A Lexicon of Decay

by Rebecca Hazelwood

Pathology
I never thought I’d keep my teeth all my life, but I never considered how I’d lose them. Decay starts early, a sticky film of plaque forming on each tooth. It’s reversible, but only if you catch it in time.

In the Chair
My mother’s dentist in Kentucky puts her hands in my mouth, a mirror in one hand and a sharp, curved explorer in the other, poking and scraping the enamel while calling out numbers. These represent my diseased teeth. I haven’t been to a dentist in three years. The hygienist records the cavities, her hands constantly moving, looping numbers on the page. After a pause, my mother’s dentist shakes her head in disbelief, but keeps going, calling out more diseased teeth. You think of numbers in the dentist’s chair: two hundred dollars for a simple filling, a thousand for a root canal, another thousand for a crown. These are dollars you don’t have.

I am 32, a first-year PhD student in Louisiana, on my Christmas break. My mother’s dentist says I have nine cavities and it will cost $8,000 to fix my off-off-white teeth. I make $12,000 a year. I cry on the drive home.

Attrition
Even healthy mouths have harmful bacteria. The proliferation is the problem. I imagine even healthy families gossip, but mine only seemed to focus on our misfortunes: my father’s infidelities and addictions, one uncle’s home repossession and unemployment, another uncle’s gambling and drinking, our distant cousins’ DUIs. I liked talking about it when I returned home to Kentucky. Sometimes there was a meanness in me, too.

Teeth are in a constant state of erosion and repair, acid eating away the surface and fluoride repairing it. This is natural wear, this attrition. Nothing in the universe seems to exist in a static state—not electrons nor teeth nor individuals. We exist because we change. I was constantly in flux, internalizing the negativity of my family, then going to therapy and learning to talk about myself with love.

Trauma
Teeth can withstand repeated attacks, but only for so long. Cavities can take years to become a problem. Years after your mouth is struck hard, your teeth can fall out. There is no one way for the body to respond to trauma. I no longer want to dwell on these facts, but they are formative: Around the time I turned 30, my aunt pointed her pistol at me, my father was arrested for a felony, I was sexually assaulted, and I was on-and-off unemployed for two years after.

Dentition
Your teeth seem like nothing but numbers to dentists: 20 baby teeth, 32 adult teeth—including your four wisdom teeth. In the United States, each tooth has a chronological number, 1 to 32, starting with the upper right tooth in the back and ending with the lower right tooth in the back. Two imperfect arcs, 32 off-white pieces. They are not bone. They do not regenerate.

Allogenic
Sometimes you lose your teeth because you refuse to adjust course, to brush twice a day and floss before bed. Sometimes you cannot afford to fix your teeth. Sometimes food gets trapped under loose fillings and a deeper cavity forms. Sometimes you inherit bad teeth.

Nobody in my family keeps their teeth. On my father’s side of the family, great Granny Rose pulled hers young and wouldn’t wear her bottom teeth. Granny Gracie’s teeth have been gone for decades, long before I noticed or maybe before I was born. My great uncle Franklin used to slide out his false teeth to shock me and then give me a gummy grin. All of Granny Gracie’s siblings struggled to keep their teeth.

Some people never brush much or floss and they have perfect teeth— or luck. Some fillings last for decades. My new dentist in Louisiana says sometimes he sees 90-year-olds with their original silver fillings from their youth. Allogenic: the same species, but genetically different. It’s possible to keep your teeth all your life, my dentist says. I never knew.

Analgesia
Eventually, teeth face demineralization. The acid bores a hole in the enamel. A cavity forms. There is nothing you can do to change what has already happened.

At 30 years old, I graduated with an MFA in creative writing from a Georgia university. Two months later, I loaded up my car for Chicago. I still remember the feeling of freedom as I passed through the silhouetted tollbooth on the Chicago Skyway, the last traces of the orange-red sky falling from the sky, Katy Perry singing I’m wide awake on the radio. I was trying to escape rather than fix the damage, looking for an analgesia, something to lessen the pain.

Systemic
When the cavity grows, it festers. The sense that you are crazy, the knowledge that you are the one who caused this break with your family—it grows and grows.

Paresthesia
The decay can become visible, an actual hole in the tooth, visible to the naked eye. It’s hard to quantify the pain, to describe it precisely, to attach a number on a pain scale. It’s hard to say how it hurts, but we know pain when it’s the only thing we can talk about—when we can see it.

Perhaps I can narrate the paresthesia, the partial loss of sensation: Picture a white Christmas five months after I moved to Chicago, exactly one year after my aunt pointed her pistol at me. Picture a snow-stilled baseball field across from my eighth-floor Chicago apartment, the outlines of trees and benches dusted in white. No people, no moving cars. No retail work, the only job I could find. I was alone, having chosen not to speak to half of my family. I walked to my local coffee shop, feet numb below me, gray snow slushing and melting under me. I drove to see a terrible movie musical alone, then ate cheap Chinese food with a friend when it was dark. When I drove home on the ice, I nearly slid out into an intersection. I pumped my brakes again and again, my reflexes working, my car finally skidding to a stop. I was all alone.

