dr M’s and the dental nurse’s ‘Oh’s’ land as my X-Ray image had appeared on the screen outside, and knew then something was quite wrong. I, on the other hand, still pretty oblivious, was asked politely by Dr M if I’d been having any problems with my teeth at all.

‘Well, yeah,” I smiled, ‘I grind them a lot at night so I get quite a lot of aching in my jaw, but I imagine that’s pretty common these days?’.

Without skipping a beat, and professionally striving to contain her disbelief, she responded: ‘You have an enormous hole in your jaw caused by an infection from an impacted wisdom tooth, and the bone density is so fine your jaw is at imminent risk of fracture. And you have no pain?’

‘No. Nothing. Just the ache, like I mentioned.’

‘I am very surprised.’ Dr M and the dental nurse exchanged looks which confirmed I was emerging as some kind of medical aberration. ‘It’s the biggest hole I’ve ever seen, and your jaw is at very high risk of fracturing.’

I must have come across like the village idiot. ‘Uh, what do you mean? Like, how would it fracture?’ You can tell it was taking a while for this to sink in.

‘Any impact. From small children, dogs jumping at your face. It may break at any moment.’

When Dr M said she wouldn’t even examine or clean my teeth for fear of causing further damage, it was dawning on me that things really weren’t looking so good. I stared once more at the X-ray of my skull, trying to make sense of a loch-like length of darkness in my lower right mandible, flowing from the base of my ear to my front teeth, and somehow all I could picture was that black space being filled with diamonds a la Damien Hirst.

‘But how long has it been there?’

‘Probably at least ten, fifteen, even twenty years,’ Dr M suggested. ‘And no one ever told you?’ Her astonishment that a hole of such magnitude had only come to light here and now, in her little dental surgery in a small town in Northern Portugal, was palpable. ‘No-one did X-rays?’

I cast my mind back but honestly couldn’t remember X-rays being done unless I was having a filling. And I hadn’t needed fillings. I’d even asked once I turned 50 about my wisdom teeth as so many people I knew were having problems but I was breezily reassured mine were fine, they were horizontal in my gums but causing no harm. And yet here I was with a hole in my jaw ‘the size of a tennis ball’, the surgeon would later confirm with the state-of-the art scans he took precise measurements from.

Perhaps my eyes finally flashed some dawning understanding at Dr M’s masked face, her eyes now concerned but deeply caring, as I noted her dexterous elision that it was ‘dangerous’ with ‘but it is not dangerous because there is a solution.’

The solution would turn out to be major surgery, in hospital, under general anaesthetic, to remove the wisdom tooth via at least one of my molars (it was two in the end); to remove the infected cyst, and to put in fracture plates either to preserve the jaw or to repair it after possible fracturing from the surgery. To add to the fun, I had a nerve that was floating free in amongst all the mess of a jawbone that had given me no sign at all of the state it was in, and this needed to be dealt with carefully to avoid temporary or even permanent paralysis of my lower lip and part of my chin.

I’m not going to keep you in further suspense - Adrian and I had to manage that for about 6 weeks (along with a diet of soft food, which we realised was not really so dissimilar to our regular diet), and I won’t put you through it, too! The surgery all went as well as Dr P and Dr M hoped it would. I am now 5 days into recovery and so far so good, although until today my face felt like it had been hit by a truck, and I could still pass as Rocky Balboa’s sister. Cold soup and banana smoothies lose their appeal by Day 3, but on the positive side I have finished reading a book I really wasn’t enjoying, and I’m hopeful that some clothes I need to repair might actually see needle-and-thread.

