In praise of modern dentistry

In praise of modern dentistry

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When I was a small child and had to go to the bathroom in the middle of the night, I would put the light on and one of the first things I would see were two sets of false teeth sitting in small glasses of water on the shelf above the sink. The teeth belonged to my mother and father, and I knew they took them out of their mouths before they went to bed and replaced them in the morning. So routine was this occurrence to me that I spent many minutes at a time searching my mouth with my fingers for the lever that would allow me to remove my teeth.

Finally I asked my parents, who clued me in to the eventual failings of teeth. I was, after all, the child of two sets of ancestors who had faulty choppers. Again, I just accepted this as the natural course of my life. One day I thought I would be toothless, too, except for a few lucky strays that remained in mouth.

Fast-forward more than half a century, and I still have almost all of my teeth. How did that enormous change come about? Dentistry is an area of health delivery that doesn’t get its proper due for the enormous advances from which we have benefited. The single best development that has preserved my teeth and those of the many millions of people around the world is the root canal procedure.

Now getting a root canal is a least favorite activity and deservedly so. But the journalist in me wants to tell the other side of the story, just to be fair. The patient I have been numerous times wants to salute the researchers and clinicians in dentistry. And although I am sitting at my keyboard in some pain at the moment from part one of a root canal procedure, which is what brought this subject to mind, I want to express my gratitude.

What exactly is a root canal procedure?

Although it’s not particularly difficult to understand, nonetheless it took centuries to invent. As I understand it, bacteria from a crack in the top of a tooth can get into the pulp below the naturally occurring enamel crown and cause an infection. Even if there is no infection, cold or heat or air can cause the nerves inside the tooth to register pain, which is an alarm.

The roots of the tooth have tiny canals in them in which the nerves reside. If the source of the intrusion that has stimulated the nerve cannot be repaired with a filling over the top of the tooth, then the pulpy decay below the enamel has to be cleaned out and the nerves have to be silenced to stop the pain. That is the function of the root canal procedure. After the nerves are removed, along with the site of any infection, the canals are filled with a sealer paste and rubber compound and covered with a dental cement to protect them from saliva.

All of the above is the job of the endodontist or specialist who uses the sophisticated tools high tech has invented to make this delicate procedure possible and the anesthetic to make it bearable. The patient must then go on, typically to another dentist, to have a crown or cap precisely fitted over the top of the tooth to replace the natural enamel. Crowns used to be made optimally of gold, but are now form-fitted with synthetic material that can be tinted the same color as the rest of the teeth, if necessary.

Interestingly, as a friend pointed out, there is something funny about the semantics involved. One goes to get “a root canal” even though one doesn’t receive “an appendix” but an appendectomy, nor “a tonsils” but a tonsillectomy. Perhaps the dental procedure should be called a “nerve homicide,” but that would only add more fear to an already fearful procedure. Well, that’s about the only funny aspect of this vital but still-dreaded tooth rescue.