Let’s start at the end: my children have a friend, charming on the other hand, who used to spit upwards very high and then, in an acrobatic display, put his own saliva back in his mouth. My children told me it was disgusting. And they expected a strong response from me, perhaps in relation to my profession as a doctor. And of course, as a physician I am left without weapons and arguments.
Surely an anthropologist can explain better than I can why what the little fellow is doing is disgusting. Also why it is disgusting to spit in a glass of water and then swallow the water; if we change the order, finally in the mouth there will be, in the same way, water mixed with saliva. But it’s not the same thing, is it? We could say that the activity of drinking and therefore mixing water with saliva does not have the commutative property. Well, then bring in an anthropologist who knows something about mathematics.
On further thought, it seems that in order for our own saliva not to be disgusting it must remain confined to our oral cavity. Already the lips are a pretty clear boundary, and when saliva slides down the face, we’d better not put it back in, right? And if our saliva has physically separated from our body, then it is already directly repulsive. So the social and personal norm seems to dictate that saliva separated from its place becomes disgusting. And that reminds me of Jehovah’s Witnesses.
In my professional life I have on occasion treated patients who are Jehovah’s Witnesses, and it has undoubtedly been a therapeutic and moral challenge. Their renunciation, for religious reasons, of blood transfusions is well known. In this religion, founded in the 19th century in the United States, the reading of the Bible is carried out with great meticulousness, and then it is interpreted in a way that I find surprising concerning blood. Jehovah’s Witnesses reject blood transfusions and treatment with blood components. But they do not only reject other people’s blood. They also reject autotransfusion, a common method of blood transfusion in scheduled surgeries, where a few days before the surgery, blood is collected and stored from the patient to be operated on, to be used, if necessary, on that same patient afterwards.
Less well known and probably less unanimous among the members of this religion is its position on hemodialysis. It seems that the key is that if the blood has not lost contact with the body, it can return to the body. In hemodialysis, the blood passes through a tube and then through a machine, but there is always a physical continuity (the blood in the tube) between the blood inside the patient’s body and the blood in the machine. For this reason, and surely because hemodialysis avoids directly, objectively and without margin for more or less fanciful interpretations, the death of a patient without renal function, this treatment is generally accepted by the majority of Jehovah’s Witnesses. Here I digress because in my (admittedly brief) internet search, I have not found anything definitive on the websites of Jehovah’s Witnesses themselves. In any case, there is a certain parallelism between saliva and blood outside the body, in the case of saliva by a “disgust” whose explanation I leave in suspense (suspense in mathematics, we could say), and in the case of blood by an interpretation of the bible more or less caught by the hairs. But, of course, the goat goes to the wild, and the saliva and blood issue reminded me of something that, frankly, is difficult to get used to: removable dental prostheses. Or if you will, to prostheses external to the body, in general (epithesis, in case it comes up as a trivia question).
In oral rehabilitation after the loss of teeth, the use of removable prostheses is frequently resorted to. I am referring to those “glass of water on the bedside table” prostheses, which are put in and taken out several times a day for cleaning, and which many patients prefer to take out to sleep. They can be complete prostheses, of the entire dental arch, or partial prostheses, which replace one or more teeth. There are patients so used to them that they can eat steaks so richly, but the most common thing, what we see in the clinic is that patients are uncomfortable, dissatisfied, and increasingly seek alternatives.
Removable prostheses move inside the mouth, leave food trapped on the gum, produce friction on the mucosa, prevent proper chewing, come out of the mouth at the least opportune moment orCOPY00 The problems are innumerable. Although dental implants have greatly reduced the use of these prostheses, there are still patients who wear them. It is true that in very old patients, who take certain medications, or who have serious chronic diseases, the use of dental implants may be inadvisable, so removable prostheses will remain in our “catalog of services” for a long time yet. Even in some occasions, although the patient has dental implants, for different reasons we recommend a removable prosthesis. In this case the prostheses are rigidly anchored to the implants, and do not move or rub. But even in this case, we still have the problem of “removability”.
The problem of “removability” is, seen from the cold perspective of the commutative property, absurd. If you believe that saliva with water in the glass and then in the mouth is the same as water in the glass and then saliva and water in the mouth, then there is no problem with dentures. But people are complicated, we do not always follow rational rules. We don’t always apply the commutative property. Nor does it apply to the patients themselves who use dental prostheses, who often feel ashamed of the act of removing the dental prosthesis so that we can explore them (even a surgeon like me realizes that, what an eye I have). It’s a low-intensity embarrassment, let’s say. It is something so subtle that it is not talked about. Some patients are even embarrassed to consult with us for a fixed prosthetic solution. The cost, both in money and in medical appointments, waiting in the office, postoperative, is a variable sometimes uncontrollable. Grandpa” is fed up with his removable prosthesis, but how is he going to tell his children that he is going to use his savings to get implants? So I am going to make, in conclusion, a plea.
Grandfathers and grandmothers of the world: your families are delighted with the removable prostheses that you wear. They only see the friendly side of removable prostheses. They are not usually present at the moment when you have to take off and put on the prosthesis. You save them that hassle. If you are happy with your removable dentures, stick with them. But if you are not… as Raphael says: what does anyone know?
Written by Javier Arias, maxillofacial surgeon. For more information, please click here.