Prison

And this is what true imprisonment is like –

Not stone walls and iron bars

For stone crumbles

Iron rusts away,

And behind them imagination soars free

No. True imprisonment is that of memory.

A walk along an evening beach

As the sun sinks to an orange rest –

Hand in hand in the crowded marketplace

With the stalls filled with brassware, strange rocks and incense too

And nights lying limb-tangled with you –

The shackles that never set you free

Are the light-forged bonds of memory.

Copyright B Purkayastha 2016

 

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Warning: Very Boring Article About Dentistry

Listen: this is probably going to be a boring post for the vast majority of you. It’s about dentistry, after all.

Since it’s boring, you don’t really need to read further; I won’t mind.

Well, for those of you who have chosen to read on, here’s what:

Recently – very recently, as of this morning – I finished constructing a complete denture for a specimen with no teeth in her lower jaw. Not only did she have no teeth in her lower jaw, she had almost no gum left either. This is something that happens in people who lose their teeth at an early age (this specimen was 57 and had lost her teeth years ago), and especially if they lose their teeth to gum disease. Gum disease – gingivitis and periodontitis – causes the bone and gum to shrink drastically around the roots of teeth, causing them to loosen and fall out. The remaining bone that used to be around the roots of the teeth is then useless since there is no tooth for it to contain, so it’s quite quickly absorbed by the body. In the end there’s only the basal jawbone left, and even that slowly disappears over the years. I have seen people with such attenuated jaws that they have literally broken their mouths simply from the effort of chewing.

I am not making this up.

Now, if we are going to give removable false teeth (dentures) to people, those dentures have to attach to something to stay in place. If there are other teeth, the dentures can be attached to them in a variety of ways, for example clasps and retainers, or by being adapted around them. However, if there are no remaining teeth, then the dentures are entirely dependent on their contact with the gum to stay in place, by the phenomenon (which you may vaguely remember hearing of in school physics class) called surface tension. The greater the extent of the remaining gum, the greater the surface tension, and the better the denture stays in place.

However, when the jawbone is badly shrunken, we have a whole mess of problems. In the first place, the lack of bone means that there’s hardly any gum at all, and the little that’s left is usually a roll of soft tissue that slides around under pressure instead of staying in one place. Secondly, if there’s some gum, the margins of the denture can be kept far enough away from the cheeks, lips and tongue that they don’t push it away when the person talks or eats. However, when there’s no gum, even the slightest movement of the tongue or cheeks tends to push the denture off the tissue.

Obviously, then, it’s not easy to do such a denture. Often, the best option would be implants – titanium screws fitted surgically in the jawbone on top of which the denture can be attached – but they are expensive, and in many cases they are simply not possible. So we have to do the best we can.

Before I go further, I need to take a few minutes to explain, as simply as possible, how we go about making a denture in people with no teeth:

First, we take an impression of the jaw using a stainless steel tray of the appropriate size using a relatively stiff material. This is because the tray doesn’t approximate very closely to the jaw shape and we need a better adaptation to get a good impression. What this relatively stiff material is varies; in the past I used to use (as they still use in dental colleges) a heat-softened wax called composition material, but these days I use a heavy-bodied silicone rubber. Then, you can do two things; you can either make a model of the jaw by pouring plaster of Paris into the impression, and make a second tray on that; or you can simply scrape the top surface of the impression away. In either case, a soft, flowing material (I used to use zinc oxide paste, an extremely messy substance; now I use a light bodied silicone rubber) is placed on the new tray or the scraped impression to take a second, more detailed impression. Clear so far?

Once this second impression hardens, we pour plaster of Paris into it to make a model (cast) of the jaw. On this cast we adapt a baseplate of hard wax or acrylic resin (generally hard wax when there’s sufficient gum available, and the much stronger acrylic resin when it isn’t). This acrylic resin is “cold cured” – doesn’t need heating to harden. On top of the baseplate we attack a curved block of softer modelling wax in which we then put the acrylic denture teeth and try them in the mouth. 

Once the position of the teeth, their appearance, etc are finalised, we make a mould around the wax, teeth and cast of more plaster of Paris. Then we boil off the wax and remove the baseplate, fill the mould with denture base acrylic, which is “heat cured” – needs heating to harden – and then heat it until it bonds with the teeth. We can then remove it and polish it, and that is the denture. 

As I said, in cases where the gum is badly shrunken, what happens is that the remaining bone has only a tiny roll of soft tissue over it, and that’s all the gum there is in the mouth. The heavy impression material, instead of recording this gum, presses it flat, and the light flowing material can’t take a proper impression of something that has been flattened. So you end up with a cast with no gum whatever. Of course, the final denture that comes out of the mould then has no gum either, is totally flat at the bottom, and floats around in the specimen’s mouth without being seated on the gum at all.

