The Best Dentist of All Time

A tribute to Jonathan Okon, D.M.D.

In one’s dark night of the soul, it's good to have a knight in shining armor. You know, to rescue you. My night of the soul, years back now, was on the same day that I found my knight— at least for my oral health. This article is about the best dentist…and why it matters to feel cared for.

This photo of a microphone will make sense later.

As readers of this newsletter are aware, I've had many years of online harassment. That online harassment started with a call from the New York Post. The New York Post is the least distinguished of publications. Say what you will about the fecklessness of the Washington Post, the cowardice of the LA Times, or the complaints you may have about the Grey Lady. All of these are fair criticisms, perhaps. One might similarly lob firebombs at Archie, Garfield, or even the disgraced Dilbert. Print media, am I right?

All of these publications and comics have a certain degree of gravitas, however, when compared to the New York Post. Suppose the New York Post had a spirit animal competition, and they nominated the vulture. In that case, I imagine we would have a flock of vultures all protesting vehemently and considering filing suit for defamation if they were chosen as the point of comparison for the New York Post. It's that bad.

In 2019, I found out the New York Post was going to write an article about the death of a patient of mine. No, I’m not going to link to it. One of their photographers would jump out from behind a car and take a picture of me strolling down the street, standing next to a friend, who is a member of our intelligence community, which would require a phone call and another phone call, and another phone call, and another phone call, to senior officials to figure out what the hell to do about this unfortunate sequence of affairs.

It was the very same day that I needed a wisdom tooth ripped out of my head.

So here's a thing about wisdom tooth removal: it's not pleasant. It's positively medieval. Do you like to think that oral surgery is somehow surgical? When you think about surgery, you mostly think about anesthesia. Unless you're a surgeon, you think about operative fields, scrubbing in, laparoscopy, nursing staff, retractors, and the Iike. Much of oral surgery is done when you're entirely conscious, under local anesthesia. This is not to denigrate the good reputation of local anesthesia.

However, no matter how much local anesthesia you're under, if you need to get a wisdom tooth out of your head, it's gonna have to be ripped out. Some tools look a lot like chisels; there is banging. Eventually, you have to fracture the tooth. Your oral surgeon will then have to remove that fractured tooth and all of its fragments from the head of the person in its entirety. It just takes some degree of brute force to do that. It's nice to have local anesthesia so it doesn't hurt in a way that would be unspeakable. However, it still feels like someone is whacking at your head with a goddamn chisel to break what was your tooth and forcibly rip a tooth out of your head in a way that feels uncanny, if not tremendously painful thanks, again, to the magic of local anesthesia.

Local anesthesia numbs the nerve endings in a part of your body so that you just literally can't have any sensory input, particularly pain, from that part of your body into your brain. Local anesthesia is overwhelmingly time-limited. You don't want to lose all feeling in that part of your body forever; you want to feel the experience of having your tooth bashed out of your head by an exquisitely trained surgeon, who also happens to be a brutal sadist when it comes to that back molar, that needs to go.

And in my case, that back molar, a wisdom tooth, needed to get out of my head because it was causing problems.

And so, with remarkable and repeated hammer strokes, a wisdom tooth was brutally, mercilessly, destroyed. It was removed, fragment by fragment, from the very back of my mouth by somebody with degrees in medicine and dentistry so that they could use their eight or so years of training to painlessly, but terrifyingly, solve my dental problem.

That is, for the time being. Because after the wisdom tooth comes out? That is when the pain can begin.

Have you heard about dry socket? No?

When you take the tooth out of the socket, do you know where the tooth should be? After that, there's just a gaping hole in your mouth. And, sometimes, that gaping hole, absent local anesthesia, can hurt like hell.

Everything you remember about local anesthesia? Which was the entire experience of a tooth being viciously destroyed in your mouth so that it can be removed? But there is no pain? Take that whole experience, and now, remove the uncanny but painless experience from your consciousness. Take everything that was unsettling about it but turn it into physical, searing, relentless pain. And put that right back in the empty socket in the back of your mouth where your tooth used to be.

If it gets too dry, that empty socket can become a source of pain. A black hole of pain. And endless reservoir of pain. Most dentists would prescribe Vicodin. Or Percocet, or whatever. But all of those things tone the sensation of pain down, but they don't eliminate the pain. They make you high, they make you foggy, they reduce the suffering, but they don't eliminate it, and they bring additional suffering and the risk of addiction along with it.

But wait a minute, my readers might wonder, what about local anesthesia? What about the ability to completely kill the pain coming from a specific part of your body, like the dry socket in which your tooth once lived just a few days prior? Couldn't local anesthesia come to the rescue in this particular instance?

Local anesthesia does precisely this. It doesn't just reduce the sensation of pain, like an opiate would, further dulling and limiting you while putting a risk for an opiate use disorder. Local anesthesia blocks the pain signals from that very focal part of your body, in this case, the socket that my tooth called home, and it prevents your brain from ever hearing the news that things are hurting. Unfortunately, anesthesia has to be administered by a needle held in the hand of a dentist, who can put it in your mouth, and it doesn't last that long. It certainly doesn't last more than a day. So if you're looking for local anesthesia to manage your pain and suffering, you'd need a dentist willing to stick it in your mouth every single day, as long as that pain was torturing you, and that would mean a dentist to his willing to see you on Tuesday, Thursday, Friday, oh, Wednesday also, let's not forget about Wednesday, and Saturday, and Sunday, the entire weekend. You'd have to have a Dentist who could see you every single day.

