Root Canal Treatment can save your broken teeth and roots!

Men are oinomaniacs and women are oniomaniacs; men love wine, women love shopping. What are people obsessed with teeth called - Endodontists, or more simply, root canal specialists! While studying to become an endodontist, we are trained in theory and practice on how to save the hopeless teeth - teeth that other dentists will readily extract to replace with an implant. However badly broken the teeth, whatever root pieces that remain - it hurts our pride to remove a tooth.

  There are obvious benefits of saving a tooth with root canal treatment over dental implants, that include both health and cost benefits. Did your child break his tooth while falling? Have you been carrying a broken tooth from some accident in the past? Has your tooth decayed and broken to leave just a small piece in your mouth? Have your teeth worn down to the roots with passing years? All these teeth can be saved by root canal treatment (RCT). Even if you have been advised to have these teeth removed for artificial tooth replacements - like dental implants or crown and bridge, you must ask your dentist once - is it possible to save these teeth with root canal treatment? Your dentist might seek a specialist (endodontist) opinion or himself lay down the pros and cons of saving the tooth. Then, as per his expert advice and your understanding of the treatment options, you may choose to either save the tooth or have it removed and replaced.

If you can survive it - RCT will save your teeth!

   Caps or crowns can be made on these roots after root canal treatment - giving it both the looks and longevity of your natural teeth. If you earlier lost some teeth and few of these roots remain, after root canal treatment they can be used to support dentures on them (overdentures). These dentures will be more stable in their place than the conventional dentures, that tend to keep falling out.

  You may wonder how a tiny piece of root can be used to support a full tooth crown, or even a denture. While you understand how a cap or crown can be made on a normal tooth, with broken teeth and roots its hard to imagine what will the crown or denture sit on! Because we do not have any crown structure to support an artificial cap, we take support both from the crown and root. 

   So are you afraid of having your tooth pulled out? Do you want to hold onto your natural tooth for as long as possible? Do you hesitate to smile because of your broken teeth? Or does the cost and time needed for a dental implant make your nervous? Thank your Endodontist - for it may not yet be time to dig a grave for your tooth!

'Take my Bad Breath away'

During the shooting of The Hunger Games: Mockingjay - Part I, Hollywood actress Jennifer Lawrence ate garlic and tuna fish and didn't brush her teeth before kissing co-star Liam Hemsworth! "I gave him fair warning", she said. While warning all people who come close to you might be an option, if you are looking for better (read more social) ways of getting rid of your bad breath, follow the tips below. 

 Bad breath, also called halitosis, may be a sign of many underlying health problems. However, 90% of the times it originates from the mouth only. Bad breath becomes a problem in socializing, with friends and partners, lowers your confidence and self-esteem and may be a precursor for more health problems to follow. So here's how to deal with it. 

• Gum disease, dental cavities where food gets lodged and dental abscesses are all common causes of bad breath. Get a dental checkup done to have these problems attended to. 
• Certain kinds of foods are associated with bad breath and you should avoid these till you feel the bad breath is cured. They include onion, garlic, meat, spicy curries, cauliflower, cabbage, coffee and dairy products. 
• Avoid smoking and alcohol for at least 2 weeks to curb bad breath. 
• Raw fruits and vegetables are rich in fibers that help to reduce bad breath and should be consumed more often. 
• Drink plenty of water and do not let your mouth feel dry anytime. This is the most common cause of bad breath in summers, in people who exercise in the gym and in children who spend a lot of time outdoors. It is not necessary to drink a glass of water every time. A frequent sip of water to keep your mouth moist may be enough. 