Now, long ago, when I was a student in dental college, I had an idea. I suggested it to the teachers, who shot it down immediately. But this specimen of mine brought this idea back to my mind.

My idea was, when you make the cast and adapt the acrylic resin baseplate, you should then take that baseplate, grind the bottom hollow, fill it with more semi liquid acrylic resin, which as I said is cold-cured and so doesn’t need heat to harden, and put it into the specimen’s mouth. Allow it to harden in the specimen’s mouth, take it out, grind and shape it until it fits well, and then pour a second cast from that baseplate. Use the baseplate on the second cast to make the denture as described.

Since I am no longer under the jurisdiction of the teachers, I tried it in the specimen and the first and second casts show the difference clearly.

First, here’s the specimen’s mouth, showing almost no gum at all.

This is the cast poured from the first impression. Note that you can see no gum at all, especially in the front of the jaw (to the left of the photo).

This is the cast poured from the baseplate I adapted in the specimen’s mouth. Look at the left of the cast, and you’ll see a roll of gum tissue which was absolutely not visible in the first cast. Also, since I adapted the baseplate in the mouth, I trimmed the edges so that the lip and tongue movements didn’t push it away.

This is the wax block adapted on the baseplate.

This is the baseplate, seen from the lower surface.

These are the teeth placed in the wax, after positioning in the specimen’s mouth. Note that on the right side of her mouth the teeth are much higher and towards the cheek than on her left side, where they are depressed and irregular. The reason for this is that on the right side her upper teeth are placed further towards the cheek, while on the left side her upper teeth have migrated downwards until they’re almost touching the lower gum. Therefore I had to arrange the teeth irregularly in order for her to be able to chew evenly. Otherwise, if I’d placed the two sides at the same level, I’d have had to leave a gap between the upper teeth and the denture teeth on the right side, and when she chewed on the left side the denture – having no teeth opposite it on the upper right – would have tilted off the gum.

And yet, my erstwhile teachers would have intensely strongly frowned on my arrangement of teeth here, and would have demanded that I mount the teeth in the wax as though the human specimen was a practice set-up in the laboratory, where everything is supposed to conform to an ideal. No wonder the usual specimen in the clinics back in the college usually went away far from happy.

Here’s the denture after being separated from the mould. It’s not yet been polished.

And here is the cast, still in the lower half of the mould.

The cast doesn’t usually survive the denture preparation, but this one did. I gave it to the specimen, in the same state as you can see in this picture. The idea is that if the denture breaks at any time, she can bring the pieces and the cast back to me, and I can place the pieces on the cast and repair the denture with fresh material along the fracture line. If the cast isn’t there, the broken pieces have to be approximated as best one can, stuck together with hard wax, a new cast poured, and the denture then repaired. There’s always some distortion and the denture then has to be readjusted in the specimen’s mouth, a troublesome and far from always successful endeavour.

So here is the denture, after polishing:

And here it is in the specimen’s mouth:

Was she happy? Yes, she was happy. She was happy enough to pay me extra and insist I take the money.

It feels good when somebody actually appreciates the effort you go to for them!

Morte D'Hitler

Moulting Day

It was Moulting Day, and all Iv’s brithers and sosters had got up early, chattering with excitement, eager to help prepare her for the occasion.

Iv’s mather and fother pushed the kids aside, but they could themselves hardly contain their pride at her being chosen for the Moulting. Her mather herself gave her a bath, and then rubbed her dry, examining her anxiously from head to foot for any signs of premature Moulting. Fortunately, there were none.

Iv could have told her there would be none. But she merely sat in sullen silence as her brithers and sosters crowded around, helping put bracelets of flowers strung together round her wrists and ankles, and getting in the way of everyone.

Her mather frowned at the children, but not very hard, because she was half beside herself with excitement. She really didn’t understand why Iv herself wasn’t interested.

“Sullen, I tell you!” she said to Iv’s fother, who was just about to leave to meet the priests and elders for the final arrangements for the Moulting. “She can’t even appreciate the honour. She doesn’t deserve it, that’s what.”

Iv’s fother smiled weakly, muttered something and left. He’d long since learnt that it was better not to reply to his mate when she was in these moods; not even to agree with her, because then she’d demand why he didn’t do something about it. Besides, it was Moulting Day, and he did have a lot to do.

