Thursday, September 04, 2008

Molar Madness: The "Local" Surgeon

(Note: A series in which our hero details the process -- and costs -- of wisdom tooth extraction in Thailand. Previous posts here and here.)

Bangkok, Thailand

This is the part where I'm warned about nerve damage.

I consulted with Dr. Dheera Ratanasakdi (Mahidol University, '78), an oral surgeon at Bumrungrad's Dental Center. He confirmed what I had been told that morning and, at my request, ordered a Panorex, which is an x-ray of the entire mouth.

The verdict: my wisdom teeth were screwed, although, interestingly, the worst tooth didn't hurt. But, even as a layman, I could see on the x-ray that my lower left wisdom tooth was (1) sideways and (2) encased in bone. Great.

What I did not see as a layman was the light line running vertically near the roots of the worst tooth.

"That's a nerve," Dr. Dheera said, "and that's what I need to warn you about."

In a wisdom tooth extraction, the coating of that nerve can become damaged. It heals, but, in the meantime, the patient can feel a numbness or a pins-and-needles sensation that lasts days, weeks or even months.

"It is painful?" I asked.

"No, but it's annoying," Dr. Dheera responded.

Dr. Dheera explained that he specialized in extracting wisdom teeth under local anesthesia, two teeth at a time. Removing all four would take about two weeks. He estimated a total cost for his services of about 20,000 baht (US$610). He also recommended that I consult with a different oral surgeon about having all four teeth removed simultaneously, which requires general anesthesia and admittance to the hospital.

He prescribed an antibiotic for the infection (ten 1 gm Augmentin tablets) and a more powerful painkiller (three 120 mg Arcoxia tablets -- which is not approved for use in the United States). Three painkiller tablets; this ain't Los Angeles.

As before, the entire procedure took less than one hour from start to finish.


Panorex: 500 baht (US$15.15)
Radiologist's Fee: 150 baht (US$4.55)
Dentist's Fee: 800 baht (US$24.25)
Dental Supplies: 150 baht (US$4.55)
Medicine: 1,268 baht (US$38.42)

TOTAL: 2,868 baht (US$86.90)

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Anonymous Anonymous said...

Karl - When I had this done (eight years ago) a medical journal had just published a paper which showed that patients who had the procedure under general anesthetic were more likely to suffer long-lasting problems arising from nerve damage. Partly on that basis, I decided to have all four teeth removed under local anesthetic. My dentist was willing to do this in one procedure. Perhaps your teeth are compounded worse than mine were - or perhaps your dentist has a different view of the appropriateness of removing all four teeth in one go. In any case, I'd recommend that you avoid general anesthetic. If you can't spend so much time in Thailand, perhaps it makes sense to get the urgent work done now and do the rest in the US or next time you visit Thailand...

9:19 AM  

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