And what kind of dentist would possibly work that hard? It's not a reasonable expectation.

One thing my readers might not know about me is that, as a physician, is I take my job pretty seriously. It may be hard to imagine, given the daily cadence of this newsletter, but I do see patients. I see patients most days of my life. I've been on call, almost continuously, for over a decade. I took two weeks off to record a full-length album a couple of years back in January 2020. Here it is— for reference:

Why did I go record an album as a vacation? Because in a recording studio, you can't have your phone on. So I was forced to have coverage and have everyone who is a patient of mine know that I was utterly incommunicado, and the microphones were on. In theory, the cell would have disrupted the sensitive recording equipment. I have to go to great lengths to convince myself to stop doing my work.

I often see patients on the weekend. I see patients almost every weekend. Even when I go on a vacation, and I don't go on many vacations that are just that, often it's a work trip that I call a vacation in my head cause I'm speaking at a conference or something. But even when I'm doing that, I make sure I get the international plan, and I'm often taking phone calls to cover the care my patients need.

My friend John Vanderslice is at the now-gone tiny telephone Mission district studio.

I could run my life differently, and other doctors do that. I should do more of that myself, but historically, I don't. I don't expect the same degree of relentless work from other people. I don't think it's advisable. Everyone should take some time off. I don't necessarily take my advice. I care about my patients; I don't want them to suffer. I have a little stick in my craw; as a psychiatrist, that psychiatric care seems to think it's OK to take the weekend off.

Many psychiatric units don't have full staffing on the weekend, and that's not the kind of thing you see in any other setting in the hospital. It's not like the intensive care unit takes “The weekend off.” Part of this is because psychiatry historically hasn't had much they could meaningfully do. Why would you rush into a hospital on a weekend to change your medication dosage when it's gonna take weeks to months for that change to have any impact? You wouldn't. So hospitals don't. As an advocate for rapid-acting treatments, like accelerated transcranial magnetic stimulation, one weekend day can make a world of difference.

Another part of the story, for me personally, is that when I first got TMS, I saw a Doctor Who had an office open on the weekends. I was having a really awful weekend, where I suppose no one would be open. When it turns out my doctor was able to provide treatment on that Sunday for my first round of TMS, it was revelatory and lifesaving, and I felt cared for in a way that I couldn't forget.

I think I've been trying to recreate that accessibility for my patients, but the thought that you don't have to wait and suffer because it's inconvenient for somebody else appeals to me. I care about that experience.

I care that people don't have to wait when things are horrible because somebody else thought of what it would be like to suffer that way. I want healers to make sure they're available to help.

It means I work too much, and I get that, but I respect any other clinician who chooses to alleviate suffering in a way that might be inconvenient for them but is life-changing for patients.

I don't expect it, however. It's outside the norm. Only a couple of organizations and people in my life have had this kind of dedication to customer service, and they stick out like a sore thumb. I remember Mercenary Audio, a company founded by a man named Fletcher. It supplied much of my early higher-end audio equipment. They had a relentless support policy, where if you're a piece of equipment went down, something vital, like a microphone preamplifier, they would ship you a replacement the next day so that your session could continue. At the same time, you waited for your piece of gear to be repaired. They doubled manufacturers’ warranties. They picked up the phone. They solved your problem. If you don't like it, send it back, and they will replace it. No questions asked. To this day, Mercenary Audio and former employees like Sean Eldon, who is now at a company called Reverb, and Adam Brass, who is now at a company that sells radio frequencysomething or other for churches, are my mental Gold standard for fantastic customer service. As a doctor, I aspire to be as responsive as Adam and Sean.

Regarding dentists, Dr. Jonathan Okon is the Adam Brass circa Mercenary Audio of dental work.

Returning to our story of my wisdom tooth extraction, only a small fraction of patients have "dry socket" --exquisite and awful pain--after the extraction of the wisdom tooth, but I was one of them. It was one of Dr. Okon's colleagues who took out my wisdom tooth in the most medieval of extractions.

The next day, I was in pain.

Dr. Okon did a remarkable thing. Instead of having me suffer or take off opiates to kill the pain, he brought me back into the office the next day and gave me an injection of modern lidocaine.

The next day, Dr. Okon brought me into the office and gave me another injection of local anesthetic.

The next day, he did the same all over again.

The next day was a Saturday, and again, I joined him at his office in Midtown Manhattan. As the only patient in the office that day, he gave me an injection of anesthetic.

The next day was a Sunday. At 7 PM, that's Sunday night, instead of leaving me to suffer, Dr. Okon gave me yet more injected local anesthesia.

The next day, the gaping hole in my mouth didn't feel so painful. And I didn't need any more local anesthesia. Dr. Okon's job was done.

Dr. Jonathan Okon is a goddamn hero.

Since then, I've sent my mom to Dr. Okon, my dear friend to Dr. Okon. I've returned for yet more dental work, and I don't have to worry anymore. I don't have to worry that I won't be cared for. It doesn't matter what the problem is with my teeth; Dr. Okon will ensure I'm OK.

Thank God, every day, for Dr. Okon.

What happened with that New York Post article? The mother of that patient has been harassing me for years. Did you think the tooth situation was painful?

I finally had to file a suit against her. This Thursday, we have the next hearing in that court case. I have a good lawyer; I am sure he's close to Dr. Okon-level. It's a high standard; I imagine you'll agree.