Decay
The decay reaches the dentin, where there is less mineral, less strength. I moved in with my mother in Kentucky because I couldn’t pay my bills in Chicago, but I still refused to speak to my father’s side of the family. The cavity grows easier in the soft dentin, under the enamel. There are no barriers to prevent decay. Each night I lay in bed doing math instead of sleeping, my obsession with numbers growing: how much money my mom paid for groceries, how many months I’d been unemployed, how many jobs I’d applied to, how much money I owed in student loans. My life was a bare minimum—what we needed to stay alive.

Amalgam
My mouth is full of metal in the back, each filling a tiny tin roof that protects the tooth. My childhood dentist preferred metal—silver fillings, metal amalgams of mercury and silver and tin and copper. They were cheaper and harder and hardier than anything else.

I first saw my childhood dentist when I was three. I bit him. He said to bring me back when I was five. I never did it again, but I don’t regret biting the man who drilled and filled my teeth with metal pieces and sent me on my way every year. I hated my punishment for not flossing. Sometimes I wanted to bite my orthodontist, too. He seemed to enjoy wrapping the metal wire around my braces and tightening it, causing my gums to bleed—like some kind of maniacal Sweeney Todd, a barber-surgeon, armed with sharp tools. For centuries, barber-surgeons provided grooming, dental extractions, and amputations, always separate from doctors. Teeth are still cared for separately from the rest of the body. I realize now that I was lucky to see a doctor, a dentist, and an orthodontist as a child.

Managed Care
When you take a long-term substitute teaching position at a Kentucky high school, you are required to get a physical. With no insurance and no paycheck, you go to the health department. The nurse asks you questions: how many months it’s been since you graduated with an MFA in creative writing (17), how many jobs you’ve had since (1), when you last had a checkup (years).

I hadn’t had good insurance since my father dropped me from his policy in college. As a grad student, I’d earned $9,000 each year, and I’d paid $1,500 of it for health insurance that didn’t even cover a pap smear. When I started wiping the snot from my nose on my hands, the nurse handed me a tissue and made me promise to get a pap smear soon. I added this to the list of medical services I needed, along with dental care. She waived the charge for the physical.

Apex
Way down under the enamel and the dentin is the pulp, where there is no mineral, no protection for the exposed nerves. You have to stop the decay there, or you will need a root canal. The apex is not the highest point but the lowest, the tip of the root of the tooth—the deepest point the tooth goes.

Applying for PhD programs saved me. The acceptances and waitlists gave me a new obsession and an end date.

Prosthodontics
Granny had four kids and a husband who’d run away to Florida with another woman while they were still married. She made fifty cents an hour working at a factory. If you can’t afford to put food on the table, Granny Gracie says, you can’t afford to go to the dentist. You let your teeth rot out.

You get them pulled. You get dentures.

Nearly one in five older Americans don’t have a single real tooth left. I was excited when I signed up for Medicaid in Louisiana. They sent a dental brochure in the mail—but it was for dentures, not cleanings and fillings.

Prognosis
When you earn $12,000 each year as a PhD student, you comparison shop for a dentist. You say over the phone that you need a handful of root canals and crowns. You apologize for asking about prices up front. You explain that you are poor and say something about bad genetics and fear to take away the shame of your poverty and your diseased teeth.  You pick the dentist who offers a 25 percent discount to full-time students without meeting him, because his personality doesn’t matter—but what he charges does.

My mother’s dentist in Kentucky could not provide for my long-term needs in Louisiana, where I lived nine months out of the year. The new dentist in Louisiana said he wanted to make his own diagnosis. He said I had fifteen cavities, not nine. I paid dental bills for the next year with student loan money.

In the Chair
You may not keep your teeth all your life, my new dentist in Louisiana says. He’s spent the afternoon drilling and scraping out the decay in my teeth, looking for clean margins like an oncologist. Several cavities are deep, close to the nerve, buried under old fillings. He says I am going to present a challenge.

The new dentist is drilling two or three at a time, focusing on cleaning out the decay and restoring the teeth before we talk about crowns. I flinch under his tools, the metal mirror rubbing the corners of my mouth raw as he peers inside, the metal band around my teeth blistering my gums as he reconstructs each tooth. The new dentist says as a matter of fact, you probably won’t keep your teeth all your life. I am now 33. He puts me on root canal watch for nine months.

Hyperemia
You will experience sensitivity, aching, pain upon biting, when the cavity reaches the root. This is hyperemia, excessive blood flow to the tooth.

It took me a long time to stop crying about my family and unemployment. It took me even longer to stop talking about it. I had to stop blaming them for what they passed down to me and instead realize the poverty and decay they’d inherited, how they’d each taken steps forward into the unknown, moving farther from home, working for more education and wealth. It wasn’t enough for me, but it wasn’t nothing. I had to take some responsibility for the decay, for the days I didn’t brush and floss, for the ways I’d gotten above my raising.

Restoration
If your cavity is deep, the dentist will need to rebuild the tooth after drilling. He puts a metal band—called a sectional—around the tooth and a wooden wedge inside for contouring the rebuilt tooth. Real teeth, especially the bicuspids and molars in the back, aren’t smooth-shaped; they’re curved and notched for chewing, unique and imperfect on purpose. Dental records are used to identify dead bodies because teeth often remain long after the rest of your body has decayed. Your teeth are more distinctive and harder than anything else in your body.

