Crossing That First Bridge

Do you remember your first clinical bridge? How could you not? Forever verdant in memory, etched on your cerebral cortex like your first pair of long pants, your first kiss or your first set of wheels is that whole episode of the First Bridge.

Actuarially speaking, the trauma of the first bridge shortened every dental student’s life by 10 years and reduced his skeletal being to the consistency of jellied consommé. Even today, the memory of it is a moment of nostalgia laced with masochism.

Picture this: Day One, 16th and Los Angeles streets in the City of Angels, 1941, in a structure erected by hominoids toward the end of the Pleistocene Period. It has now grown so decrepit, dogs refuse to relieve themselves on it. Within its stygian interior, a white-coated Olympian figure with red-striped sleeves summons a student who, lacking the adroitness to jerk sodas, has espoused a career in dentistry.

"Number 76," he intones, assuming the voice of James Earl Jones as Darth Vader, "you will commence your first bridge case at morning’s light." Having been relieved of my Christian name at the outset of the freshman year, I recognize that my double-digit persona has been addressed.

"Yes, Sir," I gulp, my marrow quietly freezing, my features petrified in the dreadful risus sardonicus. Deep within my thyroid, a shrill whistle gives a long, piercing blast to signalize the close of business, and before I can claw open my 45-button student gown to equalize the pressure, I am a 22-year-old dental student entirely surrounded by floor.

Day Two: Whatever thirst I had for a DDS degree has been effectively slaked, but there is nothing for it now but to forge ahead as if I know what I am doing. With the speed of library paste, I hastily assemble my state-of-the-art armamentarium as delineated in the Junior Crown and Bridge Syllabus. This consists of two green stone points for a contra-angle handpiece; an assortment of steel burs guaranteed by the manufacturer to turn blue after two minutes or 50 revolutions, whichever comes first; a saliva ejector; rubber dam; clamps; and a small flashlight for illuminating the darker recesses of the mouth. The Doriot handpiece -- which redlines at a dizzying 4,000 rpm right up to the moment it throws a belt or suffers pulley seizure -- completes the setup.

Days Three to 14: This period is being used to prepare the molar abutment. Although green stones are said to be on the cutting edge, the actual cutting is on a par with sawing through two inches of stainless steel with an emery board. The steel burs are of little assistance, being compounded of equal parts of pig iron and lead. Still, except for a lost week trailing the instructor around in the conga line that was fastened to his backside like a leech, the molar anchor is finally, albeit grudgingly, approved. The little column of smoke that arose from the tooth after two hours of green-stoning will later prove to have been a harbinger of things to come for the pulp, but for the nonce is a matter of signal irrelevancy.

Days 15 to 25: Abutment No. 2 proceeds at an incendiary rate now that I’ve got the hang of it. Punctuated only by an unfortunate incident wherein the saliva ejector reverses the flow of its contents, the appointment goes well. The patient, who is initially thought to be merely asleep, is discovered to be comatose, possibly related to the 16 liters of procaine he has flowing in his vascular system in lieu of blood. Beginner’s luck, or not, the bicuspid anchor is checked off as a "6" on a 1-10 scale.

Fabrication of the temporary crowns is accomplished in just slightly more time than Michelangelo required painting the Sistine Chapel. On the other hand, Michelangelo wasn’t obliged to check with the Vatican every time he thought he was finished with an angel’s finger or a wing feather. Nor was he constantly harassed by the Pope demanding, "Do it over, Buonarroti!"

During the hiatus wherein the patient is unshackled to celebrate a couple of birthdays and father a child, I am stockpiling hydrocolloid, trays and an uninterrupted water supply in anticipation of Impression Month.

Days 61 to 87: My patient seems to have grown a full beard, which is handy because we are experiencing a shortage of bibs until the advent of the next tuition rise. I effectively use the time between impression retakes waiting for the little blisters to subside by delivering with fetching candor my opinion of what a moron you’d have to be for losing the tooth I’m replacing in the first place.

Days 81 to 104: My patient is only dimly aware -- not only of what he is doing here, but that he is about to receive the best dentistry has to offer: a pontic with the Long Pin Facing. This replacement tooth is so realistic it’s scary! Only the gold occlusal, the distinctive gray-green hue of the porcelain, and the extra 3 mm length can give it away.

I have now slaved over this bridge for six months, not counting Spring Break and Christmas, and it looks as if it will go in shortly before the end of the year. My patient is becoming restive. I am able to mollify him by threatening him with a felonious blow on the sconce -- and a fervent promise that I will never touch him again if he will allow me to finish.

Day 216: Polished brighter than a new Buick, the completed bridge warms the cockles of my heart no less than if I had just thrown a span composed of Erector Set girders over the Grand Canyon.

March, 11, 1943: Despite numerous tearful entreaties on my part, my ex-patient refuses to return to the West Coast from Indonesia where he claims to have fled to escape the consequences of my having just a little difficulty seating his new bridge. My explanation that the abutment teeth drifted together a paltry quarter inch during the preparation and it was therefore not my fault, falls on deaf ears.

Apparently he also faults me for a perceived excess of brio in tapping the bridge into place with an orangewood stick and mallet during which the molar abutment disappeared into the maxillary sinus.

There’s a lesson to be learned here. That’s why I’m going into orthodontics; what could go wrong there?