It was a punishing July day in 1994, and I sought the succor of the river. After a dip I climbed out, reaching for a towel spread on the boulder shore—but my hand plunged straight down between two rocks. There was a sickening crunch as my face collided with the boulder. Napalm-white light pierced my eyes as my tongue probed crumbled enamel. The pain was brilliant.

My tooth was broken lengthwise, a triangular wedge missing from the center and a crack splitting up through the root. I didn’t have insurance, so I made an appointment with the county health clinic. The dental technician glued a temporary crown over the shattered front tooth.

“You’ll wanna get this fixed right away,” he said.

“Right away” somehow turned into five years, but I was finally on the Oregon Health Plan and spent an entire summer at OHSU having a lifetime of various dental maladies individually addressed. I had 16 cavities drilled and filled. My wisdom teeth were jerked out by a 100-pound dental student who lacked the upper body strength to pull them cleanly. This required her to stand above me wrenching them back and forth until the roots were torqued from the anchoring jawbone and my gums were raw hamburger. I had only been given a shot of Novocain, and was keenly aware of everything: the slow crunch of bone; the sound of metal grinding in my ear; the panic on the dental student’s face as all the blood left mine.

Fixing my front tooth was not so straightforward. Over the years, the maxillary tissue had eroded like a grave in high water; the dead root no longer needed the bone’s firm grip and the facial bone had slowly released its grasp. To regrow enough bone to hold a crown, a screw was driven up through the root and attached to a bracket, which was wired to the rest of my teeth. The braces created the necessary tension to reanimate the bone—though it took a full year, and tightening was required every few weeks to draw it down.

By the end of the year, my maxilla had regrown, but also lowered my gum line in an uneven fashion. A gingivectomy could solve that easily enough; lasers burned the excess tissue away, sending tendrils of my own meat-smoke into my nose accompanied by a sizzling sound. My gums were wrapped in pink wax bandages to heal before the new crown could be installed.

The next day I had to deliver a presentation in front of my entire chem class. Not only did the bandage impede my speech, but I also looked like I was wearing rubber gag teeth with thick gums and the front tooth missing. The other students grimaced while I spoke, their appalled gazes unable to look away from the horror of my mouth.

In the end, I had to apply for a credit card to pay the $5,000 bill for the crown (not covered by OHP). But finally my smile was once again my own.