A Fracture Never Goes Away
The throbbing of my cheek was louder than any alarm clock. My worries have always lived in a clenched jaw, but on this morning the tension escaped, spreading down my neck and deep into my ear. I should have been rousing my teenagers to buy binder paper and sneakers for high school or extra-long sheets for the college dorm. Instead, I stayed curled up in bed, pressing a pillow to my cheek like a cartoon character with a toothache. The pain came from somewhere deep, radiating from the left lower molar into my jaw and affecting the whole side of my face. My head tingled, and my eardrums vibrated at the slightest sound.
Over the phone, I described the situation to my dentist. He told me to come in during the lunch hour, the slot reserved for emergencies. Dental checkups were one of the things that I had been avoiding for months. I had an appointment scheduled a few months earlier; it was cancelled when the Bay Area went into shelter-in-place, as TVs blared about the “China virus.” A few months later, stylists began cutting hair outside, restaurants set up tables on the sidewalk, and shops opened up for browsing. A routine dental cleaning—face-to-face, mouth wide open—still seemed like an unnecessary elective appointment.
But this was August, and the clinic was allowing one patient at a time, with R2-D2-sized air purifiers and vacuum tubes to suck up ‘particulate matter.’ I stripped off my mask as the dentist greeted me from behind the cone of his N95 mask. With his deep-set brown eyes, he looked like a sad toucan. His eyebrows furrowed at the array of black and white images on the computer monitor, and he murmured a series of numbers to his assistant. They sounded like police codes, dispassionate ways to talk about all the things that can go wrong inside a mouth. The beak pointed toward me. When did the pain start? “Last week,” I lied, knowing that the pain really started months ago.
Is it sensitive to cold? Yes.
To heat? Yes.
To pressure? Yes.
Does the pain radiate to other parts of your jaw? Yes.
Does your ear hurt? A little, I lied again.
Do you wear a night guard? I used to, but it didn’t fit anymore. (It hadn’t for
years, but a new one wasn’t covered by insurance.)
“We can try a crown, but the tooth may be too damaged and need to be extracted,” he said. Rubbery goo filled my mouth to make an impression for a new night guard. A temporary crown was placed atop my cracked molar, and I’d have to come back in a few weeks for the permanent one.
A crown holds a damaged tooth together. Like a helmet, this thin layer of porcelain protects the tooth from further shock, which could shatter the weakened enamel. A damaged tooth can look fine to the naked eye. Made mostly of calcium, the pearly white exterior feels nothing. But even a tiny chip or microscopic fissure can allow bacteria to creep into the pulp, the soft living core of flesh, blood vessels, and nerves. The infection can grow deep in these channels, sometimes unnoticed. Teeth are said to be the densest matter in the human body. But not so strong that they are impervious to the pressure exerted by clenched jaw muscles. My father also grinds his teeth. I have seen the muscles bulging on the sides of his face in moments of stress. Maybe I look like that too, and I just don’t know it.
This particular toothache began one morning in June. I woke up with sand in my mouth, but I hadn’t been to the beach. The days blurred together after malls re-opened and police shot Breonna Taylor and George Floyd, but before the summer COVID surge and cancellation of fall classes. Around that time, old friends from high school or church would sometimes comment aggressively on my Facebook posts. “But are they dying?” one woman asked, in response to a news article reporting increasing infection rates. Instead of arguing with them, I shut my laptop just like I closed my jaw, hoping that if I didn’t see the conflict, I wouldn’t feel it.
That gritty morning, I opened my mouth wide in front of the bathroom mirror and spotted a V-shaped notch missing from in my left lower molar, second from the back. My eyes darted away from my reflection and towards the drawer. If I didn’t see the hole, maybe it didn’t exist. I grabbed a tube of sensitivity-reducing toothpaste, special ingredients from Japan designed to re-calcify damaged enamel, instead of just numbing the pain with medication. When I finally went to the dentist weeks later, I asked him to be generous with Novocaine. “Nineteen,” he murmured to the assistant, as we waited for the sensations to dull.
Crowning a tooth is a more complicated than putting a helmet on your head. A layer of enamel needs to be removed, so when the crown sits over it, the repaired tooth still fits neatly with its neighbors. But removing a layer of enamel is not like peeling off a beanie. The tooth must be ground down, with a whirring tool that rattles your skull and gives off an odor of waiting outside a Taipei crematorium after your grandmother’s funeral. Then a temporary crown is lightly glued on that sanded-down molar, like being sent home with a birthday hat after brain surgery. You have to be extra careful until it’s time to pluck off the temporary crown and cement the custom-made porcelain shell onto the raw nub.
At the end of September, the pain came humming back. By early October, it grew to a constant din, like the election news or debates over opening elementary schools. I hurt when I ate, drank cold water, sipped hot coffee, or simply breathed. I donned big black headphones during my video meetings, because the tiny pods felt like knives on my ear drums.
Over the years, there have been other times when I woke up with sand in my mouth: after a sleepless night with my colicky first baby, after a red-eye flight to visit colleges on the East Coast when that baby turned 16, and a few times in between. Each time, the tooth was crowned and life went on. But in October 2020, I could no longer tune out the pain. The next time I called the dentist, he suggested a root canal later in the month. I went on antibiotics while I waited for the appointment. Even with the medication, the pain became its own a 24-hour news cycle, a ticker of all possible outcomes: Tooth extraction! Dental implants! Insurance co-pays! Nerve damage! At night, I clutched my husband like a giant teddy bear. I couldn’t cry when his colleague was put on a ventilator, our son’s high school graduation was cancelled, or my mother whispered that “China is trying to kill us all,” but now silent tears spilled onto his shoulder. I watched the clock until it was 8 a.m., when the dentist’s office opened.