If your cavity is very deep but not deep enough for a root canal, the dentist fills the hole with a sediment liner to protect the nerve. Then he packs in the pieces of resin, tooth-colored fillings. Dentists often use resin instead of metal amalgams now, because they want your teeth to look like real teeth. When you smile, your mouth shouldn’t be full of metal; visible fillings betray your class. But dentists still have their personal preferences.

Roots
My mother’s gums are receding, more of each tooth exposed as time goes on, until there is barely anything left under the gum line. The nerves in your mouth dim as you age and your teeth become less sensitive. Sometimes you don’t even feel pain. My mother breaks teeth on French fries. She gets one tooth pulled at a time and she refuses to wear her partial dentures because they don’t feel right. My father’s teeth are yellowed from years of excessive nicotine, and they’re black around the gum line.

Resin
Americans spend over a billion dollars each year just to have whiter teeth.

Up close, my teeth are different colors, varying shades of tooth-colored resin used to build each layer of my repaired teeth. Different dentists didn’t match the color well, or maybe the resin has changed color with age. So little of the original teeth are left, especially in the back. There’s no use bleaching them, even if I could afford that kind of high-end dentistry. Resin stains but it will not bleach. I just want harder, more permanent crowns to replace the resin. I just want to keep my teeth.

Armamentarium
After a while, you start cataloguing what goes in and out of your mouth, the armamentarium, the tools the dentist uses. The dentist wears loupes—a pair of glasses with magnifiers attached to each lens—to see your teeth up close and a mirror to see the hard angles. The tool with a hook is called an explorer. Then there are pairs of tools, two of everything. There are two separate suction tools: the slow-speed suction collects saliva and the high-speed suction gets everything else, even filling pieces. The air/water syringe shoots out either air or water; the dentist uses this to clean off your teeth. The precision drill, called a high-speed handpiece, has a sharp point at the needle end, like a rollerball pen. It can drill for cavities or grind down your teeth to adjust the bite. It does not look like a mini pizza cutter, as I always imagined. The slow-speed handpiece is thicker, shaped like a rocket roaring into the space of your mouth. It’s used to polish your teeth to a shine.

In the Chair
The new dentist in Louisiana has curly brown chest hair and white, white teeth. When he is ready to numb my gums with Novocain, he doesn’t wear his loupes. His face is so close to mine that I feel something like intimacy. I don’t want to embarrass myself by staring, so I wonder where to look: the crude painting of paradise on the ceiling, the television playing 24hour news, his brown eyes? I settle on his chest hair because it feels less personal. Here comes the pinch, he says.

Hygiene
You can slow down the process. After a lifetime of sporadic dental care, you can floss your teeth every day. In the beginning of the months I spent in the dentist’s chair, I woke up in the middle of the night, one eye open, remembering that I’d forgotten about my teeth. I flossed in the dark at 2:15 a.m. The next night I remembered earlier, flossing at 1:49 a.m. Eventually, I looked forward to flossing every night. Pleasure replaced the terror of repeating my mistakes.

In the Chair
What you feel at the dentist is numbness, not pain. The Novocain feels like a pinch going in but spreads through your nerves like water in the branches of a tree. It does not feel good. It does not feel bad. It feels like you’re losing sense of where your teeth and gums meet. Your tongue becomes heavier. Your face itches as you sit across from your dentist and stare at his white, white teeth and dark, dark chest hair. You drool.

Restoration
The dental curing light hardens the resin; it is blue and it beeps, beeps, beeps. Then it is time to drill down the excess on your teeth. Using the high-speed handpiece, the dentist stops every minute to ask you to tap, tap, tap your teeth on a sheet of carbon paper. He is adjusting the bite so your teeth feel natural when you close your mouth. He drills down your teeth again, like a construction worker sanding down an overzealous application of spackle. When he finishes polishing your teeth with the slow-speed handpiece, you are done. He calls this restoration, as if your teeth are aging paintings in a museum.

Anesthesia
Nearly every night I dream of my aunt and my father. I am always with them again, wondering if they know what I have written about them. I think about asking them to forgive me for writing about the trauma. I think about asking them to love me anyway. I wake up and wonder what it would feel like if they said yes.

After oral surgery to remove two erupted wisdom teeth on the left side, including the last of my 15 cavities, my mouth is asymmetrical now— but so is my grief. It feels disproportional to have felt so much pain now that it has subsided.

Rebecca Hazelwood’s essays have appeared in Guernica, Entropy, Anthropoid, Hobart, PANK, Still, and December, where she was a finalist for the Curt Johnson Prose Award. She was named an honorable mention for The Cincinnati Review’s Robert and Adele Schiff Awards and nominated for Best of the Net. She has an MFA from Georgia College and a PhD from the University of Louisiana at Lafayette. She currently lives in Huntsville, Alabama, where she’s a lecturer at the University of Alabama in Huntsville. She drives by rockets at the NASA Marshall Space Flight Center nearly every day.