The prospect of dental care for many presents no problem, yet for others it does. Jeffrey A Oras, DMD, has looked beyond age old stereotypes attached to anxiety about dentistry, widening his understanding of what makes this anxiety unique both to dental care and at the same time related to how all of us, whether anxious or not about dental care, respond to life itself. Tooth Sense is meant to not only demystify what is behind all this, but also to offer practical insights and solutions so that everyone can more comfortably receive better care-whether you're going in for a complicated procedure or routine cleaning. The author's quest to develop the concept of Tooth Sense has taken him well beyond his original intentions, into the mysteries behind the evolution of the mouth and its surrounding organs and how the workings of this part of our anatomy may significantly impact the quality of all aspects of our lives. Part memoir, part practical guidebook, and part invitation to join Dr. Oras in looking more fully at what comprises these mysteries, Tooth Sense also assesses for dentists and patients alike the impact of various ways that dentistry is actually delivered, such as through dental office design or through using team based practice models. Throughout, we are encouraged to view dentistry as much more than a set of procedures and protocols.

TOOTH SENSE

UNCOVERING HIDDEN SECRETS OF BETTER DENTISTRY AND LIVINGBy JEFFREY A. ORAS

iUniverse, Inc.

Copyright © 2012 Jeffrey A. Oras, DMD
All right reserved.
ISBN: 978-1-4759-6532-2

Contents

Acknowledgments...........................................................ixIntroduction In Pursuit of Tooth Sense....................................1Chapter 1: More Than Finding the Wallet...................................9Chapter 2: A Saturday Night Family Dinner.................................15Chapter 3: My Father, the Steward.........................................23Chapter 4: Finding My Way in Dentistry....................................31Chapter 5: The Human Factor...............................................39Chapter 6: Considering the Science........................................49Chapter 7: Following a Hunch..............................................57Chapter 8: A New Big Picture of Human Social Behavior.....................69Chapter 9: But Dentistry Is Different.....................................75Chapter 10: Coming to My Senses...........................................81Chapter 11: Tooth Sense—Reaching beyond Science......................87Chapter 12: An Unfinished Quest...........................................93Resources.................................................................103

Chapter One

More Than Finding the Wallet

Long before I knew anything about the profession, the path to my career in dentistry was being set. The circumstances of my family, my neighborhood, the state of our country in the 1970s, and my own personal brand of curiosity, reflection, genetics, and the imprint of experience were setting my psychological and emotional table.

I've found myself later in life revisiting some specific memories and creating a small journal of vignettes that capture some "Kodak moments." I'm including several of these vignettes in this chapter and the two that follow, in order to shed light on who I am, how I chose dentistry as my profession, how I came to pursue my own path, and how I came to write this book.

In June 1971, my family took a vacation in the White Mountains of New Hampshire. One morning, not long after my parents, my younger sister, and I had driven away from the small motel where we had stayed the previous night, a crisis arose. My father couldn't find his wallet. The last time he had seen it was while packing the car.

A lost wallet is always a concern. For my father, it was cause for high anxiety. He pulled the car over to the side of the highway, and while fumbling feverishly through the glove box, his pockets, and everything within arm's reach, he boomed orders for everyone to be quiet. This order was unnecessary. The rest of us were already frozen as statues.

My mother and sister, sighing in unison, seemed to say without saying anything, "Oh boy. What now?"

The air seemed to have gone out of their bodies as if they were balloons. The smiles that had radiated from their faces deflated in anxious frowns, and what had been my sister's bouncing up and down gave way to almost mirroring my father's body language. Her whole body stiffened against the backrest.

Meanwhile, my father stared straight ahead, his hands squeezing the steering wheel, his body stiff. Noticing a part of his face in the rearview mirror, I caught a blank fixed stare. It was a familiar scenario. I was not new to seeing him this way. It was how my father reacted when he was not in control or when people around him were not doing what they were supposed to do—even though he had not indicated what they were supposed to be doing. Dad was angry, and the rest of us were in hiding.