“Come in at nine,” the receptionist told me.
More X-rays, more prodding. The dentist tilted his head to the side. “The left side of your face looks swollen,” he announced. “What we can do is open the tooth up and relieve some of the pressure, clean out some of the infection.” What he described sounded like a root canal. He numbed me up, two shots this time. “You might feel a little prick,” he said. I gave him a thumbs up. A tiny drill whinnied as it bored into Tooth 19. The dentist made grunting noises and mumbled more codes to his assistant. Suddenly, searing pain! Like what you would expect if a drill bit touched a live nerve. Then it was over. “The nerves in the tooth are almost completely dead,” the dentist said.
Bacteria can creep through chips and fissures to infect the pulp of the tooth. Infection causes pain, and when the germs spread the pain radiates to your jaw or your ear. The holes were patched with temporary putty, until my checkup in a few weeks, like having brain surgery and going home with gauze wrapped around your head. “I had a similar root canal on a tooth twenty years ago,” the dentist confided, in a moment of empathy. “It held up until just recently, and I need to have it extracted.”
By my October checkup, the pain subsided, and I was cautiously optimistic. The dentist sealed up the repaired molar. I slept with my new mouth guard, and I stretched my neck before bed. Schools would open in January, and cable news projected that Joe Biden would be the next president of the United States. But a nagging sensation crept back. Not exactly pain, just an unsettled feeling. The Monday before Thanksgiving, my jaw swelled tight and Tooth 19 winced at the touch of a spoon. Infection numbers were rising, and public health experts warned people not to gather for the holiday.
This time, the toucan shook his head. He could no longer help me. I’d have to see an endodontist. In the days after the presidential election, when the winner had yet to be certified, I went to the specialist’s office for a last attempt to salvage my molar. A CAT scan revealed a gum infection, but no obvious cracks. The endodontist challenged me to a terrible game of would-you-rather: Another root canal? Or surgery to open up my gums and repair the roots? Surprisingly, tooth extraction wasn’t one of the choices. On Thanksgiving, I ate mashed potatoes, counting the days until my next procedure.
After three shots of Novocaine, the drilling began. I plugged tiny white pods in my ears this time and hit play on the Hamilton soundtrack, hopefully loud and lengthy enough to distract me. The rap opera about the founding of the United States only slightly dulled the vibrations; after all, they were coming from inside my head. King George questioned this new nation that would keep on replacing whoever’s in charge, closing his soliloquy with a villainous laugh.
The endodontist mumbled a sound of surprise. There was a tiny fissure deep inside the molar. “It is bonded, which will preserve the tooth for a while,” he said. “But a fracture never goes away.”
At home, I curled up on couch, eating ice cream while streaming Christmas movies. For the first day or two, I popped painkillers every few hours, afraid of what I might experience if the numbing wore off. In a week or so, the pain became merely discomfort. Joe Biden was certified as the next president, but a dull ache in my jaw never fully subsided. Even with my reinforced molar, the left side of my neck tensed up as I watched flag-carrying protesters breech the White House just six days into the next year.
In various ancient traditions, teeth are believed to be connected to other aspects of our being. At the root of dental problems is not poor oral hygiene, but unresolved psychic issues.
“Our teeth act like stoic warehouses, holding onto suppressed or distorted emotional energy,” writes Melior Simms, an Australian life coach who goes by The Holistic Tooth Fairy. Traditional Chinese medicine associates each incisor, bicuspid, or molar with an energetic meridian. Tooth 19 is situated on the lung meridian. Could it have anything to do with the global respiratory pandemic? This molar also correlates with the emotions of chronic grief, sadness, and feeling trapped—feelings that are all too familiar to me.
A few days after President Biden was sworn in, I went back to my regular dentist for a checkup. The x-ray showed Tooth 19 to be structurally sound. Still, it didn’t feel quite right. The dentist, with his air purifiers and digital cameras, suggested that the root of the issue may not be related to dental care. “What’s causing you so much stress that you grind your teeth so much?” he asked. “You have to change that.” But how do I change the stress of living as an Asian woman in an increasingly divided America?
So I go to physical therapy. I go to psychotherapy. I do more yoga exercises, and I wear my nightguard religiously. Some mornings I wake up with the familiar tension—in my jaw, my neck or my cheek—and I remove the molded plastic from my mouth and check for telltale shards of calcium. I sigh with relief to find my teeth have survived another night, but I don’t take for granted that they always will.
Grace Hwang Lynch is a Taiwanese American journalist and essayist in the San Francisco Bay Area. After graduating from U.C. Berkeley with a B.A. in Rhetoric, she got her start as a broadcast journalist, before becoming a freelance writer and editor. She is an alum of the Voices of Our Nation (VONA) and Tin House writing workshops. Her reporting on Asian America can be found at PRI, NPR, and NBC Asian America. Her essays have been published by Tin House, Catapult, Paste, and more. The anthologies Lavanderia: A Mixed Load of Women, Wash, and Word and Mamas and Papas: On the Sublime and Heartbreaking Art of Parenting have included her work. In 2021, she created the literary reading series: Kòo-Sū: A Taiwanese Storytelling Experience. She is currently finishing a memoir-in-essays about food as a lens understanding family and the history of Taiwan. Follow her @gracehwanglynch on Twitter or Instagram, or at gracehwanglynch.com.