Tiger's Teeth

Poppy Thomas-Hill [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Tiger's teeth are in terrible shape. He had three fillings in his baby teeth a few days before coming to live with us. He has so much plaque built up on his teeth that I think we're going to have to get them professionally cleaned; careful attention at home isn't budging it. When I asked him about it, he said that in the infants' section of the orphanage a staff member brushed their teeth. Then, when they started grade 1 and moved into the "big" section they had a single lesson on tooth brushing after which they were left to their own devices. His fine motor skills are so poorly developed that he has difficulty writing and fastening buttons; oral hygiene was obviously not going to fare well. So, when he complained of a painful tooth shortly after coming to live with us, I booked an appointment at the dentist who also visits his school. I called and said "I want to make an appointment for a child." Now, my Japanese is sometimes strange but nothing about that sentence is difficult... "Oh, this is a DENTIST" the receptionist replied. "We don't do IVF." Right. I probably should have given up then and there. It was a long walk away, but I figured it would be good to use the school dentist because he must be good with kids, right? Yeah, not so much.

It's common at dentists (and doctors, and even hairdressers) for the initial parts of the appointment to be handled by someone less qualified. The dentist/doctor/hairdresser flits between multiple patients/clients at the same time, just dipping in to do the vital bits and leaving the rest (initial exam, triage, shampooing) to someone with a lower pay grade. It keeps the costs down, but it does feel a little like you are on an assembly line. So, my very nervous eight year old was first seated and x-rayed by a dental assistant who also prepped the tooth for filling. Then the dentist swung in and ignored Tiger's greeting, grunted in my direction without actually looking up, and started drilling (with no pain relief). I saw Tiger begin to squirm and said loudly "If it hurts, raise your hand and the dentist will stop." His previous dentist had said this, as have all the dentists I have visited in both Japan and Australia, so I don't think I was out of line. Nevertheless, Tiger threw his hand up in the air and the dentist just said "I'm nearly done, がまん。" Once finished, we were told to come back the following week. I knew it was common to do this to adults but assumed they wouldn't be so cruel to a child: the dentist drills out the tooth, puts in a temporary filling over some antibiotic gel, then the following week removes the temporary filling and put a permanent one in. Depending on the dentist they may replace the temporary filling a few times before eventually putting the permanent one in. The repeated drilling is extremely bad for the tooth but my understanding is that the dentist can claim from the national health system for each visit so dragging it out is more profitable. Some dentists can be persuaded to do a filling in one visit but charge a steep additional fee for it.

The next week Tiger was even more nervous, having had his pain completely ignored previously. Again the dentist swung into the booth ignoring both me and Tiger. He replaced the temporary filling with another temp, and said "this'll need another two or three visits." "Can't you finish it off today?" I asked. Still facing away from me he repeated in exactly the same tone and intonation "this'll need another two or three visits." Then he walked away. Tiger said "wow, that was much faster than last time!" "That's because he DIDN'T DO ANYTHING" I said loudly, "this visit was pointless." The assistant, looking uncomfortable, ignored me a turned to Tiger. "The dentist just changed the medicine in your tooth to make sure the bacteria are all gone." "Why do I need medicine in my tooth?" He asked. "You don't", I said, "but if you have to come here four times the dentist gets paid four times, so he has to make up a reason."
We walked out the reception to pay.
"Why does the dentist do that, if I don't really need it?" Tiger asked as we stood in the packed waiting room.
"Because he doesn't care if it's good for you or not, he just wants to make as much money as possible. There's no reason why a shallow cavity can't be finished in one visit. It's nothing to do with the patient's care. It's shocking."  
Normally, I wouldn't make a scene like that, but I was furious. The dentist was so rude, it was such an effort for us to walk there (it was raining and cold), and how DARE he inflict unnecessary pain on a child?
"Um, do you want me to see if we can finish this in just one more visit?" The receptionist asked. I replied in the affirmative, and magically, the "impossible to finish in one visit" filling was finished the following week.

For more adventures with dentists, click here.