Oh I wish I’d looked after me teeth!

Oh, I wish I’d looked after me teeth,

Pam Ayres, poet.

And spotted the dangers beneath
All the toffees I chewed,
And the sweet sticky food.
Oh, I wish I’d looked after me teeth.

I wish I’d been that much more willin’
When I had more tooth there than fillin’
To give up gobstoppers,
From respect to me choppers,
And to buy something else with me shillin’.

When I think of the lollies I licked
And the liquorice allsorts I picked,
Sherbet dabs, big and little,
All that hard peanut brittle,
My conscience gets horribly pricked.

My mother, she told me no end,
‘If you got a tooth, you got a friend.’
I was young then, and careless,
My toothbrush was hairless,
I never had much time to spend.

Oh I showed them the toothpaste all right,
I flashed it about late at night,
But up-and-down brushin’
And pokin’ and fussin’
Didn’t seem worth the time – I could bite!

If I’d known I was paving the way
To cavities, caps and decay,
The murder of fillin’s,
Injections and drillin’s,
I’d have thrown all me sherbet away.

So I lie in the old dentist’s chair,
And I gaze up his nose in despair,
And his drill it do whine
In these molars of mine.
‘Two amalgam,’ he’ll say, ‘for in there.’

How I laughed at my mother’s false teeth,
As they foamed in the waters beneath.
But now comes the reckonin’
It’s me they are beckonin’
Oh, I wish I’d looked after me teeth.

My teeth have always been a problem. I can’t believe it was all due to the boiled sweets I ate as a child. My worst problems occurred during times of stress in my twenties and again in my forties. Every time something happened, another tooth would blow up in an abscess, necessitating another round of root canal treatment. In time the devitalised teeth disintegrated and my mouth began to resemble the site of a major civil engineering project with bridges, crowns and ultimately a rather good titanium denture. What relevance does this have to IBS and sensitive guts? Probably not a lot, though I had often wondered about mercury toxicity from all those amalgam fillings and I was intrigued at how predictably root abscesses followed a period of stress. The latter I put down to the suppression of the immune system by cortisol, though my therapist muttered darkly about how the nature of the stress disarmed me by suppressing my bite. I wasn’t convinced.

No, I want to make another point. I like my dentist. She is entirely professional but I also enjoy her barely suppressed sense of humour. She arrived late for my check up last week and seemed a little flustered. After a thorough examination, she suggested referral for more root canal fillings to treat my recurrent tooth abscesses and recent sensitivity. I declined, explaining that I felt that more work would destabilise my bite and necessitate the refashioning of my denture which had lasted for twenty years. Although my mouth resembled a bombed out street, I pointed put, the houses were still habitable.

She wasn’t impressed with the metaphor and became exasperated, saying that we always seemed to have the same conversation. ‘Yes’, I said, giving her an old fashioned gap-tooth grin, ‘and no doubt we will have the same conversation again’. This produced a sharp intake of breath and prompted me to ask if I was the worst patient she had. She denied it, but our exchange got me thinking about the nature and purpose of a consultation with a health care professional.

We go to health care professionals when we need advice, though we may not always choose to follow it. For something as individual and intimate as health, we have to be the final arbiter of whether a certain course of action makes sense for us, bearing in mind our personal history and current circumstances. We are really the only ones who know what we and our bodies feel like.

The major factor determining the success of any treatment is whether we believe that it will be effective. It helps, of course, if there is also objective scientific evidence, but that is not always necessary. There are hundreds if not thousands of treatments for IBS. Few have good objective scientific evidence to support them, but they all have a sound rationale and, judging from patient testimony, they can all work for some of the people some of the time. The patient’s intuition for what is most likely to work, depends on our personal circumstances, beliefs and history? How many patients really scrutinise the scientific evidence? How many doctors have the time to evaluate which treatments are best?

The best any professional can do is to explain the treatment options but the final decision should lie with the patient. The best health professional is the one you can negotiate with so that you sufficiently informed to make the right decision for you. When I worked with The IBS Network, we informed our members which treatments were available, discussed the rationale and the pros and cons, identified those treatments which were potentially dangerous or unnecessarily exploitative and supported their choice.

But as a psychotherapist, I do recognise many people who want to be told how to lead their lives. So if the treatment doesn’t work, they can always blame the doctor. ‘You know them pills you gave me last week? No good! They made me worse! Can’t you find anything that will help me?’

I also know many well meaning doctors with a sense of mission based on a conviction that a certain treatment must work – and a few that have an intellectual, religious, emotional or pecuniary bias in the outcome.

I try to follow the example of the psychoanalyst, Wilfred Bion, and listen to my patients stories ‘without memory or desire’. In other words, I try not to have any therapeutic prejudices nor any ‘vested interested in a particular outcome. Of course I would like my patients to feel better and I work to help them understand what factors might facilitate that and what fears may be preventing it. But I do recognise that for some patients, their illness has so organised their life that it may be very hard to let it go and the best they might hope to achieve is to be able to live as normal a life as possible with it.

Perhaps I should have asked my dentist why she felt the need to reorganise my mouth, but she wasn’t ‘in therapy’. I nevertheless felt I had insulted her professional pride by my refusal, and I should reassure and protect her. Therapy goes both ways: I am reminded of when I used to do evening clinics to help out a local GP. On the nights I was on call, the surgery was packed. It wasn’t anything to do with my clinical skills. As one patient explained, ‘Dr Felix has not been well and we don’t like to bother him with our illnesses.’

My teeth? The abscesses have subsided and they are still standing. So I don’t need to bother my dentist until the next time!