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Root canal surgery - John C. Kirk

Mar. 22nd, 2012

12:41 am - Root canal surgery

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This morning I went to the dentist for root canal surgery. Proverbially this is supposed to be quite unpleasant, e.g. "that film sounds so bad that I'd rather have root canal than watch it". It certainly wasn't fun, but it wasn't as bad as I'd feared. For instance, my frenectomy and laser eye surgery were both worse. Anyway, I've hidden the gory details behind a cut tag.

As a side note, I looked at the posters in the window while I was in the waiting room: since these face outwards, I saw the mirror image through the back. I now know that the opposite of "smile" is "slime".
Edit: Actually, no, the opposite of "smile" is "elims" which is less amusing. I think I misread that because each letter in "lim" is symmetrical, so I treated them as a single unit when I was reading backwards.

A couple of weeks ago, I noticed a bit of an ache around my lower left wisdom tooth. It's twisted at a weird angle, so I figured that it was pushing against the tooth in front, or possibly trapping a bit of gum in between, and I was vaguely hopeful that it might be able to move into the correct position. Last Sunday (11th), this got a lot worse, so I couldn't get to sleep until 06:30. After the first couple of hours I went in search of painkillers: I had three boxes of ibuprofen, but unfortunately I discovered that they'd all gone past their expiry date. After another couple of hours, I decided to take a couple anyway, in the hope that they'd work. These are supposed to be taken "with or after food", and my empty stomach didn't feel too good after I swallowed them, but that did the trick.

The following day I bought some new drugs, and they lasted me until I could get in to see the dentist on Wednesday (14th). There are limits on how often you're supposed to take these (at least four hours between doses, maximum of six tablets per day), but I found that swishing water around my mouth acted as a reasonable substitute. Meanwhile, I noticed a slight "sucking" feeling in my upper gum: this didn't hurt, but based on past experience it probably meant that I needed a filling so I mentioned that to the dentist at the same time. As for the wisdom tooth, I decided that I wanted to have it yanked out: it's not doing me any good where it is, and if it's actively hurting me then I'm better off without it. (I've mentioned that a couple of times before, but the dentists have always told me to leave it alone.)

They took an X-ray, and both people (dentist/assistant) left the room, i.e. they retreated to a safe distance while I got irradiated. Intellectually I understand that they're more at risk from cumulative exposure, but it's slightly disconcerting. After that, the dentist said that my wisdom tooth looked fine but the tooth above it looked quite dodgy. (I'm paraphrasing.) She then asked "Does this hurt?" and tapped the upper tooth: it did. She said that people can get "referred pain", where it comes from a different part of the body instead. Anyway, she said that I'd need to come back in a week for root canal surgery to fix the upper tooth, and she'd book a hospital appointment to remove the wisdom tooth. She also advised me to cut back on sugar, and emphasised this: "You need to drastically cut back, because your teeth are rotting away." I gave up Coke in December, and I resumed WeightWatchers last Monday (12th), so hopefully that will help.

Over the following week, I noticed something interesting: my wisdom tooth area hasn't hurt at all. However, the top tooth has been extremely painful, and swishing water around no longer helps. In fact, that's enough to trigger pain. I stopped taking painkillers when I emptied the box, and I found that the best approach was just to tough it out. Any time I tried to eat/drink something (even water) after a long gap, I'd get a splitting pain. In one case, I was literally clutching at my jaw with one hand while I beat my other hand against the wall. However, this would pass after a couple of minutes, once my mouth had got used to the idea, and then I could eat/drink normally. So, pain is weird. How much of it was just psychosomatic, once I knew where it was supposed to hurt? Or did the dentist expose a nerve when she was tapping the tooth? At school I saw a hypnotist who simulated anaesthetic. (The girl who was hypnotised clearly wasn't faking it.) So, I'm willing to believe in mind over matter.

Anyway, I went back today for the follow-up. According to BUPA, this surgery involves removing all the nerve from the middle of the tooth, i.e. taking out every canal that leads to it.

I got an anaesthetic, but I could still feel it when the dentist started drilling so she gave me another shot. This is fairly common for me, possibly because of my size. I got at least one more injection later, and a "topical anaesthetic" (some kind of cream?) but I still had a bit of pain to deal with. I was aware that my back tended to arch in the chair, i.e. my shoulder blades were digging in, so I had to make a conscious effort to relax and lie back. The dentist leant her arm on my chest while she was working, possibly as a way to keep me still!

