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(Photo: Fotolia)
(Photo: Fotolia)

I realize now that I was laughably unprepared for my first oral examination by an American. One of my back molars has ached, on and off, for the last eight years. I mentioned this to a British dentist once. He investigated and surmised, casually, that I needed a root canal. I should really see a specialist, and that would cost, he estimated, the best part of a thousand quid. Ouch. Somehow I never quite got round to it, and eventually the pain went away.

You see, American readers might be surprised to learn that while the National Health Service technically provides dental care, actually finding a fully NHS dentist that will take on new patients is difficult. Patients often end up on a waiting list and will pay at least part of the cost for a visit. And for something as intricate as a root canal, you’re advised (but not obliged) to see a specialist. And in most cases, this will not be free or subsidized.

When the throbbing started up again, around the time I moved to the U.S. three years ago, I did what seemed appropriate in the circumstances: took a horse-size dose of ibuprofen and forgot about it. When this approach stopped working, around 48 hours after the initial searing pain, I broke down and trawled Yelp for a well-reviewed dentist who took my insurance. The lady on the phone was pleasant and even managed to book me in for that afternoon. I marveled at the efficiency. And hey, I thought, like a foolish child waiting for the Tooth Fairy, I have insurance now! Free (or heavily subsidized) root canal! That’s how it works, right? I’d never felt so excited at the prospect of bargain basement pain.

So I’m in The Chair. The examination room has the usual angle-poise lamps and sinister humming machines, plus a silent nurse filling tiny paper cups with pink mouthwash. The dentist, however, is late. Twenty minutes go by and my four-star rated tooth doc is still off doing whatever it is dentists do when they’re not rummaging in mouths. I’m annoyed. I draft a disgruntled Yelp review in my head. The nurse is not warming up either, standing there with her arms crossed, not speaking. We’re so close we could hold hands, but that probably isn’t going to happen.

Finally, the dentist arrives and, without comment or explanation, he fits me out with a lead bib and takes approximately 37 X-rays of my mandibles. I had—and still have—no idea why this happened. In the U.K., you’ll likely only get an x-ray if the dentist is investigating a specific problem. Apparently, American dentists conduct numerous X-rays to provide a thorough examination of any possible dental issues, but cynically, I suspect it’s because they can bill my insurer for the cost or cover themselves in the event of any legal issues pertaining to my teeth. Or perhaps, low-level radiation poisoning is the secret to most Americans’ gleaming white choppers.

At this point I should add: the guys still hadn’t looked in my mouth. When he does finally have a peek, he’s not impressed with the landscape. “You clearly aren’t flossing,” he snaps.

“Erm, yeah I am!” I protest, dishonestly.

“Then you’re doing it wrong. You have gingivitis.”

“Oh,” I say, trying to mentally Google “gingivitis”—a term that always makes me picture orange teeth. But I think it’s actually something to do with gums. If I could only reach my phone…

Next, Dr. Blunt McLate proceeds to unfurl a length of industrial-grade floss and set upon me like a tardy sadist at a fetish club catering to individuals fond of both soft, pliant gums and sharp, thin ropes. It’s agony. He still hasn’t asked me why I’m here. I’m quite certain I didn’t sign up to have my chops shredded by a tardy brute.

Next, he (verbally) attacks my silver fillings and my wisdom teeth: “You should have those replaced with white ones. And these wisdom teeth need to go,” he adds, offering no further explanation. But my fillings are sturdy. And wisdom teeth don’t—and have never—bothered me. Why would I want to have them removed? My heart is thumping as I ask the question. I feel that by doing so I am rocking him to his dental core. Most adult Americans I’ve discussed this with subsequently have had their wisdom teeth taken out, and none of them are quite sure why. It’s just “what you do.”

When the dentist has finished being silently horrified, he triumphantly lists the reasons for removal: they can cause bad breath and discomfort. I’m sure this is true, yet I’m pretty certain my wisdom teeth are doing neither. But I don’t feel confident protesting my minty freshness when my detractor’s nose is mere inches from my tattered, sweating jaws.

I decide it’s time to take control of this situation. “I actually wanted to asked you about this molar that hurts,” I say, tapping the parallel bit of face. “Pretty sure I need root canal.” Now I’m talking his language.

“Sure,” he says, after some exploratory tooth prodding. “I can recommend a specialist.” Great! Finally.

“And it’s free, right? Because, you know, I have insurance.” Again, silence.

“Erm, not with your basic dental coverage, I’m afraid. It will likely cost upwards of $1500, depending on the complexity of the root.”

Oh. I feel like walked into Tiffany and tried to pay for a diamond necklace with a $25 gift card for PetSmart.

“You know what,” I say. “I think it’s all better.”

What are some tips on navigating American doctors and dentists? Join @MindTheGap_BBCA on Twitter to discuss using hashtag #MindTheChat for a chance to win a prize from BBC AMERICA.

See more:
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A Brit’s Guide to Health Matters in the U.S.: Learning the Lingo

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Filed Under: Dentists, Doctors, Medical Care
By Ruth Margolis