“Just one’s selected every three years to Moult,” Iv’s mather reminded her, pushing away the brithers and sosters who still crowded around. “Everyone’s eager for the honour, even though they know there’s almost no chance of them being chosen. And look at you – chosen and still you don’t appreciate it.”

Iv muttered something under her breath, but fortunately her mather didn’t hear it above the chattering of the brithers and sosters, or there might have been trouble. Iv herself wasn’t quite as uninterested as she let on, of course; life was so utterly boring in Dis that she welcomed any excitement at all. And usually, when something exciting happened, she was always on the fringes, looking on. This was the first time she’d got the chance of having a personal part to play. And what a part! Right at the centre of attention, no less. Let them try putting on airs now. Let Lil or Eth or the others who ignored her try ignoring her today!

She still had no idea why the Priests had chosen her, of all those they could have, but of course nobody knew what the priests thought and how they planned and plotted and schemed behind the high walls of their temple at A’ven. Iv herself had never seen the temple, but those who had said it was made of glittery shining silvery stuff and that the glare of the sun on it was enough to give one a headache. They all said it was much better in the woods and streams of Dis. Well, not Iv – she didn’t want to see the glittery temple, but she did want to see something of the world outside Dis, someday.

“Daydreaming again!” Iv’s mather snapped. “You should be thinking of the Moulting, not gathering wool. The idea!” She fetched the Moulting Robe that had been specially made for the occasion and held it out for Iv to put on. “There,” she said. “I suppose you’ll say that’s no good either.”

Iv looked at the robe. It was dark brown, worked in designs of golden yellow. She’d said the day she was chosen to Moult that she wanted peacock blue and green, so obviously those were the colours that her parents had specifically not considered. Still, it could have been worse. The last one who’d Moulted had been dressed in – Iv suppressed a shudder at the memory – maroon and silver. “It’s not bad,” she said, holding out her arms, and shutting her ears alike to her mother’s screech of anger at this lack of enthusiasm and the squeals of delight of the brithers and sosters.

Then there was a tap on the door and Iv’s fother returned, bringing the elders and the priests, and her mather’s tirade cut off in mid sentence. She rushed to make them welcome, only to be ignored totally as the visitors crowded round Iv.

“Are you ready?” the Priest of Priests, who was slim and altogether too handsome for a priest, asked.

“I suppose,” Iv replied. The priests didn’t seem to mind that she wasn’t more enthusiastic, and merely ushered her out of the house. The street was lined on both sides by white-robed acolytes, who began sprinkling flowers on the ground before Iv’s feet. They crushed petals smeared and stained her new shoes.

“They’re all waiting for you,” the Priest of Priests said. They walked right through the village, the acolytes showering her feet with flowers all the way, until they came to the field called Pera, where the Moulting was going to happen. And oh, my, was it crowded!

Not just everyone seemed to be there, everyone was there. The entire village, and even those not from the village, was there. Iv’s Grandfothers and Grandmathers were there. Her Goodfriends from school were there, apart from her real friends. Lil and Eth were there, green with envy. Why, even the giant from the castle from up on the hill, who made noises like thunder when he walked, was there, and a jollier and friendlier giant you never did see.

There was, in fact, a full blown fairground that had been set up in the field, and when they saw Iv, everyone, customers and stallkeepers alike, crowded around her, smiling and cheering, and the acolytes finally had to beat them back with their staves.

Taking Iv by the arms, the Priest of Priests and his Chief Assistant conducted her to the middle of the field, where, in the shade of a huge tree, there was a chair on which she was formally seated, to await her Moulting. As the Priest of Priests began to calculate the exact time of the Moulting on his complicated brass instrument, first one and then another acolyte began chanting the Songs of Praise, so loudly that they almost drowned out the hubbub of the crowd, which was getting ready, and just awaiting the signal to begin. The Songs of Praise were, of course, in honour of Iv, and they made her blush even though she’d known what was coming.

“The Moulting!” the Priest of Priests shouted, holding up the brass instrument. It was a very curious thing, like seven wheels interlocked together, and only the priests understood exactly how it worked. The singing of the acolytes ceased, so suddenly it was as though they’d lost their tongues together. “The Search for Knowledge,” the Priest of Priests said, more quietly, “is sacred. The search for knowledge and enlightenment is what keeps us alive, keeps us thriving. And the Moulting symbolises, in each facet, real and spiritual, that search for knowledge. Not always is knowledge good in itself, but it is vital to seek it out, because without knowledge we would wither and die.” He paused as some of the acolytes lit the Sacred Flame in its black metal brazier, and others tied resin-soaked cloth round the blade of a long, unwieldy knife. The resin sparked and sputtered, reluctant to catch fire. Then he held up his instrument again.