Common causes of bad breath or halitosis

• Another common cause of bad breath is prolonged sinusitis. Infected sinus contents drain through your nose behind the mouth leading to halitosis. To add to that, the anti-allergics commonly used to manage sinusitis lead to drying of the mouth - further worsening the problem of bad breath. See your physician for best management of chronic sinusitis. 
• Brush your teeth thoroughly twice daily - once in  morning and once before retiring to bed. However, brushing the teeth excessively may do them more harm than good. Your brushing technique should be proper, as advised by your dentist. Use a soft, small toothbrush to clean the back of the tongue gently every time you brush your teeth. The back of the tongue is the most likely source of your bad breath if your gums and teeth are in good shape. 
• Clean in between the teeth using a dental floss or interdental toothbrush at least once daily. Food debris frequently clings to these surfaces of teeth that cannot be cleaned by brushing alone. Bacteria in your mouth grow on these food particles to produce bad breath. 
• Rinse your mouth thoroughly after every meal. If you are taking all the above precautions, you do not need to brush every time you eat. Simply rinsing will tackle the bad breath.
• If you wear any kind of denture or appliance, make sure to clean it as advised. 
• Use mints or sugarfree chewing gums to stimulate salivary flow and keep your mouth healthy. Chewing on natural products such as cloves (laung), aniseed or fennel (saunf), cinnamon (dalchini) and cardamom (elaichi) also stimulates salivary flow and freshens your breath. 
• Many people troubled by bad breath resort to mouthwashes for prolonged periods. While it is best to ask your dentist about the mouthwash you can use, make sure your mouthwash does not contain alcohol. Alcohol dries up the mouth and adds to your bad breath rather than lessening it. Mouthwashes containing zinc have been shown to be particularly effective in combating bad breath. 
• Visit your dentist every 6 months or at least once a year for regular dental checkup and cleaning. 
• If the problem persists despite all measures, it is advisable to talk to your physician, as the bad breath may indicate an underlying disease. There are tests available to analyze the type and origin of bad breath. 

Sometimes its better to keep your mouth shut and let people wonder if you are a fool, than to open it and remove all their doubt. - Mark Twain

Getting a tooth cap or crown done? Know your options...

While we all love Jack Sparrow for his morbid ways and enticing smile, how many of us are willing to woo the damsels with metal caps on our teeth? Unless ofcourse, as Jack says to Elizabeth, "One word love: curiosity.... You want to see what it's like."

  In general, there are four types of caps or crowns that can be made for your tooth:

Metal crowns

1. Metal cap: This is a low cost, high strength option, but keep cosmetics out of the need here. The cap is generally grayish to silver in color, but can also be made in gold - provided you are willing to pay for your ostentatious choice. Now losing its appeal to ceramics, many pirates who have sailed with Jack Sparrow still demand it; and many dentists - because of its proven longevity.
2. Metal - Ceramic cap: This type of crown has metal inside for strength with tooth colored ceramic or porcelain fused to the metal on the outside. These types of crowns have been in use since the 1950's and have been a favorite with dentists and patients for their reasonable cost and cosmetics. The cosmetics are impaired by the darkness of metal showing at the margins, through the cap itself or when the overlying ceramic gets chipped or worn away with time.
   
   

   

   Metal - Ceramic Crowns

3. Cosmetic Ceramic cap: Full Ceramics, though relatively new, are set to surpass the use of metal - ceramic crowns. The major reason for this is their natural tooth-like appearance, and the ability to maintain that cosmetic value over time. The cost is definitely more than metal - ceramic cap, but then you cannot 'put a cap' on beauty. The only question here is of their strength and longevity. The best brand in this class of dental crown materials, as of today, is IPS E.max.

   

   IPS E.max: High on Cosmetics

4. Zirconia Ceramic cap: There is a wide range of materials in full ceramics used today in dentistry. As a universal rule, whenever the material is stronger, it is less cosmetic in terms of giving you the natural tooth appearance. Zirconia crowns are the strongest (and costliest) of all materials, but their natural appearance will be less than the cosmetic ceramic crowns like IPS E.max (however, still better than metal - ceramic caps). The most common brands - Lava and Bruxzir warranty their crowns, but the warranty may not cover all possible problems that can arise with the capped tooth.