But I was about to break the script for this scene. I was about to take my cue from a newfound place.

The previous day, I had caught my first fish. It was just a trout, but I was nine years old; to me, it could have been a marlin. This crisis had interrupted a pleasant mental trout reverie—the nibble on the line, the tug on the line, the give-and-take with the energy on the other end, my gradual taking charge of this transaction, the shiny fish appearing below the surface and then splashing into daylight as I lifted it dangling to a grassy spot on the shore. It wasn't a keeper. So, with my father's assistance, I had unhooked it, held it firmly, and placed it back in the water. It all had taken only a short time, but it had seemed to unfold in slow motion. The experience defied any normal sense of time. Success! How much to be cherished!

Now I found myself in a state of high alert. While my mother and sister did and said nothing, I was taking it all in. During the next few moments, I prepared to do something I had never done before. It was as if the mold that held me was suddenly broken.

This instantaneous change created a rush that made my skin tingle. I was suddenly aware of everything just as much in slow motion as I had experienced landing my first fish the previous day. My mind blanked on everything except the half face I could see in the rearview mirror and shouts continuing from the driver's seat as my father continued fumbling. His showpiece Cadillac Sedan de Ville—its leather interior, dazzling dashboard, and impressive length notwithstanding—was of no comfort.

Over and above the words, I found myself saying, almost brightly, "Hey, Dad, let's go back and see if we can find it." My suggestion seemed so obvious. Yet I could see that no one else in the car had any presence of mind; it was up to me to save the day. My mother and sister were surely useless, and my father was just inconsolably confused. I was the ready one.

I was so confident in the moment that I was actually not surprised when my father took my idea and responded by immediately turning the car around and heading back to retrace our tracks. Though the road, US Route 3, was a major highway, and it was midday, I recall eeriness. The road may have been crowded, but it felt empty to me. Without any conscious thought, I leaned forward so that my arms straddled the space between the two front seats. I wanted a full view of the road ahead. I am not sure what I thought I would see. But I was in charge, even though I had in fact no conscious surveillance strategy. I was just acting on automatic pilot with total focus in response to a crisis.

I don't remember the exact distance we had traveled when he had discovered the loss. It must have been a long way from the motel. At any rate, we drove for quite a while. No one saw anything. There was talk that even if the wallet were by some remote chance on the side of the road, it would be too small to detect. I had a one-point plan: keep my eyes peeled. We were nearly all the way back to the motel, when out of the corner of my eye, just as we were passing it by, I saw something. It was almost as if I had felt it without actually seeing it. It happened in the blink of an eye.

I yelled, "Stop the car."

My father backed to where I had seen—or thought I had seen—something. Yes, there was a small rectangular object. He and I got out and as we reached it. Sure enough, his wallet was right there on the road.

Later we surmised that he had put it on the car roof, and in all of the hurried activity to get to our next destination before dark, he had forgotten about it. But in that moment, my father and I had a moment to be savored together. To say that I was proud would be an understatement. And I had never seen my father so happy. He gave me a hug, and his smile was the widest I had seen. Meanwhile, my mother and sister had remained in the rear seat as if to leave this moment to us. I looked away from my father and caught an astonished look on their faces. In the moment, they seemed a million miles away. This was a moment to be shared only with my father.

The connection that my father and I had in that moment left me feeling special in many ways. I felt special in what I accomplished, but it was more, much more. In that moment it was as if my thoughts, feelings, and beliefs all coalesced into an indelible, firm sense of myself as not just competent, but valued for that competence by my family, especially my father. Although there were no trumpets heralding this event, inside of me I just knew that I was good. I had purpose for not only myself, but for others. I had known the spot we were in and what it called for. I had been able to shine, even lead, and not only help my family avoid a huge inconvenience, but to feel confident I could help us survive other potential calamities that might befall us due to any circumstance.

