Warning: Photos Featuring Extreme Bloodshed and Violence

Before I begin: do not read this article! There is much bloodshed and violence to living tissues herein! Horror and manglement!

This is your last warning!!!!!1!!!!!!

OK, so you decided to read further? On your own head be it. Don’t say I didn’t warn you.

One of my colleagues referred a 33 year old male specimen to me. Said specimen had had pain and swelling in the back of the upper right jaw and great difficulty in opening his mouth, a condition that suggested an impacted, that is, crooked and partially erupted, wisdom tooth. Sure enough, after his pain, swelling, and jaw stiffness had been cured with antibiotics and muscle relaxants, the X Ray I took showed an impacted upper third molar, which you can see here, arrowed for your convenience.

The only solution for the problem was to remove the tooth, which is very easy to say but not so easy to do. Here’s why.

Note that the tooth is pointing forwards at an angle. This is known as a mesioangular impaction.It is very common in lower wisdom teeth, but rather rare in uppers. Apart from the rarity, there was no space to spare between the front of the tooth and the back of the tooth in front, which meant that I couldn’t stick an instrument between them and lever the tooth downwards.

That, actually, was just the start of my difficulties.

Here is what I saw when I checked the tooth in the jaw. In this photo, you can see that only a tiny part (the tip of one edge of the crown, as it happens) of the tooth is visible. Like many of the following images, this one was photographed in reflection in my mirror.

For greater clarity, I’ve marked the tooth in the photo with a black circle and arrow.

Here, in the X Ray, is what I could actually see of the tooth:

Obviously, the vast majority of the tooth being buried in the jawbone, I’d have to expose it and remove enough bone around it to be able to take it out. Here, I am cutting a flap in the gum using a No 15 Bard Parker Knife blade:

After that, I used a tungsten carbide bur mounted in an airotor surgical straight handpiece to drill away bone on both sides of the tooth, as you can see in the photo below. After that, I attempted to loosen it in its socket but was unable to do so; there was still far too much bone around it. Accordingly, I decided to cut a groove in the tooth itself and use it as a lodgement point for an instrument called an elevator.

With an elevator in the groove I’d cut in the tooth, I drew it down and out. Here’s the tooth.

I’ve marked the groove I cut with a black circle.

Now, though the tooth was out, there was a large open wound in the gum around the socket, which I’d have to close:

It took two black silk sutures to close the wound, but it was very successfully closed, as you can see. 

In case you can't see, I’ve marked the stitches for you.

Some days I think I am not totally incompetent at my job.

Lucknow and Memory: Photo Feature 2016

Some weeks ago, as I’d said here, I was in Lucknow. For a few hours, I wandered through old haunts, seeing how the city had changed. Some of the changes were expected, even positive; Lucknow is no longer the overgrown village it had been when I used to study there two decades ago. Some of the changes, on the other hand, were disconcerting.

I only paid a brief visit to my alma mater, where I discovered that I was most definitely an outsider. The last time I’d been there, back in December 2014, I’d been part of a group – the 25^th anniversary of our class – and accepted and welcomed. This time, I felt like a total stranger, a fifth wheel. I wasn’t a student, a staff member, or a patient, and so nobody really knew how to behave with me. I didn’t linger long.

Here’s the dental department. Back when I was a student, this was a crumbling building housing a couple of laboratories and lecture halls while the main department was on the other side of the street.

This is the main gate of the college. Back when I was a student the statue didn't exist.

This is the bridge across the Gomti river, behind the college, which I used to cross four times a day back in 1990 to classes and back.

In early 1990, there was a murder down there on the bank on the other side - a man stabbed with iron rods and his head smashed with a rock to prevent identification. I don't know if they ever found the culprit.

TG Hall: this used to be the hostel where I lived in 1989-90. Back then it was a dusty yard surrounded on three sides by a crumbling two storey ancient building with stairs at the corners and a pump in the middle for water. Look at it now.

Nine storeys, and lifts and all.

I think I would like this guy.

I walked the streets for hours. This area, Chowk, once had raw brick buildings and the lanes were packed earth. Now it’s a market of sorts.

There used to be a great little shop at this corner, where we students used to buy excellent sweet milk drinks (lassi). It was an institution. Gone, and replaced by a...shoe store.

This is called the Bada Imamabara, built in the 18^th century. Although it’s just behind the college, in all my years in Lucknow I’d only visited it twice before. The big gate is called the Rumi Darwaza.

Part of it has a maze called the Bhulbhulaiya which legend says is impenetrable without a guide. I went all the way through it and back again in an hour, without a guide of any sort. I detest tourist guide patter anyway.

Look at the way we Indians “respect our ancient culture”:

It’s verboten to wear footwear inside the Imambara – but scribbling on walls is fine.

This is the Martyr's Memorial. I used to come here sometimes on summer evenings to relax.

A godawful tacky “park” allegedly commemorating India’s so-called victory in the 1999 “war” in Kargil (Kashmir):

I can think of better ways of commemoration than those awful figurines.

Here’s a squirrel to make you feel better.

Here is where I learnt German and met a certain young woman who, shall we say, taught me certain things. No, I don’t know where she is now.

This is the downtown of Lucknow, Hazratganj. It used to be a ritual for us back then to wander around here on Saturday evening, an activity known as "Ganjing". The benches weren't there then.

One thing about Lucknow that has emphatically not changed is the horrible traffic. I wouldn't dare drive here.

This is the cathedral. Directly opposite was a movie theatre called Mayfair which was the only one in Lucknow which regularly screened English movies. Gone.

This part of Hazratganj is called Janpath. 

Near here, in 1990, on the left of the picture, was a signboard for an electronics shop advertising “Video and Nudio.”

There used to be a wonderful book store called Hobby Corner here, right next to this henna booth, where you could find out-of-print books at farcically low prices; I bought HR Trevor Roper’s The Last Days Of Hitler there for just twenty rupees, among others. Gone.

These fountains didn’t exist back then, though. Not all change is bad.

Sunrise over Lucknow as I left at dawn the next day.

Overall, it was a distinctly mixed experience. If it were not for a couple of old friends I met and who made me feel welcome, I probably wouldn’t have wanted to go back again.