“The Moulting is about to commence! And the best of the best of us is the One who will Moult this year. Iv,” he said, pointing at her. “Arise!”

Her knees suddenly trembling, Iv rose. The Priest of Priests turned to the crowd. “As we all know, only the best are chosen to Moult each time. It is not just an honour – it is an honour deserved.” He beckoned forward Iv’s mather and pressed the Sacred Stone into her hand. It lay on her palm, rich red and glowing. The acolytes were already going around the crowd, starting with Iv’s brithers and sosters, handing out stones to everybody. They clutched them tight to their bosoms, looking at Iv eagerly. The murmur of their conversation died away, and a great silence fell.

The Chief Assistant brought a dish in both her hands and handed it to the Priest of Priests to offer to Iv. The two pieces of fruit in the exact centre of the dish were supposed to be glowing golden, but in reality were small and crinkled and yellow, and Iv looked at them with trepidation.

“It is her right to choose not to Moult, if she so desires,” the Priest of Priests announced formally. “It is entirely her choice. If she does not Moult, we will have no Moult till the next Cycle, for only the best are chosen. It is up to her what she chooses now. Iv.”

The weight of the silence was like a mountain pressing down on her. Iv suddenly wanted, more than anything else on the world, to say no, to draw back her hand from the fruit. But even as the thought entered her head, her hand reached out, picked up one of the two pieces of fruit, and put it in her mouth. It lay on her tongue, a piece of tastelessness, for a moment, and then dissolved away.

Everyone cheered frenziedly, as though there had ever been a real possibility that Iv would have refused.  The Chief Assistant went behind the tree and brought a furry black animal at the end of a rope. “The Companion,” she announced.

Iv looked at the animal. It was really rather cute, with stubby little horns and a blunt nose. It nuzzled at her hand and she felt the touch of a coarse tongue.

“It chooses her,” the Priest of Priests announced, as though there had ever been the slightest doubt about the matter. “Feed it the other piece of fruit, Iv.” So Iv took the other piece and gave it to the animal, which plucked it from her fingers with prehensile lips and swallowed quickly.

Then the Moulting began. Iv felt it start from somewhere inside the pit of her stomach, spreading all over her in a wave. She gasped and staggered, holding to the chair for support.

“It begins!” the Priest of Priests shouted, but Iv barely heard him. She felt her body shake uncontrollably as the Moult took over her. Her great curved horns, of which she’d been so proud, fell off, first one and then the other, and bounced on the ground at her feet. Her skin, with its rough familiar plates of scale, began itching furiously, until she began, helplessly, to scratch at it, and then it began to come away. Her face felt numb, as though she was wearing a mask on it, and then it fragmented, as the new smooth skin underneath came into view. The last to go was her lovely long tail with the flat tip, which broke off, wriggled once, and was still.

Crouching on the ground, helplessly scratching at the last remnants of her old skin, Iv looked up at the crowd. Already, they looked strange to her, bizarre and unknowable; and when her mather stepped forward, she couldn’t help but leap to her feet.

“Iv,” her mather said, tears glittering in the corners of her triangular eyes, “I’m proud of you.”

Iv opened her mouth to speak. Nothing happened.

“She can’t speak yet,” the Chief Assistant said. “It takes time.”

“You’re going out in search of Knowledge.” Iv’s mather went on, ducking her head in acknowledgement of the Chief Assistant’s words. “To know, whether for good or ill. We do not know where you will go, or what you will see, for those who Moult never go the same way. Remember us sometimes, and not too harshly.”

“Now,” the Priest of Priests said, his slim, handsome body weaving sinuously. “Do it now.”

So Iv’s mather threw the Sacred Stone at her, not hard, just hard enough to strike her between her new-grown breasts and fall to the ground. But that was all it needed, and the others began to throw the stones the acolytes had given them, throw them much harder, hard enough to draw blood, hard enough to kill. Iv stumbled away, the stones falling hard around her now, scarcely aware that the Companion trotted by her side, his own Moulting happening as well.

Behind her, the Priest of Priests signalled to the Chief Assistant. “Take the flaming knife and stand guard,” he said formally, “to make sure she does not return.”

So Iv left the field of Pera, outside Dis, and came out into one of the Worlds of Knowledge. And alongside her came the Companion, now moulted, and raw and tender as Iv herself.

“I’ll call you Yedam,” Iv said to the creature, when she could speak again, and ruffled its hair. “Do you like that name?”

The Companion did not reply. There was no interpreting the look in its opaque eyes.

Copyright B Purkayastha 2016