Root Canal
Dental adventures for the week:
I had my six-month cleaning on Wednesday. While there had been flossing lapses in the past half-year, like all of December and January, I had been good for the past few weeks. I didn’t expect anything beyond a cleaning, though I was going to ask about this bit of swelling I had near Tooth #30. There was no pain associated with this swelling.
The swelling, it turned out, was a small blood-filled pimple, and not the gum swelling caused by bad flossing. The dentist was concerned, and after the cleaning she took an x-ray of the area [1]. The little pimple was caused by a tooth abscess — part of the root was rotted away — and I was to immediately make an appointment with a specialist. The specialist would decide if I’d only need some antibiotics to treat the infection or whether I’d need a root canal to drill out the rotting bits.
My dentist had high praises for this specialist (I forget what his speciality is called, but he has a D.M.D. after his name), saying that if she were in Australia and needed a root canal, she’d fly back to New York to have him do it. I’m told, contrary to every story I’d heard, the root canal should actually be painless.
So, Thursday morning, I schlepped cross town to Madison Avenue. There’s the usual paper work to fill out, though there was a slight snag with this dentist not being part of my HMOs approved list. In any case, the specialist glances at the x-ray print out my dentist gave me to show him, and decides to get a better picture with his own x-ray. Zap. One look at the results and he says, root canal: too much bone has already been lost. We’ll do it now.
I again get the story that root canals are now painless procedures. As he put it, in late 20th Century New York, if not elsewhere, root canals are not an issue. All the painful stories were from the time before better technology was brought to bear. The whole procedure would take about an hour.
The tooth gets isolated with a rubber dam with a hole cut out of it. This is so the dead tooth material and infection doesn’t splatter everywhere in the mouth. There were three injections of novocaine. I only felt the first one, and I didn’t feel too much of that, since he swabbed the injection point with some numbing liquid.
While this was all happening, I got the “what is a root canal” lecture. Teeth have roots, and within these roots are narrow canals through which nerves and bloodvessels pass. Problems happen if an infection gets into the canal, since the blood flow is minimal: the infection can just go nuts in there, eating away the bone and generating goo. If you get relatively lucky, you develop a fistula — where the goo breaks through the gum and vents — which is what that pimple/swelling was. If you get unlucky, the fistula doesn’t develop or it gets clogged, and your jaw swells. I think there’s an archetypal image of someone with a swollen jaw, a bandage wrapped across the top of the head, as a symbol of dental problems; I guess the clogged fistula is where the image comes from. In any case, the dentist’s goal is to drill out the canal, and basically take out all the debris, stopping the infection. I suppose the pain reputation for a root canal comes from not drilling out the canal carefully, or going too deep.
While most of the pain is stopped by an aggressive application of novocaine, some of the dentist’s technology is neato peachy-keen. After the initial bit of drilling, he got out some sort of potentiometer, to measure the voltage differences between a couple of points on the tooth. This is apparently an indication of how deep the root goes. There might have been some other bit of technical gee-whiz, but I can’t seem to remember it.
After he did the root canal, he took a second set of x-rays to see if everything was correctly done. After that, he put on a temporary filling — my regular dentist is supposed to do the crown after a couple of weeks. I’m supposed to come back to his office three more times to check on the condition of the tooth: over months, the lost bone is supposed to come back, as the area re-calcifies. I got a prescription for antibiotics to address the infection, and a prescription for pain killers, in case there was real pain after the novocaine wears off. A day later, no pain, though there was a fair bit of soreness on the tooth last night when I brushed. Most of that soreness went away by the morning, leaving me with an unfilled prescription for Lodine. Oh, another kudos for the dentist: he called that evening to check that I was OK.
[1] As a side note, the x-rays they take at that office are way cool. No more film held in hard plastic bite downs, she uses a little wand with a sensor at the end. The wand is attached to a PC, and the x-ray is recorded digitally. It supposedly requires only a tenth of the radiation a traditional x-ray uses. A few seconds after the zap button is pushed, the x-ray comes up on screen, associated with the right section of jaw. The only problem I see with this is that the printouts are low-rez, but that’s because they were using a sucky HP 5L, and possibly because the software wasn’t configured to print out a full-sized image.