'The Hammer Test' claimed by Bruxzir

Lava crowns and bridges

  So where does this leave you? In today's world where people are changing their smartphones and jobs with every new opportunity; where brands are endorsing their added features more than the standards of originality; it is hardly surprising that full ceramic crown is the rising trend. Is that a wise choice? While there is no substitute for the dentist's judgement for what is best for you, you must make your priorities clear to the dentist when you get a cap or crown done for your tooth.The best strength and cosmetics are the pride of zirconia crowns; while the best compromise of strength, cost and cosmetics lies with metal - ceramic caps. However, if cosmetics is what matters the most, for that beautiful, sparkling smile - there is nothing like IPS E-max. 

  

Mantriji goes to the Dentist

It all began with Mantriji donning the 'topi' a few years back. At that time, he had been in the pink of health and the parliamentarian attire dignified his authoritative persona. With passing time, his hairline had shrunk by what his waistline had gained. The Bills lay beneath the pills in his table drawer. But what happened when Mantriji had to be taken to a dentist one day? It is a tale of two T's: the 'topi' and the tooth.

  Now Mantriji's sweet tooth had always been an open secret and boxes of sweets poured in wherever he went. His physician had tried to admonish him, but could never himself catch Mantriji "sweet-handed". Only empty boxes lay strewn everywhere and Mantriji could not find place to put his feet on the ground!

  But, all the sweetness that Mantriji showered on his ardent followers, in return for the boxes, could not save him from getting a bad tooth. And the dentist was rung up in the middle of the night.

  The dentist, after making repute in his field, had decided to start his own practice recently and had sought Mantriji's blessings a few days back only. As a token of appreciation for his special box of sweets, Mantriji himself had come down to inaugurate the clinic yesterday. 

  The dentist was already awake, sitting right next to his phone when it rang and readily opened his doors to Mantriji's car waiting outside. The dentist bowed down to greet the first patient of his private practice, and Mantriji acknowledged by setting his pious feet down in the clinic. Once Mantriji had settled down in the dental chair, the dentist found a big cavity in his tooth, draining right into the roots.

  "Ah, this is where all the sweets have been going down the drain. Dont worry Mantriji, we will fix the tooth for you."

  "But if you fill the cavity, where will I keep the sweets then?"

  The dentist thought for a moment. This was certainly something they had not taught him at the dental school. He could not let his first patient walk out with a cavity and without a cavity. But then the idea struck him.

  "Mantriji, what about your topi?!"

  "Oh no no. All my disciples bow down before the topi every morning. I cannot put sweets in the topi. It will spoil their health"

  "Ok, then, how about I put a cap, er, I mean a topi on your tooth! And if you want, we can make it in ceramic instead of khadi. The shine of ceramic will bring back your youthful persona!"

  Mantriji wasn't convinced. But, the dentist was not one to give up so easily. 

  "Mantriji you will have two topis then - one on the tooth 'khaane ke liye' and one at the top 'dikhane ke liye' "

  Mantriji was mightily pleased with this suggestion and the dentist set off  to work immediately. After a few hours of drills and frills, Mantriji walked out of the clinic with a smile wider than his girth. The dentist too retired for the night, thanking the 'halwai' of the special sweets box. After all, Mantriji wasn't the only one who had mastered the art of "topi pehnana"!

Counting your root canal sittings....

Last week I had a new patient at the clinic for a root canal. As I waited for the numbing injection to take effect, we had a few moments to spare. 

 There are three kinds of people in these spare moments. One, the religious kind - who will pray to God to walk out of the dental clinic alive. Two, the social kind - who will talk to you about family, politics, sports and finally teeth to end the conversation with "Doc, have you ever yourself experienced a root canal?" and I do not know whether to sympathize or tell the truth! But the third are the spiritual kind - who will use those moments to remind you of your dental skills and how many patients have walked out of your clinic with a smile. I never understand spiritual words, and to me their words are always a threat to perform to the best of my skills and their satisfaction! Or do they really mean it that ways?

