Friday, May 4, 2007

Rooting For a Root Canal

You have to understand that at this point, I never ever expected to even get a cavity. Whatever the chemistry of my mouth is, it isn't a cavity-causing environment. (Gums, now, now gums were a different matter. Floss floss floss! Brush with a Sonicare. But even that I felt I had under control. I didn't even need to have more than the requisite "twice a year" check-up and cleaning.)

So it was with some combination of horror and ignorance that I got a toothache. I was polite about it, of course, just didn't complain TOO much, said that while it was certainly correctly called a toothe ACHE, it wasn't REALLY a toothache of the "electric cautering iron fall down on your knees in shock" kind of a toothache. But actually in that, I was fooling myself...this was a genuine toothache (of the "it's going to be very expensive" kind), as I gradually was to discover.

After a weekend of trying every natural/alternative pain relief method I could find on the Internet (none of which worked, by the way), it was finally simply a dose of Aleve that I took late on Sunday night that did the trick. I was even able to go to work on Monday, and then go see my dentist on Tuesday, embarrassed at even coming in at all, me with the trouble-free mouth.

My dentist sat down in front of me and very patiently listened to every word of the history of my complaint. While I HAD hurt before, I tried to minimize it, because the truth was I didn't want it to be something serious. I hoped he would have a perfectly decent explanation for the whole thing, such as, "There's some kind of new strain of flu going around that makes the teeth ache, but as it has now stopped, you've probably kicked it." You know, something like that, the explanation of "you had something, but now you are well."

However, what he said was, "It sounds like you might have a cracked tooth. Those are very hard to see, but let me examine you carefully." And what his careful examine revealed was that I did, indeed, have a fractured molar.

That sounds serious, doesn't it? That sounds like something you can make other people cringe with when you say, "I really had a right to complain about my pain, I had a FRACTURED MOLAR!"

"Okay...so what do you do about a fractured molar?"

He explained the process of holding the tooth together with a crown that also capped off the top so that bacteria couldn't get into the tooth's root through the crack. He talked about how it was a two hour job that entailed him having to grind the tooth down in size so that a cap could fit over it with the whole thing ending up no bigger than the size of the original tooth. I was thinking "crown, hum, that's a procedure level III on my dental plan, they only pay half, how much is this thing going to COST me, anyway?" but I said nothing about cost, only specified that I wanted the cap to be porcelain (well, it's going to be porcelain over metal).

Okay, so I left the dentist depressed about how I was going from perfect teeth to now having one of them half-way to artificial. How did I suddenly get into "procedure level III" territory? Well, a fractured tooth can happen at any time, particularly a molar, although I have no idea HOW this particular thing happened to me, or when. It could have happened a long time ago, slowly getting worse, until now it was noticeable.

In the week I had to wait before my first appointment for the crown, my tooth pain came back and I had to take ever-increasing doses of Aleve in order to get through my days at work. However, miraculously (I thought), the pain stopped by that weekend, so I didn't need to take any more pain pills. Apparently, though, that was really a bad sign.

I will say that the "novocaine-receiving, tooth-grinding, impression-taking, temporary-crown-making" process was utterly UNpainful...well, I guess I really thought as much (in these modern days of dentistry) and only worried about receiving the novocaine shot, but even that didn't hurt one bit. However, just because nothing HURT didn't mean that the procedure wasn't quite uncomfortable and stressful. I was prepared for it to be much worse than it was, though. I thought I would have to lose myself almost entirely on a meditative-like visual journey similar to what I had to do in order to not become a raving sceaming claustraphobic maniac during a couple of CAT-scans I had to have a few decades ago. I was prepared to just go into a mental trance and ignore everything that was being done to me until it was over. However, really, thanks to the "local anaesthetic" (apparently "novocaine" is not really correct, they use something else), I could have just placed full attentive consciousness on the whole procedure. In fact, I wonder if it would be of benefit to someone having this done to ask to be shown all the instruments and devices that were going to be used for this, because whereas I had previously been afraid and didn't even want to LOOK at anything, it ended up that the extreme mystery of everything made the experience worse than it needed to be.

Definitely, for me, the very worst thing was this rubber-spongy-prop-open kind of thing that my dentist jammed into my widely-stretched open mouth like a medieval bondage brank. It's purpose was mainly to keep my tongue out of the way (that my dentist described to his assistant as an "aggressive tongue," and I thought to myself, "Yes, you ought to ask my lovers about that"), but it all but threw me into a panic. I couldn't imagine that I could tolerate that thing in there for two minutes, let alone two hours, and the helpless, frightened feeling it gave me immediately threw me onto the brink of panic. However, thankfully, I was able to get a grip on my mind and float off into my meditative visualization and did not lose my mind, but pretty much got so I forgot about the thing in my mouth soon enough.

