"Dentists and Dragons - Chapter 5" by Troy H. Cheek on Mar 23, 2005

(If you missed Part 4, go back and read it first!)

The story of the film so far: After months of wrangling with insurance companies and dentists, I finally got clearance to start a root canal treatment on tooth #31. The irony of this being that had I not had trouble with the insurance companies and dentists, tooth #31 could most likely have been saved by a timely drilling and filling, which probably would have cost me almost nothing even without the help of insurance, or at least less than this root canal is costing me with insurance paying their part.

Such is the story of my life.

I've spent so much time and space talking about the insurance companies and the dentists that I've not said a whole lot about the actual root canal procedure. Said procedure is actually fairly simple, though very high on the icky meter.

First of all, you have to understand that the tooth you see is only the outermost layer. Inside this enamel is an inner core of blood vessels and tissue, liberally entwined with some very sensitive nerves. The purpose of the blood vessels and tissue it to supply the tooth with moisture and nutrients. This is the equivalent of using saddle soap on your leather car seats. Sure, like the tooth enamel, the leather car seat is dead, but a steady supply of the right type of moisture keeps it from cracking and peeling.

The purpose of the very sensitive nerves, as near as I can tell, is to get you to go see your dentist regularly.

The first step in a root canal is to drill out a section of the enamel so that the dentist can get to the chewy chocolate center. Or, as they like to call it, the pulp. The pulp, that inner core of blood vessels, tissue, and nerve endings I told you about. There wasn't a whole lot of drilling in my case because the tooth was so decayed, so removal of the pulp was fairly easy. Then the dentist digs down into the roots of the tooth to remove all the blood vessels and nerves in there, all the way down into the jaw.

This is what Dentist #5 did for me during my first visit. Sometimes, a root canal can be completed in one visit, and though Dentist #5 didn't feel good about my prospects for that, but thought I would need only one addtional visit. And since I had just finished 10 days of penicillin, he decided against prescribing any additional antibiotics.

Which was fine with me.

After a couple of days of general soreness, I woke up to a unique sensation: a total lack of pain in my mouth. This nirvana lasted for two whole days.

Then I woke up one morning with the tooth feeling a bit tender and my jaw a bit swollen. No big deal, I thought, considering what my mouth had been through lately. But within a day the pain was bad enough to be distracting and the glands under my jaw on that side were swelling quickly. Which caused every nurse and doctor I passed in the halls of the hospital to ask me how I was feeling, and to, of course, poke and prod at the swelling, which only made it hurt worse.

I called Dentist #5, spoke to the staff, and waited for him to call me back. By the time he did, my ear had started hurting as well. "Well, sounds like you've still got an infection in that tooth, or possibly your ear, or both. Sounds like that's what's causing the lymph nodes under your jaw to swell up. But I'm reluctant to prescribe you any more antibiotics until I or another health professional examines you."

"Well, I do work in a hospital, surrounded by doctors and nurses," I told him as clearly as I could while cradling my jaw in my hand.

"Oh, well, can you talk to one of them?"

"I have," I replied.

"What did they say?"

"That it looks like I still have an infection in that tooth, or possibly the ear, or both, which is causing the lymph nodes under my jaw to swell up, and that I need to have my regular doctor prescribe me some antibiotics."

"And your regular doctor is...?"

"For this tooth, I would think that would be you."

"Ah, right, ahem," he said. "Same pharmacy?"

I went back to Pharmacy #2, and Pharmacy #1 had closed since the last time I'd used it, and told them to expect another prescription from Dentist #5. This turned out to be more penicillin, same number of pills as before but taken more often, so that instead of ten days I ended up with seven.

After about the third day, the swelling went down. I know from experience to always take the full run of antibiotics, even if the symptoms go away. By the time of my next dentist appointment, I was feeling almost normal again.

Of course, during the three weeks between these appointments, the temporary patch on my tooth was slowly disintegrating. It had gone from a finely sculpted copy of a molar into a coarsely sculpted copy of a lunar landscape. Still, it had done its job, as no food had gotten down in there and no medicine or cotton gauze had leaked out.

This time, I showed up at 1:15 PM for my 2:00 PM appointment, as I was afraid of being considered late if I showed up merely on time, as almost happened the last time. I was actually swept back to a room by 1:30 PM and laid eyes on Dentist #5 by 1:45 PM. These people really did run their office by my father's schedule. Another cotton swab full of topical anesthetic and I was ready for a jaw full of caine-type medicine. They left me alone until it took effect. I killed time by reading a paperback book I'd brought along, which I would eventually end up reading through twice before I left.

An assistant came in and started mixing up some gunk. I guessed it was some kind of quick-setting epoxy, as it came in two liquid parts that started to stiffen up once they were mixed. She swirled the huge purple glob onto the end of a stick and told me to open up, because we were going to make an impression. Well, it certainly made an impression on me! She had me bite down on it, but the stick caught on my overextended wisdom tooth and I couldn't close all the way. She moved it around and bit and this time, I got full closure. Every few minutes she'd come by and poke at the glob, until finally she told me to open up so she could remove it. This turned out to take several efforts. Finally, though, I was able to do so, and she examined it and declared it a perfect impression from which they could make my new crown. She went off to do whatever it is that dental assistants do when they're not torturing me.

Once he was convinced that I was numb, Dentist #5 started fitting a dental dam into my mouth. This surprised me, and with grunts and hand signals, I was able to get the point across that last time, he'd given me a second round of shots before starting work on my tooth. He explained that last time he'd had to deaden the nerves in the tooth itself, but now they had been removed, so he only had to deaden the surrounding area so I wouldn't feel this clamp he was putting around my tooth to hold the dental dam in place.

