Thursday, December 6, 2007

Root Canal Fun

Dental Stupidity During College

When I went to college, there was no Kaiser Hospital within 50 miles of San Luis Obispo, so I wasn't able to remain on my parents' medical insurance plan. Which meant that I didn't have insurance for most of my college years. That, combined with my strong dentist-visit anxiety, meant that my teeth didn't get their regular 6-month checkups for 5 years.

Which, based on the title of this post, you might guess led to bad news in the dental health department. You'd be right.

Along with all the "little" cavities I now have to take care of, I had this one really nasty one. One of my upper right molars had a huge cavity in it — large enough, in fact, that I could feel it with my tongue and from which I sometimes had to dislodge rice. Amazingly, it didn't hurt.

Despite the lack of pain, the tooth was so decayed that my new general dentist up here in Seattle wasn't sure that the tooth could be saved at all. We talked about the possibility of a tooth implant. :(

Many X-Rays, Little Action

All told, I had 5 separate X-rays of this tooth, in 5 separate visits, counting two earlier ones not detailed here, before the root canal itself actually happened.

My general dentist took X-rays and referred me to a periodontist (gum-dentist), to get a specialist's opinion. The periodontist took more X-rays and sent me back to the dentist, pronouncing the tooth probably good enough to keep but in need of a crown lengthening procedure (in which they cut back your gums to expose more of the tooth) before a crown could be put over a post-root-canaled tooth.

The general dentist got the information from the periodontist and called me. He recommended I go directly to the endodontist (pulp-dentist) and get the tooth root-canaled right away.

So off I went to another consultation appointment, with another set of X-rays. The endodontist was very certain the tooth could be saved; in fact, he seemed surprised that everyone else was so concerned. He wasn't even certain the crown lengthing would be required, although he sounded less sure there.

The Root Canal

Based on the phrase "more fun than a root canal" and knowledge about the procedure passed down to me through popular culture, I was really not looking forward to the experience at all. I was hoping they'd put me under anethesia, like when my wisdom teeth were removed. No such luck; the plan was to use only novocaine. I requested nitrous oxide*, and agreed to pay out of pocket it for it. Apparently, dental insurance companies believe it to be "alternative treatment" and thus don't cover it.

So today was my root canal appointment. I got the N2O before the big scary novocaine needle. The endodontist explained that I could expect it to feel somewhat like a "good glass of white wine," and that comparison wasn't too far off for me. My limbs got heavy, like they do when I have a drink. I could think pretty much normally, but it was easier to let distressing thoughts sort of float away and not bother me quite as much. But compared to the Wikipedia description of N2O, the effects were really pretty weak. None of the depersonalization, derealization, nor flanging of sound. I'm not sure whether "lessened anxiety" is part of the "euphoria" continuum, but I did feel less anxious. My legs still squirmed all over the place and my hands still gripped each other, but the anxiety was less intense than I think it otherwise would have been.

Unlike my memories of sharp pain when I got novocaine shots is the roof of my mouth as a kid, this time there wasn't really any pain per se. It was pricking and unpleasant, I was freaking out in anticipation of the remembered pain, and the sensation of the needle being pulled out was utterly icky; but nothing I'd say was painful.

Digression: Needle Phobia

According to the well-named Dental Fear Central, "local anaesthetic administration can be entirely painless" but "most needle phobics have had a very bad experience with an injection." I really did not like my childhood dentist — he was scolding sort of man, and admonished me that "it doesn't really hurt that bad!". Dental Fear Central lists some reasons why the shots given by the dentist might not be the most ideal, painless experience. Of the 6 reasons listed, I suspect (or for some reasons, know) my childhood dentist guilty of 4.

He apparently didn't get the memo that "the days when 'the lecture' was part-and-parcel of a visit to the dentist are gone. ... [D]entists nowadays realize that admonishing people is a sure-fire way of keeping them away."

Anyhow, the take-home lesson here is to get a dentist who believes painless injections are possible, and cares enough to do the things necessary to make it happen. Numbing gel before the shot itself is a good start!

Novocaine successfully applied and the right side of my face all numbed up, the actual root canal procedure itself started. There were all sorts of pointy tools and files and drills, but I generally closed my eyes while they were in use. The endodontist had told me that a sign of too much N2O was tingling or pinhole vision. So while my eyes were closed, I'd count to 10, open my eyes long enough to confirm that vision was still normal, then close my eyes again.

A minute or two into the procedure, I was comfortable trusting the novocaine and the N2O to keep any real pain at bay. Which is not nearly the same as being relaxed, but at least my squirming was confined to just pressure- and noise-induced unhappiness.

While I was trapped in my unable-to-talk state, I tried to occupy myself with things other than the pressure and noise and wondering if something might hurt despite everything. So I listened to what the endodontist was saying to his assistant, or wondered about random things, like:

  • Do dental students practice root canals on cadavers? (Afterward, the assistant say, "Hmm... No, that's interesting, but I've never heard of it.")
  • Do deaf dental patients not feel as cut-off, communication-wise, when getting a dental procedure done?
  • Do deaf dentists feel cut-off from communication in the same way as speaking patients do, or is it different when you're the one in charge?
  • What kind of conlang could you make out of the phonemes available to you while having a dental procedure done? (I could use all unrounded vowels up to the close-mid height. I only had from the velars back available for consonants, though.)
  • Would someone on N2O pass a field sobriety test? Would their reactions be distinguishable from a drunk's, even if neither passed?

Isn't that the sort of thing you think about while getting a root canal done? :P


I was surprised that I wasn't in excruiating pain, after all I'd heard about how bad root canals were. I've been taking over-the-counter pain killers, which are doing the job. I'm still a little nervous about chewing on the right side of my mouth, but the endodontist says the temporary filling should be good for at least 8–12 months...

* Wikipedia claims nitrous oxide to be an analgesic, but the endodontist was emphatic that it is not. He said you definitely wanted some real pain killers with your nitrous oxide, or else not even the laughing gas would keep you happy.


John Cowan said...

Root-canals basically are only painful if you are badly infected, where the tissue is too damaged for the local to take effect. Apparently this wasn't the case.

Arthaey Angosii said...

My tooth wasn't infected, just majorly decayed. I guess I'll count my relative blessings. :)