The stories in the next two chapters illustrate other sides of those dynamics. This story's impact continued after leaving home and, in fact, informs me now. I have "landed many fish" and "found many wallets" in my life, and for my ability to do so I am grateful to my family—in spite of, or perhaps because of, its dysfunctions and the periodic emotional chaos. One clear gift it has supplied is the ready impulse to understand and empathize, and to be a calmer witness to patients who may be experiencing treatment as an event emotionally charged with memories and associations.

What I have come to see over time, though, is that this success story also brought with it a large message of complete self-reliance, very large expectations of myself, and a propensity to see a solution only in terms of what I alone could do. Although this perspective gave me the confidence to pursue my career and to handle any situation I might encounter while treating patients, this had a significant downside for years. I found myself driven in negative ways to take on more responsibility and to consider myself uniquely gifted, more than the situation called for or was really appropriate for the situation. Looking back, seeing myself as the last lifeline of rescue—the more critical the situation, the more heroic I fantasized myself capable of being—was not only bordering on ridiculous, but it was completely counterproductive.

Where this led will become clear as the rest of this book charts my path. Yet these stories are more than just insight into my own personal biography. The greater purpose here is to acknowledge a common theme that we all share, bearing in mind that all of us have our own path based upon some sequence of events, and our response to those events. So this book as I have said in the introduction is trying to accomplish various tasks. Within this context I am not only trying to make a case for tooth sense, I wish to awaken your own introspection for the purpose beyond just how you cope during dental care. Viewing yourself in this authentic way, with integrity and dignity for all that has transpired in your life, will come in handy later in the book.

Chapter Two

A Saturday Night Family Dinner

One summer evening in 1976, our family was getting ready for our typical Saturday night dinner. It was a particularly hot evening in July. My mother and father were preparing the food for the meal. Earlier in the day, they both had been working on individual projects. My father had tended to the yard, and my mother had cleaned the inside of the house. When they were cooking, it was as if they were one. My father was preparing to barbecue steaks and bake potatoes wrapped in foil while my mother was removing fresh corn from the husks in preparation for steaming and setting out the ingredients for salad and her famous coleslaw.

Around six in the evening, the summer air still held the heat of the day. Our brick ranch home was not air conditioned, yet with all the windows and doors open, the slight breeze that moved through the house seemed to vitalize the family. This was a safe, aromatic, almost idyllic time and place. I felt my parents coming together in such moments. I could almost smell the synchronicity of the project of preparing dinner. In such moments, my father was the master of his castle, barbecuing in the backyard, using the pit that was built into the exterior wall of our home. He never said so, but he seemed to be at his best when he was providing. This was usually my favorite time to be around my family.

What was sometimes missing in such moments was a clear picture of what was expected of me. I wanted to help. I was fifteen. All of my friends did routine chores. But I hesitated, with good reason. My offers, tentative as they were, at important moments like this suddenly seemed unwanted. At these times, I thought my parents regarded me as a nuisance. In fact, I often was told that my assistance was unwelcome. I just couldn't get it right.

On this particular evening, though, I did have an assignment. I was to sort kindling from the woodpile in the yard and lay the bed of sticks for starting the fire. I brought over what I thought where appropriate ingredients. My father examined my work product. There were at least three defects: my pieces were too big, they were too wet, and they weren't positioned properly. I felt lost, alone, and defeated.

Next I went inside to see what my mother was doing. As usual, she had at least three things going on at the same time. She was very good at multitasking and had everything in its place. Like a conductor, she kept her eye simultaneously on every section of her orchestra. She was cutting the cabbage, carrots, and celery for the coleslaw while keeping a watchful eye on the corn boiling on the stove. She also had several projects going on in the oven in preparation for Sunday's lunch since we were expecting her two sisters and brother.