The very best thing that happened, and I admit that it is odd for something like this to give so much pleasure, but I absolutely LOVED the taking of the impression of my teeth. I think this is something that can really scare some people (like the mouth-prop-open thing did for me) because it flickers toward their gag reflex, but because the whole back half of my mouth cavity had no feeling at all, I was only conscious of the device around my front bottom teeth. In a strange way it was at first quite erotic, as if my teeth were a penis and the impression material contained within this curved holder were the depths of a vagina; it was amazingly pleasurable to sink my teeth right into it. But then I understood that this was more comforting and embracing than it was stimulative of a sexual thrusting power, so I realized it was more like being back in the womb. I felt so thoroughly held and embraced and loved by this thing and I never wanted to come back out of it. But even the eventual taking of it off, the way the dental assistant had to rock it a little and the sensation of the suction of the material against my teeth as it released its grip, that felt good, too.

But all the rest of it was one long session of grinding, grinding, grinding, and the sizing of the temporary crown was that, too, grinding and grinding and grinding, over and over again, until I finally felt that it was no longer sitting up too high in my mouth. Determing that, though, was along the same order of difficulty as deciding which ophthalmolic lens is better, "this one or this one" during an eye exam. "I don't know! Let me the first one again. And now the second one again." Back and forth, back and forth.

The dentist informed me, though, that although he had now taken the impressions and carved my tooth down to size, he wasn't going to order the crown from the lab, yet, because there was some troublesome motion in my tooth and he wanted to send me to an endodontist, first, for a consultation. I thought this meant the consultation was to determine whether I needed a root canal, or not, which, if I did need one, the endodontist would be the one to do it.

Despite my now having to leave one dental office and make an appointment for another one, I lucked out in that the endodontist was able to see me more or less right away. He just had to eat his lunch first, said the front desk person, but that would give me time to get there.

It wasn't that far away...I had to go from Mid-Wilshire over to Century City.

The endodontist was surprisingly young and handsome. I don't know what I had expected, but this was a pleasant surprise. He proceeded to examine my condition by testing me for feeling with a probe and then with something that was cold. I felt that I was passing the test by not feeling any pain or cold, except I did in some places, and I reluctantly indicated those areas, feeling that those were failures, but actually, I was failing, because my lack of feeling meant that the nerve in my tooth was dead and where I did feel something were areas that were peripheral to the fractured tooth.

It ended up that this consultation was not to determine whether or not I should have a root canal, but whether I COULD have a root canal, or should the tooth be EXTRACTED. The root canal was the "better" of the two choices. I was so shocked to realize that not only had I entered into crown and root canal territory, but that I had even gotten into possible tooth extraction territory. So now the idea of the root canal (something I had understood that I should be very afraid of) was actually something to be happy about and to WANT! So I went into that procedure gladly and actually, it didn't hurt me one bit, either, and neither did the four shots of local anesthetic I received in preparation for the procedure. Also the root canal work was much less stressful and uncomfortable than the crown work.

After my mouth and face had been numbed by the anesthetic was when the front desk woman happened to come in to inform me that while my insurance policy covered root canals (I know they pay 50% after I meet the $50 deductible, but their total coverage for one calendar year is $1,000 and I have no idea how much they have already covered for my routine exams and cleaning, and I don't know what the crown will cost), they required a pre-authorization for the procedure. Somehow that meant that they weren't able to tell the endodontist billing person over the phone that day how much of the procedure the insurance company would cover and how much was my portion, so the upshot of it all was that I had to pay for it in full today, and the medical office would file a claim and the insurance company would pay me the portion that would have gone to the doctor. And the full amount was $1,300. Okay, whatever, yes I could pay that today.

Once the money piece was settled, the root canal could begin. There was one thing peculiar in this procedure to me, something unexpected, and that was the aspect of the dental dam which at first appeared from my fore-shortened view to be something like a big yellow balloon that the endodontist presumably was going to attempt to stuff into my mouth. In actuality (I say without having looked at it from a normal perspective), I ascertained that it was somewhat like a flexible latex ring that was bigger than the circumference of my mouth, with a molar-sized hole in it over near the outer edge of the ring. The tiny hole was stretched down around the tooth itself, isolating it from the rest of my mouth, leaving it protruding up all by itself to be worked on above the field of the dental dam.

The endodontist told me that a molar would have three or four roots, so I was counting the number of times he drilled in order to ascertain when he might be finished. However, after the third drilling, he suddenly put all the tools down, ripped the dental dam off, and left the room, saying he would get back to me. He closed the door behind him and left me there alone, bewildered by myself in the closed room. I felt that this could not be good.

When he did finally come back, he told me that he couldn't finish the root canal today, that there was so much pus and active infection inside the tooth that he wanted me to undergo a course of antibiotics, first, to clear all that up. Up until that time I had had no idea that this infection due to bacteria getting into the root via the tooth's crack was so bad, but already it had killed the nerve and who knows, it might have even damaged the bone (which is what I believe my tooth's motion had indicated to my dentist). I could see that this fractured molar was getting to be more and more serious than I had ever thought.

The traffic back home was horrible, hardly moving at all, and I saw that I was nearly out of gas. I wasn't familiar with the locations of gas stations in that area, so I took the first one that I finally came to, a Mobil station that charged $3.90 a gallon. If I weren't already depressed enough over all these tooth difficulties, it cost me more than $50 to fill my tank and I see that we really are on the brink of paying $4.00 a gallon these days. Suddenly I felt very poor and helpless against a rising tide of difficulties.

I was supposed to start the medication right away, plus I was worried about what I would feel when the anaesthetic wore off, so I was eager to get my prescriptions for the antibiotic and pain pills filled. Rite Aid was inescusably slow, until it was as stressful to sit there in their waiting room as it had been to be in the dental chairs. They said the prescriptions would be ready in an hour, but it ended up being an hour and forty-five minutes. The extremely low price was very pleasant, though, $16.00 for three prescriptions, thanks to my health insurance plan (and dispensing generics instead of brand name drugs).

By the time I was finally home, it was after 6:00. I really had spent ALL day on all this dental work.

Later that night, my dentist called me to seriously discuss the ramifications of my procedures and to help me decide how to proceed. He was very worried about the fact that it seemed 50/50 regarding whether I should finish with the root canal and crown or instead have the tooth extracted and have an implant made and installed. If I chose to try to save the tooth, that is, finish the root canal and have the crown, but then later complications arose so that the repair work failed and the tooth had to be pulled after all, the insurance coverage wouldn't cover any of the repair work. An extraction and implant would cost $2,100 he told me, and I would have to cover that entirely by myself.

But ultimately, I care more about saving the tooth than I care about the money. Which in a way is strange, because the tooth seems pretty much gone already. The endodontist did not put the temporary crown back on, because he said if the infection flared up, it would hurt me like hell for him to pry the crown off, so he's just leaving it off until the infection seems gone. When the temporary crown had been in there (only long enough for me to drive from the dentist office to the endodontist office), it looked almost like a real tooth, but now what I can see in there is my ground down real tooth, looking like it was cut off right at the surface of the gum line. I guess in reality it is a little taller than that, but that's how it looks to me. So just about the only difference between the "crown" solution and the "extraction" solution is that instead of the crown being attached to a metal pin as it would be in the "extraction" solution, it would be attached to my tooth's root in the "crown" solution. Still, this is the choice that both the endodontist and my dentist recommend, so long as I understand the financial ramifications of my choice.

But I'm more positive than they are. While they see a 50/50 chance between their work succeeding or failing with this tooth, I feel that while a cracked tooth, itself, can't be fixed (it won't grow back together like a broken bone, and "cementing" it together and holding it with a cap is not as strong as the real thing), I feel that what could cause failure would be continued infection destroying more of the bone so that the bone can't hold the tooth in, but in my view, I CAN kill the infection, and BONE can grow back. So as long as as much of the natural components are still there, I feel that the odds are in my favor.

"It's good to think positively, I guess," said my scientific, statistically-minded dentist, but he didn't seem to really appreciate the power of such thinking. Okay, whatever happens. I'm still thinking positively. None of this should have happened, but somehow it did, but I'm not about to assume that the bad luck will just keep on happening like a column of dominoes. The bad luck stops here

3 comments:

Katty, Westside Dental said...

See the trick is to get a supplemental dental plan that will give you a price discount right off the bat. Then you file a claim to your insurance company for the rest. Check out this lady she did that and saved additional $1000 or so on her dental crowns.

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