Friday, May 6, 2011

Root Canals Are Not Hell

So, tooth #4 (that's upper right premolar/bicuspid to those of you in the know) has been on the Terrorist Watch List for several years. Had I gotten the stupid cavity filled when it was first spotted, it would have been a lot cheaper and less involved in the end. But it seems that whenever I have the mental focus and stamina to deal with the dentist, I lack the time and finances. If I have the time, I lack the focus and the finances. If I have the finances, I lack the time and the stamina. On any average day, I score 1 of 3 and count myself lucky to be doing so well.

But, at the last tooth cleaning and x-ray, the dentist pointed out that tooth #4 had gone over to the Dark Side. The cavity took up nearly 50% of the tooth, and if it wasn't already in contact with the nerve pulp, it would be any second now.

I've had one tooth with an infected nerve pulp. It was worse than any migraine I've ever had. Worse than the gall bladder attacks I suffered through. Worse than breaking my ankle or my elbow. It was so bad, all I could do was curl up around my jaw with an ice pack on the worst of it and pray for the sweet release of death. Instead, I got a dental appointment the following Monday, an immediate referral to an endodontist, and a root canal the following morning.

I like my endodontist. I'd like him even if he hadn't prescribed me Vicodin and then given me so much local anesthetic I wouldn't have noticed if he'd implanted antlers over my ears. Unfortunately, because of the stress of the infected tooth, the anxiety of Oh My Og, a ROOT CANAL, I don't actually remember much. Just him and his assistant being very sympathetic and patting me on the head, and a bit of explanation as to why root canals are not as bad as everyone thinks they are.

Bit of explanation:

First, they used to be as bad as everyone thinks they are. Apparently, dentists weren't great at making sure the patient was as numb as could be. Then, they didn't always get all the nerve fibers out, because those nerves get really, really tiny. Finally, the majority of root canals got infected and caused pain that could be measured on the Richter scale.

No longer!

First, it's now standard procedure to treat the pain and prevent the pain. Yay! On my first root canal, both my brand new regular dentist who'd never seen me before and my brand new endodontist who'd never seen me before, prescribed me enough Vicodin to see me through until the appointment. Otherwise, I think I may have removed my entire lower jaw on my own.

Then, the endodontist went to great lengths to make sure I was completely numb. Swabs of stuff that numb the top layer of skin so the shots don't hurt. Multiple shots in many places, distributing the anesthetic all over the place, and a metered syringe so the anesthetic itself didn't cause pain by creating a huge bubble of liquid pressing on other nerves.

Both times, there was one point I felt some pain. On the first root canal, I could feel some tugging with a bit of owchie pinching. One mention of "Mmmrmffrmm-rrmmff", and he stopped everything, added more anesthetic, waited for it to take hold, and off we went. The second time, apparently, my hard palate had not gotten the note about the anesthesia, so I got two, maybe three shots right in there. Those did hurt, however, understanding the gateway hypothesis of pain management (your brain can only concentrate on one big owie at a time), I dug my nail into my thumb, providing a pain I had control over, and the shots no longer bothered me.

Second! Dentists didn't use to clear out all the nerve fibers during root canals, leaving both very aggravated and angry nerves behind, and the potential for rampant infections in the canal itself. The nerve fibers themselves often have a diameter less than that of a human hair. My endodontist told me this was a real problem until some clever dentist noticed a neurosurgeon using one of those gee-whiz microscopes during a brain surgery. Well, if it helps during brain surgery, why couldn't it help during a root canal? Granted, not as sexy, but even more appreciated. With the technical assistance of excellent micro-vision granted, nerve fibers were hunted down and destroyed like some timely metaphor including an allusion to Osama bin Laden and his Pakistani compound.

Third! The terrible post root canal infections. Happened a lot. Apparently - and this is what my endodontist explained to me - unlike a wound being infected when bacteria is introduced at the time of trauma, what often happens with root nerves is they are traumatized by some other incident, become inflamed - that is, get red, hot, and bothered, and have more bloodflow going to them - and attract stray bacteria in the bloodstream which have managed to avoid the white blood cells. The immune system does not like to attack nerve fibers. Bad things happen. So, a bacterium which lands there is safe. And it has a party. And then bad things happen.

To prevent that, or cure it if that's what's going on, once the nerve root has been extracted and destroyed, the endodontist flushes the entire canal with a bleach solution. Intellectually, I'm a big fan of bleach. Kill the germs! Whiten the laundry! Eliminate the bad smells! Except, I really dislike the smell of bleach, and having that smell in my mouth was probably the most uncomfortable part of the whole procedure. Blech. Worth it though.

After all this is done, the endodontist seals the canal with a substance called gutta percha. Most excellent name, isn't it? Gutta Percha. Gutta Percha. Gutta Percha is the inelastic latex-like sap from a tropical tree, and it's been in commercial use since 1842. When warm, it's ductile and malleable, and when it cools down, it doesn't become brittle like unvulcanized rubber does. That's your botanical/chemistry lesson for today. These days, the demand is so high, that a chemically identical, artificial form of gutta percha is manufactured so we don't kill all the trees.

Once the root canal is filled,  a cotton plug is put in, and a temporary filling is added. One then gets to follow up with one's regular dentist for a crown. The cotton is there to let them know when they've drilled down far enough.

I will say, for a procedure that involved nerve endings so notoriously sensitive it made for a horrifying torture scene in Marathon Man, the current reality is far more pleasant. Of course, being someone who gets anxious about any dental adventures, I took half a Valium before going and was significantly more mellow than I would have been otherwise. Even so, the procedure took only about an hour, the Sith tooth can no longer harm me, and I was so well anesthetized that even half my nose was numb when I left. Lunch at Chili's was interesting, because while I could get food into my mouth, using a straw was adventurous. My server brought me extra napkins and didn't even ask.

I did not get full feeling back in my face until eight hours after the procedure. So, I amused myself by poking different parts of my face or trying to smile at the mirror and determining which muscles were still affected. I had a lovely time chatting with the endodontist and his assistant. He even showed me pictures from a couple of his textbooks when I mentioned the trouble I was having with what may be Sjogren's syndrome. We agreed that the picture of the parotid gland tumor was really, really gross. I scored points for knowing that Lou Gehrig's disease was ALS, not myasthenia gravis.

I'm not saying I'd like a weekly root canal. After all, I'd run out of roots before the year was out. However, I am learning that procedures whose very mention could make me crawl up in a chair and break out in a cold sweat are not actually the Hell on Earth they used to be. In fact, considering the alternative (ice pack, praying for the sweet release of death), I'll take the root canal just about any day.

So, Dr. Bruce Smith of Escondido, thank you to you and your wonderful staff. The Dark Side was defeated. I have one less ticking time bomb in my mouth, and while I may still break into a cold sweat, I know it's more of a conditioned, cultural reflex than anything to do with reality.

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