 This patient introduced me to a different plane of thinking. Of the two root canals he had got done earlier, one dentist had taken eleven sittings and another had taken three sittings; and "obviously if I could, I would go back to the first one because his root canal was better". And I have been praying and meditating ever since to make this third dentist his best in five sittings!

The first sitting - Drilling through the crown, Cleaning the roots & Stepping down the tooth from bite

 Conventionally speaking, and still practiced by many, a root canal takes three sittings followed by two sittings for its capping, add or take one to the total. Contemporary practice, strongly supported by scientific studies (One visit vs multiple visit approach to root canal treatment), advocates single sitting root canal treatment in many, but not all cases (add two sittings for capping). So if your tooth meets the clinical criteria for single sitting root canal treatment, you might be spending as few as three sittings with your beloved dentist; while in cases of more severe infections or complicated root canals, you might possibly start liking your dreaded dentist after six or seven sittings.

 So does it mean you are going to be poked a needle every sitting? No. Usually if your spiritual qualms have had an impact on your dentist to do his best in the first sitting itself, subsequent sittings will not require anesthetic shots - and they will not be painful either. (Is root canal treatment painful)

 Is there any way you can have it rushed up? You can request your dentist for a single sitting root canal - but it is up to his clinical judgement to decide for or against it. And if cost factor is not a deterrent for you, you may opt for a dentist with CAD CAM system in his clinic. That will have your cap ready in the same sitting. 

Shades of white: Tooth colored fillings

Rodney Dangerfield, the American comedian and actor, best remembered for his line "I don't get no respect!", once remarked "I told my dentist my teeth are going yellow. He told me to wear a brown tie!" Well, the world has changed and respect is no longer in wearing contrasting ties but having matching fillings in your teeth. 

 We come across "tooth colored fillings" in a lot of marketing campaigns and cosmetic magazines. Patients demand that their teeth be restored with "the tooth colored filling". Treatment cost for these fillings spans the pennies in your pocket to whatever's in the wallet. So here is a run down on the three types of tooth colored fillings that your dentist may be referring to. 

1. Tooth-colored Cement filling. This is a low strength filling material that can be quickly done at the chair-side. Best used for fillings in milk teeth and fillings at the junction of your tooth crown and root, they have a limited shade range and are not exactly tooth colored. They have been used for decades in dentistry and are the go to fillings in many situations. 

• Technical Name: Glass ionomer cement
• Good: Releases cavity-preventing fluoride, Chemically attaches (bonds) to the tooth
• Not so good: Low strength, Poor cosmetics
• Cost: Minimum
• Additional reading: More about tooth colored fillings

2. Tooth-colored Composite filling. This is what your dentist should actually be doing when you ask him for a tooth-colored filling. Your dentist minimally drills the tooth, packs the cavity with composite, strengthens it in place within seconds using light and polishes it for you to walk away with a beautiful, healthy smile. 

• Technical Name: Resin-based Dental Composites
• Good: High strength, High cosmetics
• Not so good: Needs refurbishing/ replacement every few years
• Cost: Worthwhile
• Additional reading: Bonding in dentistry

3. Tooth-colored Ceramic filling. If you thought ceramic was only for crowns and bridges, you are missing out on the best material for your cavity. It is done where other fillings will not work, it is done where other fillings will not last and it is done where other fillings will lack the beauty of it all. 

• Technical name: Ceramic inlays/ onlays
• Good: Best in strength, longevity and cosmetics
• Not so good: Requires multiple visits to the dentist and more tooth drilling
• Cost: Substantially high
• Additional reading: Inlays and Onlays

Does scaling weaken the teeth?

Of all the treatments that are available for a dental patient today, cleaning of teeth is simultaneously the most innocuous and infamous - at least for the first timers. This simple procedure, called scaling, where tartar or calculus deposits are removed from the gums and teeth, gives your teeth a life and your smile a shine. Many patients however express their concern that this procedure will weaken their teeth. 

 Over the years, I have tried to dwell deeper into the roots of this notion and have found there are indeed reasons for it. Reasons that I cannot refuse, but reasons that I can refute. 