As I was about to offer to be her sous chef, she shooed me out of the kitchen. She said, "Go, go, go!" Even in the kitchen, I was not enough.

When preparations were complete, my parents, sister, and I were seated. The food should have been appetizing, but my feelings of inadequacy had already left me uncomfortable. Also, the smile and gait that my father had exhibited earlier were gone. I always sat to his left, and it was as if someone else had taken his place because his look had turned dark. Did I do something else wrong? Maybe I wasn't the reason that my father's attitude had changed. My mother was very quiet. Maybe she was the source of my father's irritation. I set aside my speculations as best I could and was ready to eat.

As we started to dig into the meal, my sister and I began a conversation about something we had seen that day on TV. We had made no more than three comments when my father interrupted and said, "Jeff, you need to be more aware of what is going on. What happened to you outside? You were making the fire pit and then you just left. You know this family depends on all of us working together. We can't tolerate this lackadaisical thinking. Where did you go?"

I mustered my best defense and said, "You didn't like how I was helping you, so I left you alone."

"That's inexcusable," he said. "Once you start something with me, I need you there to complete it! That's what I was talking to you about a couple of days ago concerning your schoolwork. You only seem to apply yourself when and if you please."

I quickly lost my appetite, yet I stayed there as was expected and tried to eat my dinner. I felt an impulse to please and protect my mother and sister so they wouldn't have to take any further brunt. Despite the hurt, a part of me seemed to be staying to make sense of all this and learn more about the dynamic that was taking shape. I was wishing that experiencing this firestorm would ultimately help me figure out how I could cope.

At that point, something started to change inside me. It was as if the disconnect between my mind and my body was widening. I don't know what changed first. Was it my mind that locked trying to follow his comments—or was it my body that just seemed to freeze? If the table had spontaneously burst into flames, I don't think I could have moved. All this tension seemed to put me in some kind of altered state. I was as if time were moving slower, not exactly what I needed. I wanted him to be done. My hearing seemed to fade, turning down the volume that was coming from my father, even as he kept going on and on. It was as if he was having a conversation with himself.

The "conversation," however, was not with himself. It was directed at me. It became simply noise, garbled by the confusion of all the cues whose decryption I felt I must be missing despite my efforts at processing. What was this all about? There was no logical explanation. Perhaps it might be the tension and negative energy that my father might have in his relationship with my mother and which was somehow being redirected toward me. I intuited only enough to complicate and confuse myself. I was angry, but was the anger at my father's confusing rant at me, or was the anger at myself and my inability to link the nonverbal tension with unwarranted verbal attention? I couldn't answer that.

The flood of different feelings devolved into a strange detachment and withdrawal, not only from the conversation, but between my mind and body as well. I don't know which was greater: the frozen state of my mind, the paralysis of my body, or my sense that both mind and body were betraying me.

Underneath there was great sadness. I remember thinking that all I wanted was for the family to be happy and enjoy this fine meal on this hot summer day. That part seemed so clear to me. Why wasn't it possible for everyone else?

As this entire swirl continued to sustain my paralysis and loss of appetite, I heard my father as if from a distance start to say something I thought might be useful. But the dreaded words were when I was your age.

I instantly knew what was next to follow would not be useful. It always was a diatribe in which he made references to overcoming hardship, meeting challenges, and staying alert and focused. I had only the vaguest ideas of what he was referring to. Who was this person? Was he ever fifteen; if so, when and where? What challenges and hardships? And why such passionate emphasis?

At a loss for answers, his precepts washed over me. I do not recall exactly what happened thereafter. At some point he did fall silent and got up from the table, leaving me to find my way back to this place and time. Thus the prospect of an enjoyable family dinner had ended in a way so many other family events had ended, leaving me in a state of stunned and lonely devastation.

(Continues...)

Excerpted from TOOTH SENSEby JEFFREY A. ORAS Copyright © 2012 by Jeffrey A. Oras, DMD. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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