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Root-canal treatment: Need it be painful?

11th February 2012
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Dentists attending to a patient. (File photo)

Santias Gasolini had developed deep seated caries in both of his lower second molars. The bilateral condition with the distal walls of teeth missing and central trough-like features conveyed the impression that nature had carried out the destruction of the hard structure with the principle of equity to the fore.

No other tooth in Gasolini’s mouth had any trace of inter dental or central decay.

To the query, “Why is it that only two of your lower molars are affected by decay whereas the rest are without any trace of ‘rot’?” Gasolini answered, “I think I have an answer for that. Intermittent use of hard toffee and peppermint.” I would at one time be munching sweetmeat on one side of the mouth mostly around first and second molars. I would then shift the chewing of the same on the opposite side.

At least three to four toffees and peppermints in the mouth with the lower jaw regularly crunching into the body of the toffee gave my palate a lot of pleasure. There have been times when I carry out such toffee-peppermint switches during the night in bed, well aware that such a habit violates the norms of hygiene.

A few days ago I realized that I could no longer have the pleasure of over indulgence. The lower left side of the jaw gave me terrible pains and sleepless nights. I do not want to remove any of my teeth, come what may. I am prepared to go to any extent to have my teeth salvaged so that they remain in the dental arch for many years to come.

The notion of loosing one of my natural teeth is unacceptable. Doctor, tell me will you be able to save my teeth? I believe the lower molar on the right side is in similar predicament”. The Dental Surgeon (DS), in order to assess the tooth’s status percussed it with the handle of the mirror.

He asked the patient, “Is it paining?” Gasolini said, “Certainly. It is not in my system to over react, but please see to it that you don’t do that again”. The DS took the hint. Lifting a 12 inch ruler he said to the patient, “If O on this ruler is an indicator for no pain at all, 12 would imply unbearable and excruciating pain.

At what point of the scale would your pain that was elicited when I percussed your tooth come to?” The patient was not sure, “Doctor do you mean to imply the degree of pain?” The DS said, “Exactly. Tell me whether that was unbearable or bearable?” Gasolini said, “I would put it on the scale of 5 to 6”. The DS stated, “That certainly indicates that you are not at all comfortable. I shall begin by taking periapical X-ray picture of the lower left second molar. We shall do likewise for these right side”.

The dental X-ray pictures were taken with the cone of the machine positioned correctly so that the emerging rays would hit the film at right angle. The films were developed in no time. Both films were clear without displaying any artifacts. In both cases it was easy to see that the caries had totally exposed the pulp. The apical end of the roots had infection.

Gasolini was prescribed antibiotic and an analgesic with vitamin B complex for five days after which he was told that his Root Canal Treatment(RCT) would commence. Gasolini said, “I would like to start on my left side. The molar on the right is not bothering me at the moment”. The DS said, “We shall do that”. The patient wanted to know whether RCT would be completed in one sitting. The DS answered him,’’ It can be done.

However as a patient you will have to sit for about 4 to 6 hours at a stretch. This could be physically taxing for you. It is not easy for any patient to carry on sitting in the dental chair having a dental procedure carried out in his mouth for a duration of 45 minutes leave aside 3 or 6 hours.

Also, it is better to have RCT carried out in four to five sittings on alternate days. Each sitting normally is of about 45 minutes. There are other patients in the lounge waiting to have their dental treatment carried out. It would obviously cause a lot of inconvenience to the patients if they are told to wait for eternity. The alternate in form of small sessions ensures that the Dental Surgeon’s concentration remains totally focused.”

Gasolini asked another question, “Can you do RCT on both the molars simultaneously?” The DS said, “It is fraught with danger especially when one side is already anesthetized and half of the tongue on that side is numb. In such a situation the opposite side cannot be similarly anesthetized. The complete numbing of the tongue thereby would choke the patient and cause acute respiratory distress to him.

No Dental Surgeon would ever want such a horrendous situation to occur in his clinic. However, if after two or three sittings on alternate days, if there is no anesthetic utilized for one side, the canals of the molar on the other side can be opened by anesthetizing that side. This would save time for the patient and enable him to have RCT of both sides completed.” Gasolini went on, “Doctor is RCT very painful?” DS: “Not at all.

During the first two sittings the patient is anesthetized. During the latter sittings his pain threshold level will not be such as to make the patient wince. He can easily condition himself towards a mind-set that enables him to endure little discomforts.

As the RCT progresses and with the extirpation of remnants of the nerve the pain disappears outright.” Gasolini, “Why is it necessary to have a crown placed on a tooth which has undergone RCT?”

DS: “With the removal of the nerve and capillaries from the pulp and the canals the tooth becomes devoid of its organic component. The tooth, from being a vital portion of the dentition becomes non-vital. It is emptied of its contents. It is like an empty cylinder. Any force exerted on the tooth is likely to damage it. It could even fracture.

Of course a patient can carefully eat food equally on both sides and avoid very hard foodstuff to keep the tooth with the RCT intact in his mouth. However, with a crown placed on the tooth, the root canal treated tooth is fortified. It is strengthened to take up masticatory load more efficiently.

It is therefore more conducive to the dental health of the patient to carry out reinforcement of the tooth that has undergone RCT.” In the middle of January this year he came to the Dental Clinic to have his porcelain crowns fitted.

This was done without recourse to local anesthesia. Gasolini was immaculately dressed. He had a glistening golden medal on the left side of the lapel of his blue coat.

The medal had Tanzania’s flag on it with ‘50 years of independence’ embossed on it. The Dental Surgeon said, “You look very elegant. The medal on your coat is a collector’s item.”

Gasolini, without any hesitation, unfastened the pain of his medal and handed it over to the DS. He said, “Doctor, this is for you. You certainly deserve it. There is total painlessness now.”

SOURCE: THE GUARDIAN
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