1. Teeth start to shake after cleaning. So you never went to a dentist before for cleaning of teeth. Or your dentist told you to get it done before but you could never gather the courage for it. This sitting your dentist said its now or never. So you get it done, and your lower front teeth start shaking. Undeniably scaling weakened your teeth, right? In actuality, years of tartar deposition have pushed your gums away from your teeth. The tartar at this point, was what was holding your teeth firmly in place. And your dentist removed it so that your gums may once again embrace what was always theirs - the tooth roots. While it will take a couple of days for your gums to hug those roots after years of separation, you should celebrate the reunion with the beautiful smile that scaling gave you! 
2. Gums bleed more after cleaning. This is the gums baring their blush for all the missed hugs and kisses. Let the blood flow! If you have learnt to brush and floss properly now, the bleeding will stop in a couple of days. The bleeding should not be a reason for you to be softer on your brushing and flossing. 
3. Teeth become sensitive after cleaning. And the gums, now overwhelmed with emotions, ask the tooth, "What makes you so sensitive now?". The tooth readily admits, "When you used to hold me once, I never realized the depths of my own sensitivity. It is only when calculus had pushed you away from me and my roots are now exposed to the fury and coldness that lies in this world, that I need you to protect me once again." And the gums promise, "We will, we always will......as long as you take care of us!"
4. Spaces between teeth that were not there before. Because tartar or calculus forms very slowly, taking months to years, we do not realize when it has pushed the gums away and taken its place. We realize it only when it is removed as a chunk during scaling. 
5. Scaling weakens enamel. Scaling, being the innocuous procedure it is, cannot damage the hardest substance in the body. It will, however, expose roughness in enamel which is removed by polishing after scaling. 

 The right hug can give life to your teeth. What do you want it to be - tartar or healthy gums? 

Root Canal or Dental Implants?

If you have a bad tooth, how far will you go to save it? Or would you want to save it at all?

 As a root canal specialist, I openly admit my bias to attempt to save every tooth; rather than remove it to be replaced by a dental implant. And I also know of dental implant specialists who say that dental implants are a replacement option for missing teeth, not a replacement for teeth per se. (Not so fast with Dental Implants). That is to say, if you have already lost a tooth, dental implant is the best substitute option. But if you have a tooth that can be saved by root canal, here are 5 reasons why you should save your tooth:

1. The world is going "natural". Alternative medical disciplines, that believe in nature's cures, are gaining popularity everywhere. The world is moving from fertilizers to organic foods. Science is accepting that tuning into nature relaxes more than popping pills for every ailment. Vegans and animal right activists are campaigning for the cause of nature. When the whole world is going "natural", do you want to lose your natural tooth for an artificial replacement?
   
2. Health is wealth. With the excellent benefits they offer, dental implants cannot still stand up to the natural teeth in terms of health and function. The biggest health problem that loss of a natural tooth poses is loss of the bone at the place of the tooth. And while dental implants do exceptionally well compared to bridges and dentures in this regard. there is nothing like your natural tooth for the health of jaw bone. And, root canal incurs less treatment expenses than dental implants.  
3. Time is money. Conventionally, dental implant treatment takes months for completion - starting with a surgical stage to the final capping stage. While capping is now, in many cases, immediately done after the surgery that places implant in your jawbone, so has root canal treatment evolved from a multiple visit to a single visit procedure. And, did i mention that root canal is more economical too? 
4. The million dollar smile! When it comes to looks, there is nothing that can match your natural tooth. While this may not be so relevant here on a bigger scale considering both a root canal tooth and a dental implant will require capping, minute aspects of cosmetics like "emergence profile" - how the tooth or cap comes out from the gums, are usually better for a natural tooth. Moreover, you may opt for the most cosmetic ceramic crowns for root canal teeth at a much lower cost than what you would have to pay for less cosmetic systems with implants!
5. What does Science say? Even medical science accepts the fact that a natural tooth is the best in terms of health and function. Also, there have been numerous studies comparing the success rates of root canal and dental implants - and all of them show similar results; with root canal faring marginally better in most studies (How long will my root canal last?). These studies also slay the common misconception that a root canal treated tooth will keep taking you back to the dentist and one day, you will eventually have to let the tooth go for a dental implant. In fact, a study showed that 12% of dental implants needed further intervention as compared to 1% of root canal treated teeth. (Root Canal or Dental Implant). 

