Dental insurance puzzles me. The medical community knows that poor dental health leads to poor medical health: infections, bone loss, and gum disease are often harbingers of even worse health conditions.

They’ve been linked to heart disease, “thickness in the neck blood vessels,” and  Bone loss in the teeth and jaws can accelerate bone loss throughout the body.  (Source: Mayo Clinic) At the very least, infections of the mouth can cause problems with the brain should they decide to march northward.

And yet dental care is considered nearly a luxury and cosmetic dentistry were frivolous, as if having a decent smile doesn’t impact nearly every facet of a person’s life.

My dental insurance is considered “very good,” although it has a limit of $2000 per calendar year. Because I’ve had dental issues my entire life, I always opt for the maximum coverage, and yet, it’s only $2000. A single crown and a root canal could exhaust the entire cap of benefits. Dental implants are considered non-necessary and are excluded. Even though they are usually the best choice long-term given eating efficiency, bone loss, pain, and maintenance access (source). Plus, because dentures do not protect against further bone loss, someone who gets them will have to have them adjusted every time bone has shrunk enough so that they no longer fit.

Why is there such a low cap? I guess because they can.

After seeing the x-rays of the amount of bone I’ve lost, a shrinking foundation from which my teeth are rooted, I knew I had to do something about it.

I had another bone graft—my second with this dentist—and two implants. I saw the estimated cost and, after bursting the paper bag in which I had been hyperventilating, planned it carefully. I told them I wanted as much done at one time, no matter the cost.

The decision to have extensive dental work—or any sort of surgery for that matter—is not a decision lightly made for any patient with Rheumatoid Disease. It requires our being off the medications we take that keeps—or attempts to keep—our immune systems from attacking our body. The medications that make it possible for many of our bodies to function at all. Unfortunately, because of those medications, we are at a much greater risk of getting infections or illness. It’s a big deal. A huge deal. My rheumatologist recommends two weeks before and two weeks after. So a whole month without the stuff that allows me to work. Or shower.

Those two things may be somewhat connected.

Biologics and methotrexate allegedly (and I use that word oh-so-lightly) keep working for a few weeks after you stop taking them—just at a lower efficacy.


I had been struggling while being on them for a few months—as soon as I stopped taking them, I noticed immediate repercussions.

I had forgotten what a flare was. I had become accustomed to having mid-level pain and recurring inflammation that migrated throughout my body, with occasional spikes in pain and inflammation, but no real “watermelon feet.” I refer to my original flare as the “fruity feet,” with my feet carrying the appearance of feet as taut as a ripe fruit, just waiting to burst.

What an odd measuring stick that is.

“How bad is your swelling and pain?”

“Weeelllll…at least it’s not watermelon feet.”

And yet, within just a few days of a missed dose, what had been mid-level was now incapacitating. Enter stage left Prednisone and all its lovely side-effects. Actually, now that I think about it, the Prednisone seemed to have very little—if any—effect at all.

Oh, flare pain and inflammation. It had (SO NOT) been too long.

Hello, sweetie.

We had no grand reunion, but I was suddenly oh-so-grateful for the reminder that this was no longer my everyday life. Just my life for the next four weeks.

I’m grateful, too, for my girl, who brought ice packs and hot towels and helped me carry things and helped me in all sorts of fetch-y ways.

This is strange, having a witness to the really ugly parts of Rheumatoid Disease. I still feel the need to struggle to make it look like it’s better than it is, but my acting ability falls far short when I really can’t walk.

I am really, really, really not used to having a witness. I have a history of disappearing when things are rough, either R.D. or depression, and returning only to pretend that my absence never happened. It’s been my SOP for years, decades, even, and then wondered how I was so isolated.

Like a two year old playing hide-and-seek, I knew that if I couldn’t see you, you couldn’t see me.

Out of sight, out of mind.

And if I were out of mind, then when I was back to bouncing—or whatever it is that decidedly non-perky people do—I could just answer, “Okay,” or “Good,” or “Just fine,” when someone asked me how I had been.

If no one sees it, it didn’t happen, right?

I’m pretty sure that describes both Congress and Hollywood these days.

It’s a mask, that  veil of “fineness” behind which I’ve hidden for far too long. I no longer say that I’m fine when someone asks how I am, but my presence only when I am (at least mostly) fine does the lying for me.

Behind a mask lies a liar; the mask is an inauthenticity that poisons everything.

There’s a difference, I think, in choosing to share different parts of yourself with different people  and purposely hiding information.

After all, not everyone is worthy of knowing the “real” you. The parts of you that you choose to share with those you work with, with those you know peripherally, even maybe those within your blood family.

That’s why we choose friends and packs and tribes.

But purposely hiding how you are—your lack of fineness—when people actually ask (that’ll teach them, right?) is something different, I think.

Side note: I absolutely loathe when people say, “Hey, how you doin’?” as a substitution for “Hello.” It’s so ingrained in us to ask questions to which we really don’t want the answers instead of meaning what we say.

It’s a habit I’ve been working on breaking for a very long time. Instead, I try speaking only when I have something to say and saying only what I mean.

Some days I do better than others.  Some days my smart-assery outweighs my conscious thought.

As for the expense of the dental work, the cost of everything I need to do to make my mouth whole—or close to it–is, without exaggeration, the cost of a new, small car.

The fact that I need a car without a manual transmission to replace my fifteen-year-old Saturn is another subject entirely.

I can only slay one dragon at a time.

I am ever-so-grateful my credit rating exceeds my income, and I was able to find a credit card that offered 15 months with no interest, a “sign-on” bonus, and 1.5% cash back.

I hate debt. Hate it.

Hate it.

My house is debt enough, and I have this. And this doesn’t even taken into account that in a few months, I’ll need to have another implant when the bone is mature.

But again, one dragon at a time.

But for now, I will be grateful that I have fifteen months to pay off what I absolutely needed now.

Life is good.

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Dental Insurance and Hiding Behind the Mask

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