I’ve been preoccupied this Spring with my twin surgeries – amputating my big toe and blowing a kidney stone all to bits. I’ve almost forgotten that I lost a tooth a few months ago, and my dentist has suggested getting an implant to replace it.

The good news is that my teeth are in great condition, probably the best in my adult life: no cavities, strong gums, and little plaque.

My water and electric brushes and obsessive flossing are paying off. Dr. Merryman and his techs have been great for me and are teaching me how to take good care of my teeth, including some prescription toothpaste.

The other news is that I have to decide how or whether to try to fill a large hole in my jaw where a big tooth used to be.

I believe aging calls for thought and consideration, not evasion, avoidance, or impulse. I just can’t do everything I would like to do and be responsible.

This past month, I’ve greatly improved my health and well-being. I’m on a roll. But there are boundaries and limits.

Empty spaces can be dangerous for older gums and teeth; they often lead to trouble.

And the hole in m lower jaw is uncomfortable. The tooth came out a few months ago.

Food gets stuck there, and the tooth protrudes and annoys my tongue. Sometimes, it hurts when I chew on something tricky.

There is also the psychological element – I lost a toe this summer and a tooth this Spring. I don’t wish to lose any more of me; I’d love to go the other way.

I want to fill that hole in my mouth; chewing is sometimes awkward; I feel like I’m coming apart somehow, even though I know this isn’t true.

But there is an important ethical question, perhaps more than one:

Dr. Merryman, my excellent dentist, and I kicked around these issues with his staff this morning.

There are options – an insert that can go into the space in the daytime and be taken out at night. That would cost about $1,100 to make. I could agree to an artificial bridge to fill the space and keep my teeth straight.

That would cost at least $3,000.

I have no dental insurance.

And I could do nothing, I’m 75, and I can survive the way it is.

I am eating normally and not in any significant pain, just discomfort.

Food occasionally gets stuck in these holes (there are two), and I want to know if it is possible to fill one or both (the other tooth, a failed implant, was removed four years ago.

I want to fill those holes. I asked Dr. Merryman what the best way to do this was, and he said his first choice by far was an implant. It was, he said, the best way to go for me and my mouth.

He said the technology had advanced dramatically; I have a solid bone where the tooth was, and it would stay in my mouth securely for the rest of my life, keeping the other teeth supported and straight.

Since the rest of my teeth look better than ever, I will almost certainly have them all for the rest of my life, thanks to him and Anne, his hygiene aide.

He is a fantastic doctor, and I trust him completely.

Dr. Merryman said he respected my ethical concerns; there were valid issues regarding morbidity, as he put it. There is a point where one is old enough that it makes no sense to spend thousands of dollars on procedures and surgeries that are not life-threatening.

I don’t go to an office and travel in high circles.

Aesthetics is not the issue. If Maria doesn’t mind how I look, I don’t think about it. She thinks I need to do what is best for me, always. The problem is that this isn’t always clear. It was evident with the toe and clear with the kidney stone surgery and the tooth I lost.

I’m talking about being comfortable.

This next stop, if there is one,  isn’t so clear.

And even then, we agree, that’s a real issue past a certain point.

An implant would cost $4,000, money I do not have and would have to borrow.

What is something else happens to the farm, it is old and creaky at times.

I’m a blogger now, not a book writer, there are no significant checks in my future, and we have been nearly destroyed by  expenses this year, the roof, and other urgent repairs to the farmhouse.

We do not have large amounts of money salted away for emergencies. Or implant procedures.

We need and want to build an upstairs bathroom, which will cost much money.

Can I justify this implant? Should I just get an insert of some kind to get me through the day?

Dr. Merryman says the inserts are often uncomfortable and irritating. Lots of people don’t like them.

He suggested I get a consultation from an oral surgeon he recommended in Saratoga Springs.

I knew the name. I know this Dr, Dr. Skelling. He helped clean up the disaster that was my first implant, an experience I never wish to repeat. He is compassionate, knowledgeable, and sincere.

He did a great job removing the implant from my upper jaw.

I have an appointment to see him in June.

There are all kinds of ethical issues involving getting older. How much money should I take when many younger and poorer people have nothing? Can I justify spending this money to feel more comfortable in my mouth and good about myself?

Do I want to risk borrowing money that might fall on Maria when I go? I’m 75, a few months away from 76. Those are valid and important issues for me to consider.

Have I come close to or reached the point where I accept that I am getting older and don’t need or can justify expensive treatments that most people can’t have and that I could live without?

I can get the money; that is not the problem.

But it will take a couple of years, at least, to pay it off, and other things need to be done – the bathroom comes to mind. That’s first on our list. And I need a new brace to replace the one the first brace was built to support my toe.

It didn’t quite work out.

I need to really think about this. I want the rest of my life to be comfortable and whole. That is worth something. But what?

So I will go ahead and see Dr. Kelling and ask him some questions about the implant procedure and whether or not he thinks it’s something I need. I made the appointment today.

In the meantime, I’ll meditate, think, and read and gather information about this implant idea and talk to Maria (I know she will say to do it) and again to Dr. Merryman, whom I trust.

My medical health choices have been winners so far. Can I trust myself aga

I also trust Dr. Merryman’s staff; we all talked about this several times today. We went over the pros and cons. After my consultation in Saratoga Springs with Dr. Skelling, I will decide.

I won’t do anything without Maria’s blessing; those are the rules.

I’ll share my decisions and the process of coming to them.