 Dental science and technology has today progressed to a point where almost every tooth can be saved with root canal, provided you are willing to, because there are many adjunctive treatments to help in the worst of cases. Even root canal cases that have failed can be successfully re-treated (Endodontic Retreatment). So, are you ready to make the choice? 

The Better Bet??

The tooth's BFF (1) - Toothbrush

How mighty may a bristle and a thread be? David's sling hurled Goliath to the ground. But that was a sling. This is one thread called "floss" and a tuft of bristles called "toothbrush" we are talking about. This is you as David we are talking about - holding the thread and bristles in your hand daily morning, looking sleepily into a mirror. Wait. Are we talking about those tiny germs that you can't even see as Goliath? Goliath may as well have fallen himself on reading this!

As colossal as Goliath?

 Here is what you need to know about your first dental buddy - the toothbrush. 

1. Your toothbrush is important. A quick finger rub over your teeth is not an alternative. It may be quick, but it only cleans your finger - not your teeth. Rinsing before going to bed, just because you will anyways brush the next morning, is not an alternative either. While sleeping, you make less saliva which makes your teeth more prone to decay. Using a mouthwash in the hope that some fancy chemical in it, whose name no one understands, will kill the germs is also not an alternative. The germs deposit a thin layer of plaque on your teeth that can only be removed by your toothbrush. 
2. Select a soft to medium brush. Ultra-soft bristles are for sensitive teeth and will lack cleaning effectiveness, while hard bristles will damage your teeth. 
3. Select a smaller sized brush. Smaller head brushes will reach till the last tooth and even its back surface. They will clean better if your teeth are crowded. On the flip side, it will take you longer to brush all the teeth with a small brush. If your last molars (wisdom teeth) are incredibly difficult to reach, you may keep two brushes - a small children's brush for the last ones, and a regular sized for other teeth. So much talk about children not having wisdom!
4. Do not overdo it. Brushing two times is good enough. Brushing after every meal is not usually necessary because if your meal had any acidic or citric foods, your teeth will be softer for sometime and get damaged by brushing. But make sure to rinse after every meal. Even if nothing acidic, it may have had broccoli!

   

   
   

5. Be a little possessive of your friend. Don't let it kiss someone else's friend in the toothbrush stand. Or you will be sharing each other's enemies (read germs!)
6. I used the word "little". If you try to encase the brush or brush head in a thick walled prison, a certain kind - and a very bad kind - of germs will be happily growing on the bristles, waiting for a riot to happen the next time you use it. 
7. So how to keep it? Rinse your toothbrush with tap water after brushing and keep it in an upright position to dry, facing away from other toothbrushes; or the toothbrush case should have some vent holes in it to allow air and moisture through.
8. Renew your friendship. Change your toothbrush every 3-4 months or when its bristles start fraying. If the bristles start to fray in less than 2 months, either you have evolved to have more than 32 teeth - or more likely are overdoing it. If they are as new even after 4 months, do you care for your friend? In case you get cold, sore throat or ulcers in your mouth, change your toothbrush once you are healthy again as your toothbrush will be carrying those germs still. 
   
9. Toothbrush design - criss-cross bristles, zig-zag bristles, multicolored bristles, circular bristles, magical bristles! A toothbrush is only as good as the hand holding it. If the brushing technique is good, even plain flat bristles can take down Goliath. In India, neem twigs were used and still continue to be used in some parts as a toothbrush. And the brushing was very effectively done by chewing on those twigs. 
10. Making new friends. Powered or electric toothbrushes are becoming common today. They are as effective and thorough in cleaning teeth as the manual ones, and sometimes even more fun. They are especially suitable for those with limited dexterity, as happens with age and special needs. For children who avoid brushing, they are a good way to get them into the habit.

