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?