At one point the dentist said "Sugar". I've often heard people say that as a substitute for swearing, but I suppose that it may carry more weight for a dentist, if they view sugar as a nasty thing that causes damage. I'm not sure what went wrong, but I could appreciate her satisfaction when she successfully removed each canal.

One key difference between this surgery and previous dentist visits is that they used a "dam". This was a thin blue piece of plastic that stretched across the inside of my mouth and rested on my face. Presumably this looked a bit like a hammock underneath the tooth, so I didn't have stuff falling onto my tongue while they worked. However, the worst part of the process was that I had difficulty swallowing with my mouth open, so it felt as if I was choking. I could still breathe ok through my nose, so I just had to convince myself that I was safe and overrule my panic impulses. (Throat: "Help, I can't breathe!" Brain: "Yes you can, shut up.")

The whole thing lasted about an hour. After the surgery finished, the dentist got me to sign a consent form. This included an acknowledgment that root canal treatment is 80%-90% effective, i.e. 10%-20% of people will need to do something else. Presumably that involves having the tooth extracted, but hopefully I won't need to do that. It would have been better to give me this form before the surgery: I assume that was an oversight, but it wouldn't have affected my decision so no harm done.

I need to go back again next week to have a crown fitted: this is basically a hat that goes over the tooth, to stop it from splitting. Apparently it will be made of silver, so at least it won't be as "bling" as a gold tooth. Effectively I'll be the inverse Terminator: metal over an organic tooth, rather than organic tissue covering a metal tooth. If I'm going to turn into a soulless cyborg then I may as well chronicle the process from the start...

After I left, it occurred to me that I met two of the criteria from the FAST test (to detect strokes): my face was drooping on one side, and my speech was slurred. Fortunately my arms still worked ok. The anaesthetic had spread out as far as my lower eyelid, and it felt a bit strange to touch my face. My finger could feel my cheek, but my cheek couldn't feel my finger. The dentist warned me that the area might feel a bit tender afterwards, but there's been no recurrence of the old pain, which is good. However, it does feel as if I've got something stuck between my teeth. I wonder whether that's a similar effect: now that the nerves have all been scooped out from inside that tooth, I can only feel it pushing against the surrounding teeth and I can't feel them pushing back. It's a bit like being in an office during a powercut; you don't really notice the noise that all the computers make until they go silent.

The dentist said that there wasn't much left of my original tooth, so it looks a bit strange now. Here's a photo to illustrate it:

Teeth

(Sorry for the poor quality: it's surprisingly difficult to photograph your own mouth, particularly when you have to snarl at the same time.)

It's the rightmost tooth: the manky looking bit is original, and the white bit is all new. The replacement material is sculpted to match my other teeth, but little bits have been flaking off during the day. This evening I ate an apple, and I felt something hard on my tongue. I checked the mirror, and one of the new "prongs" of the tooth has snapped off. I hope that filling material isn't toxic, because I've been swallowing several bits of it. I also hope that the remainder of the tooth will last until I get the crown next week. For now, I'll try to eat with the right side of my mouth.

Anyway, I think I need to be more diligent about going for regular check-ups at the dentist, rather than waiting until there's a problem.

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Comments:

[User Picture]
From:susannahf
Date:March 22nd, 2012 08:22 am (UTC)
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Consent *after* the procedure? Definitely a bit dodgy. Had she explained all the stuff before? Even if she had, it's still a bit cheeky.

Also, FAST test. You don't need all the signs. Any of them can be a sign of a stroke. It's important people understand this! Most strokes won't have all three. In your case, it's not relevant - there's another obvious explanation for it. Just like I wouldn't assume someone of having a heart attack if they complained of central crushing chest pain, and had a big metal girder on their chest...
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[User Picture]
From:johnckirk
Date:March 22nd, 2012 11:36 am (UTC)
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She didn't mention the 80% thing until after the procedure. I'm calling it a consent form, but I can't remember what the actual title was; I just assume that's what it was supposed to be.

Good point about the FAST test, I didn't explain that very well. In my case, if I had coincidentally been having a stroke then the only symptom I could pay attention to was my arms, and they were fine.
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