Redhead Dread Part II

A couple of months ago, I wrote an extensive blog post about my experiences as a general dentist treating redheads.  I called it Redhead Dread to suggest that redheads dread going to the dentist.  The post was based upon research which found that individuals with red hair required more local anesthesia than non-redheads.  A natural conclusion from that research was that redheads would avoid dental care and/or be fearful of the dentist because of a greater likelihood of a past, painful experience in the dental chair.

Joan on Mad Men is a Redhead - does she dread the dentist

Joan (Christina Hendricks) plays a sassy character on Mad Men. But would she secretly dread a trip to the dentist? (image from fanpop.com)

A research paper released just last month by the Journal of Endodontics detailed the findings of a well designed study which looked at the effects of dental local anesthesia on women with red hair.  This study had a control group of women with dark hair in order to observe the differences. Some of the findings were surprising. Key conclusions were:

  1. In standard injections for the lower teeth using lidocaine (not novocaine), there was no difference in the success of the local anesthesia between redheads and dark haired females.
  2. Redheads felt more pain on needle insertion than dark haired females.
  3. Redheads experienced “significantly higher levels of dental anxiety” when compared to dark haired females.

Considerations for Dental Patients

The first conclusion stunned me, as it contradicted both previous research as well as my own experiences treating dozens of redheads over the past several years.  This was a well designed study but there was a relatively small number of study subjects.  Could the small number of participants explain the unexpected response? Possibly.  But I am not going to doubt or second guess the authors.  Nevertheless, a follow-up study with more participants would be beneficial.

In my own observations as a general dentist, conclusions 2 and 3 are closely linked and were expected. The anticipation of pain can make anyone, regardless of hair color, either amplify a minor pain stimulus into a very painful one, or create a perception of pain when no pain should have occurred.  Stated another way, an expectation of pain can create pain out of nowhere!

Because the first conclusion was a surprise, I do expect there will be additional research on this topic, which I will write about. Until then, we can conclude:

Redheads will have greater anxiety when it comes to receiving dental care. If you are a redhead, don’t be afraid to tell your dentist about any fears you may have!

Dental MythBuster #3 – Root Canals Hurt!

One very common dental myth that I encounter frequently in private practice in Orange, CT is the notion that root canals hurt.  If you even mention the word “root canal” to someone they will often shudder with fear.  This is one dental myth that does not seem to die, and as a dentist, it really strikes a nerve with me (pun intended).  To see the degree to which this root canal myth is propagated, watch this video:

President Obama’s reference to a root canal is at the 38 second mark.  This dental myth transcends politics.  It doesn’t matter if you are a Republican, Democrat, Independent, Whig, Libertartian, or other party affiliation.  If the President of the United States maligns root canals, you are inclined to believe that root canals are undesirable and are to be avoided at all costs!

Why Teeth Need Root Canals

Root Canal Picture

Root Canal Picture. Courtesy of the American Association of Endodontists.

In my personal experience as a dentist in Orange, CT, over 90% of the time a patient needs a root canal it is due to dental decay (a.k.a. cavities).  In these cases, the bacteria from the decay enter the nerve of the tooth, resulting in pain for the patient.  This should be very intuitive: you have live nerve tissue that is normally sequestered from the outside environment which is now suddenly exposed to nasty bacteria.  Of course it is going to hurt! The other teeth needing root canals are primarily due to other factors such as trauma, cracking, and resorption.

Why Patients Associate Pain with Root Canals

Woman with a toothache needs a root canal

A woman in pain needing a root canal. She will associate this pain with the actual root canal procedure.

This scenario plays out fairly frequently.  A patient calls our office with extreme tooth pain.  The pain is often described as “unbearable” or “the worst pain I’ve ever had” or sometimes even “worse than childbirth.”  An x-ray is taken and I perform a limited exam. I observe dental decay into the nerve of their tooth.  I discuss the findings with the patient and recommend a root canal. The patient consents.

I place topical anesthetic over the injection site and assure the patient that the pain will soon be gone. I then administer the local anesthetic with the patient feeling little to no sensation of the needle.  Within just a few minutes, they are profoundly numb, and their pain is gone!  I then perform the root canal procedure, removing the bacteria in the tooth, and then filling the roots of the tooth.  The procedure now done, the patient goes home, the numbing wears off, and the pain is still gone.  And it is gone for good and they still have their tooth!

Years later, the patient will then recount his/her experience, and say:

Yeah, I had a root canal at the dentist. It was the worst pain I have ever experienced!

This happens all too often. The patient confuses the pain that caused him to need the root canal with the pain (or lack therof) of the procedure.  And every person who listens to this story then thinks that root canals hurt.  And thus, the myth lives on!

So remember:

  • Root canals do not cause pain, they relieve it.
  • Root canals allow you to keep a very compromised tooth.
  • There are no substitutes for your own natural teeth.

If you’re still scared after all this, you can always be sedated for the procedure. But we hope we’ve busted this myth and eliminated this fear.

What the heck is numbing jelly?

“Numbing Jelly” or Dental Topical Anesthesia.

I often ask my patients what they hate the most about a trip to the dentist, and a solid majority always says one thing: The Shot.  There are other things that patients do not like, and I even compiled an abridged list of things patients have told me they dread:

  • The sound of the dental drill.
  • The feeling of “too many things” in their mouth.
  • Being tilted back too far.
  • The thought of a “hole” being drilled into a body part.
  • The “suction thingy” (a.k.a. saliva ejector or spit sucker).
  • The spray of the water.
  • The taste of metal instruments.
  • Two individuals (dentist and assistant) staring into their mouth
  • And literally hundreds of other things…

All of these things are reasons why patients avoid the dentist.  However, based on my experience as a dentist, these items all pale in comparison to the administration of local anesthetic.  Local anesthetic is necessary for all types of dental procedures, including fillings, crowns, root canals, implants, etc.  It doesn’t matter whether you’re in Orange, CT where I practice or thousands of miles away, patients hate the shot!

Dentist and Needles | Topical anesthetic| West Hartford Family DentistryNot surprisingly, dentists and dental supply manufacturers have been identifying and developing techniques over the years to eliminate the pain and fear associated with the local anesthesia injection.  Perhaps the biggest and most significant development was the introduction of narrow diameter disposable needles.  Prior to the 1950s, the needles used were much larger in order for them to be able to stand up to multiple sterilization cycles. I’ve had many older patients who experienced dental procedures back in the 1940s who described these as “horse needles.” Now we use much narrower disposable needles.  I will cover the history of dental needles in a future blog post.  But regardless, a needle is still a needle!

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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!