CHARLOTTE, NC (Karen Garloch/The Charlotte Observer) - Tiffany Terrell can't explain exactly how it happened.
"A cavity here, and a cavity there," and pretty soon, she'd lost half the teeth in her mouth. Those that remained were decayed or broken.
At 38 and single, Terrell had become embarrassed to smile. When she did, three discolored, misshapen teeth showed prominently in front.
Although naturally outgoing, she cut herself off from friends and avoided going out to eat. Without molars, chewing was impossible. She was thankful that her banking job didn't involve dealing with the public.
Then late one night in March, while browsing Facebook, she saw an offer that seemed sent by God.
Dr. Amir Marashi, a Charlotte-based oral surgeon, was giving away dental implant surgery – a $50,000 value that is not typically covered by insurance – through a program he called "Second Chance."
Terrell typed in an entry, describing how her damaged teeth had stolen her confidence. Of 200 applicants, she was one of 50 chosen for in-person interviews. She quickly reached the top 10, who were called back for a second round.
"She touched my heart," Marashi said. "The goodness oozes out of her."
As a dentist and a medical doctor who has specialized in oral surgery in Charlotte for 15 years, Marashi said he created the program because he wanted to give back to the community. He plans to offer it annually. "We all need a second chance sometime."
Life got too busy
Terrell and her family landed in Charlotte by chance. She was 19 when her father, a United Methodist minister, died in 1998. She said she and her family – mother Linda and three siblings – got in the car, left their home in Virginia and settled in Charlotte when they "got tired of driving."
In her 20s and 30s, Terrell held jobs as a bank teller and office manager for a car dealership, and she had dental insurance. But her teeth had started going bad in college. And her insurance never covered all the work that needed to be done. The total cost might be $3,000, but her plan covered only $1,200. Sometimes she would pay out-of-pocket to get a tooth filled or have one pulled.
Because she didn't have toothaches, she didn't think of it as a major problem. Before long, instead of the standard 32 teeth, she had only 17.
"The next thing you know, you don't have hardly any teeth in your mouth," Terrell said. "Life got busier. I don't really remember."
From 2011 to 2014, she had a job at a call center that again offered dental insurance. But a root canal and an extraction used up the coverage in the first six months. Then in September 2014, she got laid off. She worked temporary jobs until she got hired last November by Citibank in Fort Mill, where she works in the consumer business support unit.
At one time, Terrell dreamed of becoming a chef. But that no longer seemed like an option. The decline in her dental health left her self-conscious and insecure. Plus, she couldn't eat anything but soft foods. Nothing crunchy.
"I don't remember the last time I truly bit into any food," she said in April, a few weeks before she was scheduled to have her surgery.
The timing was good. She'd recently begun waking up in the middle of the night with horrible headaches. She could feel pain moving up her left jaw. Things appeared to be getting worse.
Before the surgery, Terrell met with Marashi several times at Greater Charlotte Oral & Facial Surgery offices in Pineville and the Steele Creek area. He took CT scans of her jaw that gave him an exact map of her mouth.
As part of his evaluation, Marashi determined that Terrell would be a good candidate for implants. Unlike dentures, which can be removed, implants are false teeth that are attached to posts in the gums and remain permanently.
Implants, she learned, would not only allow her to chew again and have a pretty smile; they would help preserve her facial structure, preventing bone deterioration that occurs when teeth are missing.
Using those CT images, Marashi plotted surgery down to the millimeter. He worked with Drs. Bruce Miller and Sarah Jafari-Namin, of Charlotte Prosthodontics, who volunteered to install the implants free.
Surgery for 7 hours
On May 6, Tiffany Terrell arrived at the Steele Creek office at about 6:45 a.m. with her mother, Linda Terrell, and her sister, Tahren Brandon.
Tiffany was both excited and nervous. She hadn't slept much, but she said, "I'll get plenty of sleep in a little bit."
At 7 a.m., nurses took Tiffany to the back of Marashi's office to one of two operating rooms.
She talked about music with the nurse anesthetist, who administered a sedative that quickly put her to sleep. Nurses covered her body, her forehead and hair with sterile blue papery drapes. Marashi began injecting her gums to numb her mouth.
Then Marashi began removing her damaged teeth, gums and bone. Into her jawbone, he implanted eight titanium posts – four in the upper part of her mouth, four in the lower.
In the final part of the surgery, the prosthodontists, Miller and Jafari-Namin, attached temporary sets of upper and lower teeth onto the implants. These will stay in place for about six to nine months, while the bones and implants heal and the swelling goes down. Then the doctors will attach permanent dentures.
The surgery lasted more than seven hours.
As Tiffany began waking up, someone held a mirror to her face. Still drowsy, she smiled, and when she saw her teeth for the first time, she began to cry.
In the waiting room, Tiffany's mother sat checking messages on her phone and chatting with the staff. For years, she said, she'd been concerned about her daughter's dental health.
"I know that it's kind of held her back," Linda Terrell said.
Education is prized in the Terrell family, she said. Tiffany's sister Tahren is working on her third master's degree. Tiffany finished two years at Pensacola Christian College but didn't get a degree.
Even without good teeth, Tiffany is "a beauty inside and out," Linda Terrell said. "She has what we call the 'it' factor. She has what it takes to really go far.
"She just was so low in her confidence and her appearance. I know – all of us know – that this is a brand-new start."
Worth the wait
It was about 2:30 p.m. when the doctors and nurses helped Tiffany to her feet and walked her down the hall to the waiting room. When Tiffany saw her own smile in the big round mirror on the wall, she began to cry again.
She and her mother embraced, and they both sobbed. Tiffany wasn't able to speak. But she gave everyone a thumbs-up before she walked out for the ride home.
Over the next few days, she said she barely took any of the painkillers she had been prescribed. She said she felt "no pain, no discomfort, just a lisp."
Having a full set of teeth felt so unusual she couldn't speak clearly. "I know it will fade as my tongue adjusts to the crowding," Tiffany said.
There are other adjustments. One day after surgery, when she smiled at a colleague, Tiffany instinctively covered her mouth and looked down. But the colleague, who knew about her surgery, said: "Smile, honey. You don't have to hide anymore."
"That was just really nice," Tiffany said. "I really didn't realize how withdrawn I had become."
For about eight weeks, while the implants bond to her jawbone, Tiffany is subsisting on a diet of yogurt, smoothies, soup and mashed potatoes. She's looking forward to the day when she can indulge again in her favorite "guilty pleasure" – cashews. Marashi has offered to buy her some.
Even now, the difference in her life is apparent. A week before the surgery, she became an aunt for the first time. Since then, she has held her niece for pictures without feeling she had to hide.