 Your tooth's BFF - Brush, Floss and Fluoride. These friends are there to keep you from getting cavities, bleeding gums and bad breath caused by germs or microbes.

Your tooth's covering called enamel is the hardest thing in the body. It takes us dentists the hardest things known to man - diamond and carbide to drill through it. Teeth last centuries of burial and burn after death, and teeth are sometimes the only thing left of a body for identification.These teeth get damaged and destroyed by cavity causing microbes in a matter of few months. Now, isn't that being more gigantic than Goliath?

Is root canal treatment painful?

Dentists have been called lots of things. Of the good sounding are magicians and doctors. "Magicians" because someone said dentists put metal into your mouth and pull coins out of your pocket. About "doctors" I am not so sure. I think most patients call dentists Dr. So and So because of the fear of what they will have to endure in the hands of an offended dentist! And most dentists call themselves Doctor because otherwise nobody believes the "magic tricks"!

 But the unholier of the adjectives is painful. On his website www.hatedentists.com, Dr. Joe Bulger, himself a renowned dentist from West Toronto, puts pain as the most common reason for this overwhelming inclination in many. For some, the inclination is instinctive and they turn their back to a dentist even at a party when they have anything sweet in their cup. Its as if a word with the dentist will pierce a cavity into their tooth and they will never know if the tooth was softened by the sweetness of their cup or of the dentist's words. Others like to keep the sentiment synonymous with certain dental procedures; and root canal treatment (RCT) seems to be their first choice.

Root canal treatment is done to cure an infection in the tooth - the infection that is the cause of tooth pain. And if done in time, it will not be painful. So, as a dentist, am I shoving the blame on the patient - that they do not get it done on time? Or can it be painful even for those who stroll down on a leisure trip to us every few months? Or have you ever heard anyone say, "I came out of the dental clinic smiling after a root canal"? If you haven't, here are the reasons why.  

 Pain before the treatment - the anesthetic shot. This is the part of root canal treatment that is not painless for anybody. Depending on the tooth to be treated, you may need one or two pricks to numb the tooth and depending on the tooth to be treated, that prick may be painless or painful. With topical anesthetic sprays and gels and fine needles, the prick and the injection can be made almost painless in the hands of a good dentist. But if you want a "painless root canal treatment", the only catch (other than he being good at it) is to ask your dentist what local anesthetic system he uses, as the newer computerized systems maybe more comfortable for you. 

 Pain during the treatment - pins and needles. You definitely can boast of your leisure trips here. If treated at an early stage, you will not feel the slightest of pain during root canal treatment under good anesthesia. But if you have waited long enough for the tooth to become very sensitive and painful, the anesthetic is not going to have its full effect in the hands of the best dentist and the best system. Its not revenge being sought by the dentist for your long absence from his appointment log; its the chemistry of the anesthetic and biology of the infection that don't seem to like each other. The result is you will feel something pricking inside every time an instrument is taken deep into the root. 

 Pain after the treatment - hurts to chew. After the treatment there may be some pain on chewing from that side, but it is mild enough to be taken care of by routine pain killers. However, not every story has such a quiet ending - and those which do not are precisely the ones that have bequeathed a tooth-saving treatment like root canal its notoriety. Very rarely, the infection for which the root canal is being done, flares up after the first sitting. While this cannot always be predicted and prevented, what you must know is that you are safest getting your treatment done by a specialist (endodontist) or a reputed, experienced dentist.

 So is root canal treatment painful - definitely more than the regular dental checkups, making them justifiably "leisure trips"; and definitely less than the pain of "pleasure trips" - if you plan to get it done at your pleasure. Once a tooth is anesthetized, there is really no pain during or after the treatment. And the only reason no one ever said he came out smiling after a root canal is - because the lips were numb with the teeth so he couldn't feel his smile!!