But major surgery in a foreign hospital in a country where you still speak little of the language - and certainly zilch when in a spiralling state of anxiety - was really never a consideration. Perhaps it should’ve been? I mean, of course we mused before we left what might happen if either of us got ill and needed hospital treatment but even that was pictured as an emergency situation you’d just have to get on with if it happened. While this was, to all intents and purposes, an ‘emergency’, we had to wait for bookable space in the operating theatre and that was about 4 weeks on from the confirmatory discussion with the dental surgeon, Dr P. We had time to both distract ourselves (thank goodness those weeks were mostly filled with seeing the boys and then old friends from Exeter, whose kindness and support gave us both more confidence but also more insight into just what recovery would mean) but also time for the anxiety to rise. I would wake up at 3am in the morning, fearing the loss of all my teeth, or cardiac arrest on the operating table, and on the day of the operation I ensured that I’d left a practical note of my key passwords for Adrian on my laptop, just in case. I wrote a melancholic farewell in my diary to my two long-serving molars, who were to be the cannon-fodder of circumstances arising whether from personal or systemic neglect (I err to the latter, but accept I was complacent, and allowed work to trump all personal health concerns), and noted the two remaining blank pages that I hoped I would return to fill.

If we’d had to face this alone, just the two of us, I honestly don’t know how we’d have managed. The dental team and the anaesthetist have all been amazing, on the end of a WhatsApp with reassurance whenever I’ve needed it, even late at night. They took care to explain everything to both of us, including the risks, of course (which did not include losing all my teeth nor cardiac arrest, I must add) and made sure we knew they were there for us any time of the day or night. And, no, this hasn’t been free, and I am well aware of just how lucky I’ve been in so many ways: for a problem that, if left undetected, would have resulted almost inevitably in a fractured jaw, the likely loss of several teeth, and only an A+E department in the UK (if we were still there) to respond; that we came here with a contingency fund meaning we had the money to pay for the surgery; and that we had been recommended such excellent dentists by our good friends here. Luck, when you look at it like this, has very much been on our side, not least because we have made friends here in good, kind people who have rallied to our sides, and helped us deal with practicalities as well as the emotional stuff. T+R even opened up their home to us after the surgery, with a fridge-full of vegan yoghurt for me and beer for Adrian, and generous supplies of kindness and humour. The absolute godsend was that R, as a GP, took care of me when I reacted badly to the meds the day after surgery, made simple adjustments, and constantly insisted that everything was normal, however abnormal it may all have felt.

But despite this, it still makes me so angry and so distressed for the state of public health, and dentistry specifically, in the UK, when a missed appointment has you de-registered, and now across the UK millions find themselves without this essential service. And they are suffering, and unlikely to be handed the skilful, compassionate treatment I have received here. In Devon alone, there were 78,000 people on waiting lists last summer, with no dentist taking on any more NHS adult patients in the county. I have a vivid memory of a news report we watched before we left of a poor woman in Cornwall who had such awful dental pain that she was living on soup, and couldn’t go out with friends because of the pain endured when she tried to eat or drink anything. Her only option was to wait for something catastrophic so that it could be dealt with by A+E. You hear of people pulling out their own teeth or even trying to smash them out with a hammer. My poor Mum, with a history of dental issues (seems thin bone density is a genetic thing in our family), was also deregistered at the age of 78 because she didn’t keep her check-ups going during COVID. Reasons for leaving the UK - including the sheer hurt at what the country is currently doing to its people - have only been confirmed. When I told friends and family my news, they were unanimous: thank goodness you’re there where you can access good health care and actually see a dentist. It’s true. I feel very, very lucky. But still very, very angry at the daily cruelty and neglect inflicted on so many we’ve left on our tragic island.

So, while you a) count your blessings that you do still have a dentist and hastily book that overdue appointment or b) wonder about a dental visit as part of your summer holiday itinerary overseas, I will polish off yet another bowl of spinach and potato soup (actually much nicer than it sounds), and indulge in a banana smoothie for pudding. Another week or so for recovery is expected, and then maybe in a year’s time the bone will have regrown enough for an implant to be put into what is currently a rather large hole at the back of my lower jaw. But that’s a thought for another day.