dentist or dialysis?


About 6 weeks ago, after at least 2 years of planning, I started recruiting patients for my first clinical trial. I named it the Kidney and Periodontal Disease study primarily for the cutesy acronym, KAPD—to be pronounced “capped.” You know, like teeth? Tee hee. I’m hoping I can show that treating the periodontal disease, a chronic infection of the structures supporting the teeth, will decrease the damaging havoc that the periodontal bacteria are thought to set off in the kidneys, thereby slowing down worsening of chronic kidney disease—because a dental cleaning twice a year is probably cheaper than years of dialysis.

The real reason I embarked upon this out-of-the-box research program is because one of my mentors mentioned out of the blue a study that found dogs with cavities were more likely to have kidney disease than dogs without cavities. This made me wonder if the same was true in people. After a little investigation I found a study that found, not cavities, but rather significant gum disease is associated with chronic kidney disease in people and, soon bing-bang-POW!— my research program was born. (Note: bing-bang-pow in research time means a solid year of writing, revising, and submitting grant applications to raise the money to do the work).

But the real real reason I am doing this work was demonstrated to me about a year and a half ago.

I was having pain in the area of my right lower wisdom tooth. It started out with just occasional sharp shooting pains when I was biting down on something and sometimes when I drank something cold. I started using Sensodyne. Couldn’t tell if it helped or not, because the pains were so random. My dentist poked around the tooth. It never hurt when he poked. X-rays twice. Negative. The only thing my dentist could come up with was that there was probably a tiny fracture in the tooth that couldn’t be seen on a regular X-ray and recommended I have my wisdom teeth extracted. He had been trying to convince me to have them pulled for years anyway. He seemed to consider them the source of all evil in my mouth because 2 of them were the sites of the only 2 cavities I’ve ever had and because they were surrounded by excessive, difficult to keep clean gum tissue. I resisted. Because they were my teeth and I was very proud to have all 32 of them at age 42.

This went on for about a year until the pain became constant. I acquiesced; I would have my wisdom teeth pulled. I believe someone did a research study that found pain was associated with fires being lit under one’s ass. My dentist gave me a referral to a local oral surgeon.

“Yes, hello, I need to have my wisdom teeth extracted,” I said to the young slightly drawling female voice answering my call.

“OK, Ma’am. Our first available new patient appointment is…” she said a date damn near a month away.

“I was hoping to come in sooner. I’m in a lot of pain.”

“Do you have dental insurance?”

“Yes I have Delta Dental.”

“You can come in tomorrow morning at 9.”

At 8:55 the next morning, I sat in the clean well-lit clinic lobby, waiting to be called back to see the surgeon.  The phone at the reception desk a few feet away rang. The same young woman with whom I spoke answered. Though I could only hear the receptionist, I could sense the urgency of the voice on the other end of the line.

“OK, Ma’am,” she spoke into the receiver. “Your son can come in for evaluation on…” she gave a date several weeks away.

“That is our first available appointment. What kind of insurance does he have?...Medi-Caid?”

“No, Ma’am, I understand he’s in pain, but there is no way he can come in and have his tooth pulled before he goes back to college next week. We haven’t seen him before, so he has to be evaluated first, and then we have to get authorization from your insurance before we can even schedule the procedure. That usually takes at least two months.”

I sat there dismayed, wondering what the ramifications of this young man not being able to get timely dental care would be.  I thought about the mother on the other end of that phone, desperately trying to get her baby the care he needed. I wondered about her mouth. Medi-caid insurance for poor adults doesn’t cover basic dental care. Just extractions for those with emergency-level, painful problems. Periodontal disease doesn’t even hurt.