I had just been reassured and calmed down when the clamp jumped off, bounced off my upper teeth, and clattered across the floor. "Hand me a larger clamp," he requested of his assistant, the lovely Vanna. I made a mental note to have him check my upper teeth for new cracks, as that clamp hit hard enough to get my attention, even numbed.

As I lay there counting ceiling tiles, they drilled and scraped out the last of that temporary patch, removed the gauze, and flushed out the medicine. Now we were ready for the second step of the root canal treatment. The now empty root canals were filed into their final shapes, flushed out some more, and only needed to be sealed off to complete this step.

Sealing off sounds so simple that I was surprised that it turned out to be a bit more involved.

They pulled out a thin wire with little rubber stop on it. Then they pulled out a box with dials and displays on it. One lead from the box clipped to the little thin wire. The other lead clipped to the side of my mouth. Listening to the beeps coming from the box, the dentist carefully adjusted the rubber stops until the thin wire went just far enough down the root canal hole to make the box go beeeeep. I assume that it was using some kind of resistance measuring to see how deep the hole was before it hit living tissue. I tried to use grunts and hand signals to explain that my body has a weird magnetic field which causes electronic wristwatches to die after a few weeks and causes all sorts of other problems, but I couldn't quite get the point across.

After three wires had been placed in my three root canal holes, they moved the dental dam around and explained that we were going to take a quick X-ray. This proved difficult as the dental dam was still clamped to my tooth, and tooth #31 is way back there. But the lovely Vanna was persistant and eventually got the X-ray film stuffed back in there, jammed between several parts of my mouth which most assuredly had not been covered by the Y-caine injection earlier. This was also about the time I realized that if my mouth wasn't being held all the way open, that clamp would bite into my gums.

But, knowing that a bad X-ray meant another X-ray, I held still. The X-ray came back a little light and a little off-center, but perfectly usable in confirming that they had the correct lengths for the wires. The wires were removed and, I thought, the worst was over. If I remember correctly, the length for each of the three holes was 23mm.

Then they came at me with these little rods with orange cones on the ends. The rods were about as big around as a pencil lead. The cones were just big enough that you could hold them well with your fingers. With Vanna holding a pad full of some grey gunk, Dentist #5 smeared one of the little rods with said gunk and pushed it down into a root hole. Then he said "Little Feat."

I wondered why he said that. How did he know that I was a fan of the band Little Feat? Then, I noticed that the lovely Vanna was hosing cold water onto my tooth as fast as that little sprayer would spray it, suctioning it out just as fast. And I noticed that in spite of this, I felt a distant warming sensation in my mouth. I decided that he'd actually said "little heat."

This was repeated twice, and I figured out that they were cementing those rods into my root canal holes, thus sealing them off. The dental dam was carefully removed at this time. Vanna sprayed and suctioned out my whole mouth, which was appreciated, and the dentist had me close my mouth enough to hit the ends of the rods, telling me to close no further, lest I need them repositioned. They took another X-ray to double-check the placement. I chewed on a big wad of gauze to keep from closing my mouth too far.

Placement was good, so now it was time to cut off the ends of those rods. The lovely Vanna held the ends with a pair of forceps (aka tweezers) while Dentist #5 cut the rods with his handy drill. I heard a "click" as the first end cone was dropped onto the metal tray. I heard a second "click" as the next one was dropped.

Then I heard "uh oh!"

On the list of things one does not want to hear spoken during a dental procedure, "uh oh!" ranks right up near the top. I had just enough time to wonder what was wrong before I felt something tiny and sharp fall down into the back of my mouth. Vanna was jabbing at it with the suction hose but couldn't get a good shot at it, and was instead just adding to my gag reflex. The dentist was asking if he was to raise the back of the power seat, could I cough it up? I indicated that I thought that was a good idea.

Sitting upright and clutching at a trash can, I was able to cough up a little orange cone. The dentist stopped pounding me on the back and powered the back of the set back down. I was ready to get back to work, as was the dentist, but Vanna had to let her hands shake and apologize about twenty times before she was ready. I told her it was nothing. Heck, I've swallowed less pleasant things by choice before. That made her blush for some reason.

Dentist #5 proceeded to drill around in the tooth some more, shaping it for what came next. Vanna kept the suction going full blast, so nothing fell anywhere it wasn't supposed to. Using something they called a miracle mix, which as near as I could tell was simply yet another quick-setting epoxy, they filled in the gaping hole in the tooth and sculping me a nice temporary biting surface.

He explained that this officially ended the root canal portion of tonight's program. The next step was the crown. Now, he could just throw the crown on and be done with it, and in many cases he would do just that. However, since I'd been having problems with infections and whatnot, he was worried that he might put the crown on, then tomorrow I'd develop some problem that would require him to rip it off to get to the, pardon the expression, root of the problem. This would be a lot of work and, incidentally, since it would ruin the crown, it would also be costly.

Or, the dentist explained, I could wait a day or two and see if problems developed, then come in for the crown. I decided we'd do that, and made an appointment for the following Monday.

Why the crown, you might ask? After all, the root canals are sealed and that epoxy made me a good biting surface back there. That would be enough, you would think.

Well, it turns out that it isn't. The epoxy, though tough, isn't as tough as tooth and won't last forever, though it will last longer than the temporary stuff they'd used before. Also, remember the function of the blood vessels and tissue inside the tooth? They supply the tooth with moisture and nutrients to prevent the tooth from becoming brittle and cracking. While the surrounding gums will continue to provide some of this, the tooth will still be weaker than it was before, especially considering all the parts drilled out during the root canal. A ceramic crown over the tooth will help protect it.

I'll let you know how that turns out.

Continue on to Part 6.

Copyright 2005 by Troy H. Cheek. Reprint with prior written permission only. Comments and questions to