I needed a new crown.
The temporary crown over the implant post had worn out and popped off in Ann Arbor in October, where a dentist I’ve come to think of as Dr. Doofus glued it back on for nearly $400 and then again for $74, when her first gluing was insufficiently sticky.
I was attracted by the price here of $200, and the Montreal couple in the next room at bizarro Mektoub resort had determined this Varkala man was reliable. They had researched up and down the coast for an Indian dentist to replace two of the woman’s failing bridges – work that involved 14 teeth and much shaping and welding. “He has recommendations from Westerners, even Americans,” the man said.
Dr. S’s office is across from the Bata shop in downtown Varkala, next to a fruit vendor. His sign features an extracted tooth smiling from a red circle that could be a pool of blood and a peeling slogan: “We care your smile.”
S’s “dental spa” (his card has grimacing Halloween lips in lurid color around clenched teeth) is up a flight of unwashed stairs on Temple Street.
At the top of the stairs, shoes and sandals are left for hygienic reasons at the door, but the inside made clear shoes weren’t the problem. It was in miniature the 3 a.m. Greyhound bus station in Fort Wayne, Indiana a half century ago minus the wino on the floor by the Coke machine. The foul cushions on the benches were decoratively striped. Across, by the reception counter, were four battered folding chairs, each with a grease blotch above where countless anxious heads had leaned on the off-white wall.
I was encouraged that I had found the place, even if it looked like a place for a drug buy. I hadn’t been able to find the sign from my scooter in the carnival blaze of sign-crazy India and had gone too far along Temple Street.
I asked a passing man in creased trousers and a long-sleeved shirt with a tie, the sign here of a respectable place holder. “I show you,” he said. He waited patiently while I locked up in front of a peppers vendor then took me by the hand into and out of the path of an onrushing bus, its horn blaring, through a maze of tuk-tuk rickshaws swirling hornet-like, housewives and servant runners from the hive of businesses on the street to the office and then up the stairs to the door itself. “You must be removing shoes,” he said, pointing to the pile at the door.
He was a sweet man, and I was encouraged because I had asked him what he thought of Dr. S. as we marched unscathed though traffic.
“The best,” he said.
My Canadian neighbors had been persuaded by the endorsements but I remembered as I stepped barefoot onto the grimy office floor that I hadn’t asked exactly where they’d seen those endorsements, which might be as reliable as the endorsements I’d read from happy travelers of a hotel in Bangalore which turned out to have a rap nightclub on the floor below.
Come to think of it, I didn’t know anything about the Canadians except that he had studied at an ashram. Were they good judges of dentists? Did Canadian dentists have clean floors?
Why was the door with the TOILET sign darkened with smudges?
However, I am cheap, and this was simple dentistry which shouldn’t even lead to blood. Pop off the old, take an impression, cement on the new…
S. was an Indian hipster, down to the blue jeans and the carefully oiled Frankie Avalon hair. He donned gloves, pushed me back firmly in the chair, tapped the questionable crown, and said, “Yes, yes.”
The crown would be zirconia – the latest thing. He made a starting offer.
I’m careful with my health. I did the math. Not even 50% of a bad Ann Arbor gluing, so if it fell out, I wasn’t out much.
And his equipment looked clean. True, the assistant was one of the receptionists, and she had come in from the desk and was wielding the spit-sucker without gloves, but everything was going in her direction, not from her to me. And yes there was no soap in the muddy bathroom, but surely the office had soap somewhere? What the hell. When I joined the Army I signed up to be a paratrooper. Geronimo!
Next step: X-rays.
That was down the street, the assistant said. He had been leaning in silence against the wall, apparently a patient in pain.
“Just there behind,” he said, pointing vaguely north. “See sign ‘BAR’? Yes? There behind.”
The next morning I went for the pictures and pretended confusion as they pointed at my feet. The place looked too dirty for bare feet. “No, no,” I said. “My teeth.” I pointed and handed over the sheet of paper with S’s instructions.
“Twenty minutes,” the man behind the counter said. “Sit there.”
There was an odd odor, maybe of burned hair. I went outside.
A young woman came immediately and led me forcefully into a room with an X-ray table. “No, No. Stand,” she said and roughly turned me around. She found the tooth and made me hold a small tab behind it with my forefinger while she pushed the button.
Then I went to the machine that circles your head and bit on a tiny piece of plastic intended to keep me in position. I clenched and waited while the rotors warmed up, humming like a ceiling fan. It took so long my teeth began chattering from the strain, but it made no difference. I left with a negative that cost 580 rupees.
I scootered back down the street for my appointment. “No, no,” said the receptionist, counting through a stack of rupees. She fluttered her hands as at a bug. “No electricity until five o’clock. You come then.”
