Friday, April 14, 2017

The Periodontist | Lefsetz Letter

“I don’t want to be the bearer of bad news.”


I thought the hygienist cleaned and the dentist evaluated.

But not at this joint.

My old dentist had a love affair with Alaska. For three months every summer he took his boat up north and regaled me with incredible tales thereafter. The only problem was if you had a crisis during those three months.

I did.

So I went to see his old associate, the one who bailed when the seaman wouldn’t cough up his practice as promised. This young man said the tooth in question was unsavable and would have to be extracted and replaced with an implant.

But then I called Irving. Medical consigliere to the stars.

Irving had been imploring me to see his guy for years. And Irving’s track record is impeccable. He always hooks me up with the top guys, with an appointment right away, oftentimes outside scheduled business hours, with no wait. And if you don’t think that’s important, if you don’t think that’s an asset…

You just haven’t been broke down and busted on the side of the road, with no direction home, wondering how you’re going to escape this pain.

So I got an appointment.

But just before I went, Irving said he’d forgotten to tell me this was the most expensive dentist in the world.

And he is. He’s 50% more expensive than any dentist I’ve ever seen. Assuming you need serious work. Cleanings? Routine stuff? That’s all reasonable. But if you need a crown…

You’re gonna pay $1500 more than anywhere else, but this dentist has his own lab and there’s no waiting, from drilling to replacement it’s two, maybe three days.

And he saved the tooth.

So, ultimately I saved money. Instead of paying for an implant, for half the price I continued to use my own tooth, which is always preferable.

The next time the crack was below the gum line. I had to go for an emergency root canal, on my birthday no less. The endodontist, another Beverly Hills bigwig, told me there was no way the dentist could save the tooth, that an implant would be necessary. But this guy, my guy, Irving’s guy, said “I’m gonna work my magic.” And he did, he put on a crown.

And it’s been an endless series of crowns. Is it my age? My affinity for trail mix stirred up in Dannon coffee yogurt? I don’t know, but I’ve given up the trail mix, it’s just too expensive and aggravating in the long run.

And last spring the dentist replaced a crown. But in October, I started to get pain. December too. And then January. There’d be pressure when I bit down, and I’d barely be able to eat for a couple of days, and then it would fade away. And at the beginning of February the dentist adjusted the crown, you know, with the carbon paper, even though his work is always perfect, I’ve never had to go back for a tweak. And then, the pain went away.

Voila! Victory!

Now I’m a pessimist. Mix that up with some OCD and anxiety and I can anticipate disaster at every turn. But I’m trying to change, I asked myself why I was so concerned with Wednesday morning’s cleaning, after all, it was routine, I’d been pain free for months.

But then the hygienist uttered the above words.

There was a pocket. An infection. The dentist would render an opinion.

And he came in and did. Asked me if I had a periodontist.


My old girlfriend got substandard care from one back in the seventies, in a location far distant from the big city, she had some kind of gum graft, that’s all I knew, it had something to do with gums.

And I’m flummoxed and speechless and this dentist says he’ll call down the hall and get the periodontist to come over and grant an opinion.

Now the service is unbelievable, and I believe I’m undeserving of the attention. Hell, when I complained at an earlier visit, he said he’d have the endodontist stop by for an evaluation, which I declined, silly me. I mean what kind of operation is it where the service people come to YOU? I haven’t had a house call since the fifties!

But the word comes in that the periodontist is unavailable. Which aggravates me, because I’m out of town next week and I’ve got no time but then word came that he was going to appear.

And he did. In scrubs. With his nurse. It was like “M.A.S.H.,” I was getting undivided attention in the encampment.

And the first thing this periodontist asked was if I’d ever had a bad experience with dentists.


Don’t they usually drill with impunity?

But when you pay through the nose, they give you their time. This dentist, in the penthouse, in the Golden Triangle, has all the time in the world for me, he never punches the clock. And this periodontist, who I did not know and wasn’t paying, was the same way.

There was a problem…

He wanted a full set of x-rays, and I should come in tomorrow, i.e. today, they’d squeeze me in no matter what.

So I show up today, and this periodontist engages me in conversation. Time is money, but we’re talking about his home country, his education, his father, we’re becoming old buddies.

But then he says we’re best off meeting for coffee and he calls in the nurse and we get down to business.

The nurse who attended when he did the first hip to jaw transplant. Thirty five years ago. When he was head of surgery at USC.

So he thinks it’s a failed root canal. I’d gone where everybody does, to that place in downtown Santa Monica, not thinking twice, not calling Irving for advice, two decades back. And now my decision is coming back to haunt me. The root could be broken. If so, I need an extraction and an implant, which had me horrified when I contemplated it last night, but in the hands of this genius I was oh-so-calm.

Whereupon they marshaled the troops for an immediate 3-D scan, which is definitive.

So I got in my car, and drove down south, to an office where the proprietor told me she jumped through hoops for this guy, he needed it right away. I felt like royalty.

Although I knew I was gonna pay for this experience.

That’s another thing. I was wearing ratty jeans and a Polo shirt. Not Beverly Hills appropriate. Kinda like the visit with the dermatologist the day before, who treats plenty of stars but is more impressed by education. I had to tell him I turned down Columbia, that sure, I’d gone to law school, but only practiced a couple of years. I was trying to impress him, to show him I was worthy, which felt creepy, but the truth is they judge you on your image, and your ability to pay.

Actually, the dermatologist is not charging me at all, one of the perks of my mini-fame. Yup, the higher up the food chain you go, the less you pay. But if you do have to open your wallet, it’s significant. And know that they’re judging you on the tip.

So I end up getting into it with the proprietor, who also shoots the pictures. She was an “Alpha Female,” self-described. She’d been married four times, but she didn’t need the men to raise her children.

And this is what I love about life. You can connect online, but when you’re up close and personal people will tell you anything and everything, assuming you ask and you’re interested, and I do and I am, because the only thing that counts is people and their stories.

And since we had bonded… She said she thought it was a fair exchange, suggested I refrain from paying, since I’d given her my time and my advice, but like a schmo I said no. But when I got the bill, I was wondering if I should have said yes.

And while I was waiting for my card to be run, she told me she could see what the periodontist was worried about, that the root had caved and there was bone loss and if I told anybody she’d told me she’d deny it, that was for the radiologist to say, but I was glad she did, so I wasn’t on pins and needles for twenty four hours.

Yup, you hope for the best but when the professionals are concerned expect the worst.

And this is gonna be an ordeal, and it’s gonna be expensive, but when you put yourself in the hands of geniuses, your odds of success are so much greater. I believe in the big doctor, who oftentimes is no more expensive than the nobody.

So you too can go to Beverly Hills.

Or you can say no to the expense. Or choose to spend your money elsewhere.

Or maybe you’re a rube like the looky-loos in the van taking pictures blocking my way on Rodeo Drive. I wouldn’t think of doing that, the same way you don’t interrupt a star at dinner, these are things you learn in Los Angeles, you respect the famous people’s space.

And the truth is, they respect yours, because in the City of Angels, with Beverly Hills at its heart, you never really know who someone might be. They might be dressed like a homeless person and be a zillionaire. So you get deference, not always, but oftentimes.

But I still don’t think I deserve it.


No comments: