Dental MythBuster #1 – Knee on My Chest?

Dental MythBuster #1 – The dentist pulled so hard he put his knee on my chest!

As a general dentist who routinely extracts all kinds of teeth, I’ve heard this story so many times that sometimes I am even inclined to believe it!  However, it is not true, at least not in the United States for the past 50 years.  I’ve heard this story everywhere I have practiced dentistry, from Buffalo, NY to my current city of Orange, CT.  The dental myth is documented on numerous areas on the internet, including here.

Funny Picture of Dentist Pulling a Tooth with Knee on Chest

Dental Myth – The dentist had to put his knee on my chest in order to pull the tooth.

When people hear this myth, the image to the left is immediately conjured up.  They envision a dentist with a rusty pair of pliers purchased at their local Home Depot, pulling hard with sweat dripping. The forces require that the dentist stabilize the patient with their knee. Variations on this myth include “legs on my chest”, “forearm on my neck” as well as my personal favorite “the dentist had two assistants hold me down to pull my tooth.”

The extraction of a tooth requires more “brains than brawn.”  It is not about brute force applied randomly nor haphazardly.  Extractions require the controlled, methodical, and timely application of forces in a variety of directions, with a pulling force being the least frequently used and least effective.  Tooth extractions use the concept of a “lever” which is a lesson most of us learned in high school physics.  A lever is a rigid object (in this case a piece of molded metal called a dental elevator) that is used with a pivot point (called a fulcrum).  The lever is placed against the tooth to be removed, and by rotating the elevator against the fulcrum, a large force is exerted against the tooth to be removed.  The force then “elevates” the tooth out of the jawbone without producing any pulling forces – and without a need for a knee to be placed on the patient’s chest!

Dental elevator extracting a tooth without need for pulling

A dental elevator being used as a lever – extraction occurs without any pulling motion.

The graphic to the left shows a dental elevator being used as a lever, with the fulcrum being the adjacent tooth.  A sideways and upwards force is generated using the instrument in this way. Note that there are no pliers here!  I (along with other dentists who extract teeth) can frequently get the tooth out with this motion only.  It requires only wrist strength and no muscles above the elbow are used.  And most importantly, it does not require the dentist to put his or her knee on the patient’s chest!

On occasion, some teeth require more than just elevation with a dental elevator to remove completely.  This can include sectioning the tooth into 2 or more pieces, cutting some of the tissue surrounding the tooth, use of dental forceps, and other techniques. The detailed descriptions of each technique are beyond the scope of this blog post. However, none of the techniques involve a pulling motion.

Steve Martin Dentist Little Shop of Horrors pulling a tooth

Steve Martin as a sadistic dentist

So the next time you hear this myth, call them out on it, as it is not true… unless their dentist is Steve Martin and they are living in the movie Little Shop of Horrors!  Or they resemble Dustin Hoffman and just recently were found acting the movie Marathon Man!

If you are in the vicinity of New Haven, CT and need your tooth removed, you can come see me. As promised, I perform all types of tooth extractions, some with IV sedation.  And I promise I won’t put my knee on your chest!

Stay tuned for another Dental MythBuster blog post in the near future!

 

Comments

  1. Ha Ha. I heard this story before getting my wisdom teeth pulled. They said the dentist would put his knee on my chest. I was scared because I couldn’t afford being put to sleep and we were going to do it with novacaine only and I was wide awake. I didn’t feel a thing other than pushing. The dentist didn’t do any pulling just a screwdriver thing to push them out. So you are right. I love the Steve Martin pic. 🙂

    • ncalcaterra says:

      Hi and thanks for the post.
      You are proof positive of two things:
      1. That the “myth” lives on.
      2. That it is just a myth – that is, you don’t need to stand on the patient’s chest to effectively remove a tooth!

  2. Great post! Unfortunately I have needed many teeth removed in my years and in all the times there was just pressure and twisting only. But all my friends continue to tell me the story of the foot on the chest even though it never happened to me and never happened to my friends.

  3. Thank you for the post. You summed it up perfectly – “pressure and twisting” are really the only sensations you feel when having a tooth extracted.

  4. Dr. Calcaterra, thanks so much for a great article. I love when my patients tell me this, whether about themselves or someone else. I look them seriously right in the eyes and ask, “Wow – so did they call 911 after the dentist crushed your chest in with his knee?” They look back blankly for a second until it starts to sink in – if we really had to use that much force, we’d crush their ribs and they’d have MUCH bigger problems that a tooth not coming out, like punctured lungs and heart. Not sure why they don’t think of that, but……..

    Kind of like the myth that wisdom teeth “push.” I mean……have you ever pulled wisdom teeth that had lots of muscles attached that they could use to push other teeth out of the way?

    And the whole, “The tooth roots were wrapped around the jawbone!” Well……..WHAT ELSE ARE THEY WRAPPED AROUND THAT KEEPS THEM IN PLACE!? Ummmmmm, hello! If it’s not bone holding them, what is? I sure HOPE their roots were solidly embedded in bone, although the ones that aren’t are a lot easier to pull, aren’t they?

    • Dr. Payet,
      You are another dentist who has heard the same myth. I have yet to meet a dentist who has NOT heard some variation on this story, and heard it multiple times.

      It is quite satisfying to have a skeptical patient and then remove their tooth using only an elevator. Up until then, they are convinced that you can ONLY remove a tooth by pulling as hard as you can. Maybe this blog post will help convince some skeptical patients. But I think this myth is so ingrained it will be tough to eliminate… it’s almost as if the roots of this myth are tightly wrapped around the jawbone!

  5. Kilashandra says:

    It isn’t just an urban legend. In 1985, I needed an extraction on an abscessed tooth. It was a small rural community with only one dentist – an older man with very large hands who had a reputation for being rough. He didn’t give me any anesthetic (saying that the abscess would prevent it from working anyway). He did put his foot on the chair between my legs and held me down with his shin – knee in my chest.
    When he went in to pull the tooth, he evidently couldn’t see properly (I have a very small mouth), and he pulled the tooth he intended to pull along with the tooth next to it.
    The ‘knee in the chest’ may more often than not be a myth or urban legend, but it does actually happen from time to time.

    • Kilashandra,
      That is an interesting story. Based upon your telling of it, are you sure this individual was a real, licensed dentist? There are lots of individuals in very rural areas who do “under the table” dentistry who are not real dentists. And those are the types who are more likely to employ incorrect techniques such as the “knee on my chest.”

      • Kilashandra says:

        He had a very old framed license and diploma – if memory serves, from Ohio State University – hanging in his office, so I am pretty certain he was a legitimate dentist. He was in his mid to late 60s when this event occurred (and he may have possibly been older. I was not good at gauging ages of older people when I was a child, and he died around 1993 from some geriatric related natural cause), so his schooling was likely around or just before WWII.
        It is unfortunate that he was a legitimate dentist, because people like him both cause a lot of trauma and give the profession a bad name. I know three people whose jaws were accidentally broken when he was working in their mouths.
        I refused to go back to this dentist after what he did to me, so when I finally had to have some work done when I was about 14, my family took me to a dentist in a neighboring county, and I was very, very frightened (now we call it PTSD); and that dentist told me to quit being such a baby (because I was shaking and had tears running down the sides of my face) then he slapped me – not just a little tap to try to help me regain control – a full force slap across the face.
        As an adult, I needed a root canal (and I have nothing against that procedure – by that point, I had had several root canal procedures with no complications). I did not have the same good fortune with that procedure. It was on an upper front tooth, and somehow while filing out the ‘root,’ some of the infected material was pushed up – and I can’t remember exactly how the hospital worded this, so please forgive me if I say this incorrectly – pushed up either into or through my sinus and was starting to spread into my brain. My memories of that are confused, because I went into shock about an hour after the procedure and woke up in the hospital getting IV antibiotics.

        As a result of all this, as you can imagine, I have a pretty severe fear reaction when seeing a dentist. I was very fortunate to find a dentist who was very caring and considerate. I remained his patient until he retired a couple of years ago. I have had a difficult time finding a new dentist – because it is hard to push past the trauma. It’s also not easy to find a dentist willing to work with someone who has so much trauma.
        Recently though, a friend recommended his dentist to me, and we had a consult last week. He seems like he is going to work out for me. He was understanding about my history – and he took the time to go over all my medical history with me personally. I got a very good feeling from him – he genuinely seems to care about his patients. My bad dental experiences are hopefully in my past.

        So, in closing, while it is only the barest sliver of a fraction of a percentage, the ‘knee in the chest’ is not merely a myth or urban legend; and if a patient presents to you citing it having happened in his or her personal history (as opposed to it happening to a friend or a friend of a friend), don’t discount it out of hand. The patient may very well be telling the truth. I also can’t begin to explain how much courage it takes to even go to the dentist for a cleaning after suffering that sort of trauma.

        • Kilashandra,
          I’m sorry you had to experience that. I am not doubting that you experienced this. He obviously did not know what he was doing. Regardless, the most important thing is that you were able to overcome the fear from those experiences and then move on.

    • This also happened to me. The dentist was pulling my front tooth when she put a her knees on the arms of the chair I was sitting in, she used her body for leverage. My tooth was not as loose as the dental assistant made it out to be. I don’t like dentist to this day. I have found a great cosmetic dentist and I go to him and only him

      • Janet,
        I wasn’t there for the extraction. However, if that really did occur, I can tell you that the dentist had no idea what she was doing. Even if you are an 80 pound weakling, you do not need to place a foot on the chest or chair for leverage.

  6. I have to disagree. I had an impacted wisdom tooth pulled that had a ball root on the bottom. I was layed back in a chair, my tooth was broken into four pieces, and each piece required the dentist to use what looked like a miniature pry bar, and his knee on my chest. The whole process took three hours. Afterwards, I was black and blue from my eyeball to below my collar bone. This dentist was also a well renowned dentist in our area, so I don’t know how this would have gone with a fly by night operation.

    • Ben,
      Your description of lying back in the char, having the tooth broken/sectioned into smaller pieces, and a crowbar like instrument being used are commonplace and routine. Having a knee placed on your chest is completely and totally unnecessary to remove pieces like that (or extract any tooth for that matter). So either the dentist was completely incompetent or your account is being greatly exaggerated in order to make the story sound more interesting. Only you know the real truth.

      • Well I will tell you that in a very small town in Coolidge, Az there was a dentist that DID actually put his knee on my chest. The nurse also DID have to help him hold me down. It was NOT however because he couldn’t get it out. It was because I was coming out of the chair! The Lidocaine did not work. My tooth was in 5 pieces because he broke it. He actually had to cut into my gum to get it out. I was from the pain that I was coming out of the chair not because he had to pull so hard because it wouldn’t come out. It wouldn’t come out in one piece but that’s a whole different thing. So yes I am sorry it IS true that at least my dentist about 10 years ago DID put his knee on my chest to keep me in the chair.

        • What you are describing is a procedure that did not go the way it should have. If you were moving so much he had to put his knee on your chest, then the procedure should have been stopped. It is common for an assistant to stabilize the head during the procedure. If everything you are saying is true and not an exaggeration, then that is unfortunate.

  7. Kate Richardson says:

    I didn’t have the dentist (yes, licensed) put his knee on my body, but DID have him put his knee on the chair in an attempt to pull a tooth which had curved roots that allowed the tooth to move back and forth (and break) but not come out. This went on literally for hours–past the time his office closed–on a Friday. The dentist was in the Statesboro, GA area–I can probably find his name with a little digging. The year was 1997. Eventually he decided the tooth just wouldn’t come out and called a cosmetic surgeon friend of his–who wanted several thousand dollars I didn’t have to even look at the mess in my mouth.

    Instead I went home and my whole head swelled up and bruised. It hurt to breathe–honestly. As my husband was military at the time, I went to the military ER where they called in a military dentist. She opened the clinic several times over the weekend to give me shots of long-acting lidocaine. (Regular narcotic pain meds and NSAID’s weren’t even touching the pain I was experiencing.) On the following Monday, the head of the military dental clinic (Ft. Stewart, GA) made an exception to the “active duty only” policy, made a tiny cut in my gum which required a single stitch, got the roots loose, the then broken tooth out (with no pain) and sent me on my way.

    After that I never even had a filling done by anyone who wasn’t an actual oral surgeon. And any of those or endodontists were ones my primary care doctor or oral surgeon actually went to themselves–not just some colleague or friend from college.

  8. I agree that this isn’t commonplace, but I’m sure it happens in rural areas still. About 4 years ago, in the US Virgin Islands I was 16 years old and had my first root canal, my dentist cemented the crown on it (after my recent experience getting another crown in the mainland US I even question every aspect of how he did this) only to realize he didn’t make sure it was level. So he spent a good 30 minutes trying to pull it out of my mouth and did place his knee on the chair to get leverage. In the end, he didn’t get anywhere and just filed most of it away and charged us the same price : /

  9. Hi

    I happened onto your blog because of a search about a friend’s hypersensitivity to novicaine epinephrine but I clickef on some other things while here. I just wanted to say that a dentist needed to do the knee on chest thing to me oncr in 1996. She was a small person and it was a wisdom tooth extraction that was extremely difficult because of the angle and of them (they were coming in very askew) and my small jaw with tightly spaced teeth. I had one other extraction in my life and that dentist also had an extremely difficult time and called in help and extra tools to complete the extraction although no knee to chest this time. The dentist who did do the knee move asked me politely before doing it after struggling a very very long time with the extraction and she didnt hurt me at all. She said she had never had to do it before and seemed upset that such drastic measures were needed. She didnt hurt me and was an excellent and compassionate dentist, not remotely a sadist. So I just wanted to say it may be extremely rare but it is still a real thing.

    • Also….it was more of a bracing thing. She didnt rest her bodyweight on me at all. She just needed brace herself at a certain angle that was challenging for her to get leverage. She also showed me the xrays later and discussed with me in detail that my wisdom teeth/jaw had a deformity that caused them to grow in sideways 90degrees from normal … underneath my other teeth. She had never seen that before. She was concerned that I would have future problems there if the teeth grew into the jawbone further. I am grateful to her for rising to the challenge and bracing her knee against me didnt bother me then or now! She is a fantastic dentist. By the way, my father had a similar jaw/wisdom tooth malformation so I think it’s a freaky genetic thing.

  10. Just wanted to let you know that some of what you’re describing in this article definitely does happen, and not just in rural towns. I grew up with a wonderful, gentle dentist, and very few problems with my teeth. At 20 years old and in college in Akron Ohio in 1995, with college dental insurance, I was told during a cleaning that I needed a tooth pulled. In hindsight I should have gotten a second opinion, since I knew that tooth didn’t even have a cavity two years prior. But I was young and inexperienced, and it never crossed my mind that this dentist wasn’t as trustworthy as my Dr at home had been. The day I went in for the procedure was fine, until the procedure actually began. The dentist was in his late 60’s, early 70’s, and started to pull the tooth even though I wasn’t completely numb. He put the instrument around/on my tooth, his other hand on my forehead, and just rocked the tooth back and forth for what felt like a loooong time. I had tears streaming down my face and was motioning for him to stop because I could feel the root up into my jaw, but he just snapped at me to lie still and be quiet. The tooth wouldn’t come out, and his next step was to put a knee up on the chair beside me and throw his whole body into it, with his hand still on my forehead as my head jerked back and forth. It was even more terrifying than it was painful. When the tooth finally came out he told me never to come back if I was going to act like that. I couldn’t answer, tears were still streaming down my face, and as i went out front to pay the office staff was so upset they wanted me to stay while they called someone to file a complaint. It was horrific, and the single reason that I chose IV sedation to have my wisdom teeth out years later.
    My dentist now is a gentle, experienced, and kind man. He recently pulled a tooth for me (the only one I’ve needed extracted since, and he thinks that it was damaged by the poor extraction of the other) with only local anesthetic, after he explained how simple an extraction ‘should’ be. It was a great experience to replace the other one burned into my memory.
    So, I want to encourage you not to dismiss someone’s claims of something like this happening directly to them. If I came to your office and was brave enough to share this terrifying memory I have (and I’m a person that’s afraid of very little, generally), and your answer was to tell me that it couldn’t have really happened, that would have so discouraged me.

    • Maria,

      Regardless of the exact details of your history, it sounds like an unpleasant experience that no one should undergo. It’s unfortunate that happened to you.

      You appear to be selectively twisting parts of what I wrote. First, I deal with phobic patients all the time – patients seek me out over this – I do IV sedation which very few dentists do – and I always empathize. I would never directly contradict what a patient tells me directly. Secondly, you wrote that the dentist put his knee on the chair. There is a big difference between a knee on the chair versus putting a knee on your chest.

      For a healthy dentist/oral surgeon with a patient in a traditional dental chair, there is absolutely no reason why a knee should be placed on the patient’s chest (or chair). The term “pulling” a tooth is actually not accurate, as there is little to no pulling that needs to occur to get a tooth out. It is a selective application of forces that actually takes very little strength. No competent practitioner has a need to do this with his/her knee.

      I was not there for the procedure. Perhaps, since the dentist in question was in his late 60s/early 70s, he had an orthopedic issue that prevented him from using proper technique? I don’t know.

      In my own experience, I call tell you with 100% confidence that patients have selective memories and can/do/will embellish facts over time. With time, the root canal that I did that took 1 hour and 2 shots all of a sudden became, in the patient’s mind – a 3 hour ordeal involving 5 shots with a needle that was 3 inches long. Now, I am not saying that you are embellishing things, but there is a tendency for that to occur.

      Anyhow, I’m glad you’ve gotten past this and have good things to say about modern dentistry now.

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