I don’t think so, I said, rolling my eyes like Dennis Hopper. That’s too late. That could put me on the streets in Varkala at twilight time and it’s hard enough at noon on a scooter to dodge the tuk-tuks and pedestrians and trucks all plunging without a glance left or right into the dodgem-car street. I don’t want to drive a scooter here after dark unless I’m bleeding heavily already.
Friday I went back. The electricity was on and the unwashed hygienist was there with her hose.
This was the plan, Dr. S. said, pulling my X-ray negative from its brown envelope and holding it up toward the ceiling fluorescent for a moment. He would give me two crowns. My implant with the temporary crown at number 5 rested in porous bone and should be bridged for extra support to the solid implant at number 4.
“But isn’t that crown good?” I said. “Number four?”
“Yes,” he said. It was fine, but it would have to be reshaped to help number five.
At least 20,000, maybe 21,000, he said, holding my mouth open with two gloved fingers.
No, I told him. Just one.
He may be exactly right about the bone. He wears his blue jeans well, and he does have those endorsements. I was focusing on the superficial. After all, I had a Vermont implant fail because of too-porous bone for number 13, though the surgeon who removed its wobbly remains wondered aloud how it had ever been inserted at such an insupportable angle.
I have concluded that finding a competent dentist anywhere requires some false starts, some What the hell! sessions with licensed professionals who sat always in the back and missed Friday classes to get an early start on whatever dental students do on weekends. And as I waited I read in India Dentist a complaint from a senior dental surgeon that competence was a worry here, too. India dental schools had lost all credibility and standards had plummeted since they separated for turf reasons from universities. Now, he wrote angrily, the students simply “vomited back” on exams what their instructors had force-fed them the previous day. They had no understanding of the medical aspects of dentistry.
S. shrugged at my decision. OK.
He picked up his drill, humming to himself. One it must be. One, two, double my fee. Two, one, out it may come…
Wait! The cost?
“Ten thousand ,” he said. “Cash.”
He drew a diagram. Make it 11,000, he said, with this shield to “prevent corrosion.” He drew a crown with a short skirt. He may well have drawn the extracted tooth on his street sign.
OK. And add the undercoating, I said. I wanted the best.
That was the time to leap from the chair and negotiate. I could have gotten him down to 8 or 9, even with the skirt, but I didn’t. I was getting oddly restive, partly because the receptionist-assistant seemed to be falling asleep on her feet, though her hose was on and sucking air.
His job now, he said briskly, was to “shorten” my temporary crown and then take impressions. My tooth would be ready in seven days.
But I was going to Sri Lanka maybe, I said, maybe sooner than that.
Four days, he said, and pushed me back in the chair, opened my mouth, and as quickly as a knifefighter jabbed me in the upper gum with a needle. No sweet talk from him.
Then he buffed the temporary crown for 15 minutes, and the assistant seemed to do her job skillfully. I gagged just once when she thrust the suction device in too far.
I understood only belatedly what he’d done. It worried me a bit. I had never heard of the technique. He had shortened my temporary crown by half, shaping the plastic into a base for the new crown.
“But the temporary came off twice,” I said, “in October. It has a hole in it. If you glue the new one to it, won’t the new one just pull it off?”
“Yes, yes,” he said. “Come Wednesday. It is not a problem.”
Twenty-four hours later, his work was smooth to my tongue, but my lower lip was a bit numb. I think I’ll do without a shot Wednesday, I told myself. Just pop off the old and glue in the new, please. Why would my lip be numb? What was in that needle? Why did he give me a shot, anyway? The implant is nerveless…
But isn’t all life a mystery?
Wednesday was Christmas. I climbed the stairs at 3:30. Dr. S. was waiting, wearing the same shirt as for my first appointment. No assistant was needed this time. The new crown fit perfectly. He puffed air on the temporary, squirted glue in the new crown and pushed it into place.
“How does it feel?”
“A little high,” I think.
He inserted a strip of carbon paper. ‘Bite!”
He examined the tooth. No, the bite was perfect. He held out a wad of cotton. “Bite on this for half hour please.”
He held out his hand for the rupees.
In the outer office, the receptionist handed me a 10-year guarantee for the crown. “Zirconia,” she said.
Outside, the scooter wouldn’t start. “Damn that Rafi!” I said clumsily, talking past the cotton, but that’s another story.
Two days later, the crown feels pretty good—maybe a little high at the back—though my tongue detects extra cement that oozed out during the insertion and initially I had to pull off cotton there from the wad.
Yesterday I ate a Snickers bar and chewed on that side, and my crown on a crown didn’t move a smidgeon.