As people with diabetes, we are told time and again to make sure we schedule regular oral care visits, as diabetes makes us both more susceptible to oral disease (cavities, periodontal issues, etc.) and makes it more difficult for us to recover from the procedures needed to treat that disease. "Why," you may then ask, "have you never sought out dental care as an adult, even when preventative care was made available to you, free of charge?" My answer to that can be summed up in a single word.

Orthodontia.

While my parents knew from the time of my first molars that I would need braces to straighten out the teeth of my lower jaw, our dentist recommended waiting until I was 12 and all my permanent teeth had come in. I don't know all of the issues involved in my not having my teeth fixed as a minor -- only that fixing my younger sister's teeth couldn't wait for her permanent teeth, and that my parents didn't have the finances to provide orthodontia for both of us. (Remember that this was back in the Dark Ages, before dental insurance was a standard benefit of employment.)

While I have taken the option of dental insurance every time it has been offered to me, I have avoided preventative dentistry for two reasons: first, because adult orthodontia was not covered by any of the dental plans offered to me, and second, because coverage of anything beyond the usual six-month visit and cleaning was minimal, with a maximum annual benefit that would not exceed the cost of filling or repairing two cavities a year, and that would have been beyond my ability to pay for. So, like a traditional (indemnity) healthcare plan, I've considered my dental coverage as something to keep in reserve for emergencies.

Leave it to Murphy for that emergency to crop up over a year after I lost my last employment-based dental insurance and two weeks before I was covered by my current employer's plan. It felt as if a cavity which needed re-filling had eroded to the point where the nerve was exposed. Now, minor dentalgia is something that I've had on and off for years -- sensitive today, fine tomorrow -- but this was something that progressed to the point where for three days, I could barely eat solid food, and the only thing that mitigated the pain was to keep that side of my mouth filled with cool (but not cold) water.

So I looked through the list of dentists and dental practices covered by my incoming plan and chose one that had weekend hours and a number of specialists in the practice. (Did I mention my father's family has a strong history of periodontal disease?) Unfortunately, this practice is not as keen on walk-ins as I would have expected from a large group -- but they were able to see me that Saturday and make a preliminary assessment. The dentist found two possible causes for the pain -- a broken cavity, and an adjacent cracked tooth. She conjectured most of the pain was due to the cavity, and that while it was deep, it would respond to normal drilling-and-filling. She couldn't do the work right then because she needed clearance from my primary care physician. (This is due less to my diabetes than to my hypertension and a moderate heart murmur for which I need to premedicate with antibiotics.) I made an appointment for the earliest the dentist and I could both manage -- Monday afternoon, after my relief colleague would have clocked in at work. I then walked home, changed into jerseys, and punched my pedals over to my PCP's office as quickly as I could get there. I rode out with prescriptions for both the antibiotic and a prescription-strength pain reliever, and a note clearing me for the procedure.

Monday last saw a cool, rainy afternoon, and since I misjudged how wet my MTB shorts would get on the short ride from work to the dentist's office, I didn't have a spare/dry pair of pants to change. I'd also made sure to snack on something I expected to keep my blood glucose in the 110's to 120's during the procedure, and my blood pressure was running within reasonable-for-me levels. I was somewhat surprised to find my glucose down at 98 when the dentist began work, but since I'm not on any glucose-controlling medication, I knew I couldn't drop too low.

The big surprise was that when the dentist finished and raised the back of the chair, I was shaky. Shaky like "I'm running low" shaky -- but my blood glucose was a reasonable 95. My blood pressure had risen to a scary 160/98 on my own cuff (which I know to be accurate). While the dentist explained that the anaesthetic would cause my pressure to rise a bit, I figured the she was talking maybe 10-20 points. This was somewhat more. To make matters worse, the dentist then figured they should measure my pressure on their machine, which routinely reads 20-30 points higher than my own. As things turned out, the more I was walking around from office to office, the less shaky I became, to the point that I began to realize that I had also had that sort of shakiness when I ran borderline hypothermic. I just happened to have my normal thermometer with me -- and indeed, it read 96.0 F -- low enough for me to have all sorts of strange reactions. The culprits were the cold, damp shorts and the air-conditioned office.

The dentist, however, is not buying it. She seems to think that because my sugar was running lower than I'd wanted, I didn't eat enough before, and furthermore, she doesn't want to treat me unless my pressure reads on the low side on their monitor -- in other words, so low that I'd've passed out before I would have even gotten three steps into the office's reception area. 

The icing to this cake is that while treating Issue Number 1 has caused the acute pain to abate, it's caused Issue Number 2 to progress to the point where any sharp or shear stress (like biting into something hard, or grinding-chewing anything) puts me enough discomfort that the more radical approach may end up being necessary -- but "my" dentist will likely refuse to treat it because I can't fit her miscalibrated machine's unrealistic parameters.