Root Canals Get No Lovin’

Root Canal awareness week banner

Root Canal Awareness Week 2014. Logo courtesy AAE.

As we get ready to kick off the 8th annual Root Canal Awareness Week on Sunday March 30, it is remarkable to see that root canals are still perceived to be horribly painful and worse than torture. I outlined this myth in one of my Dental MythBuster posts called Dental MythBuster #3 – Root Canals Hurt!

Needless to say, despite that post getting over 12,000 views, the myth lives on in the popular media. Let’s see where:

  • The New York Times, February 7, 2014. “…taxes you pay on your investments has as much appeal as a root canal.”
  • The Los Angeles Times, June 14, 2009. “For the average American, modern air travel has all the appeal of a root canal.”
  • Northwest Indiana News, February 20, 2014. “… the topic of life insurance has about as much appeal as a root canal.”
  • The Los Angeles Times, March 29, 2011. “I had a root canal, and that was fun” (this was done in a sarcastic manner).
  • Washington’s Blog, August 26, 2013. “the American people would much rather get a root canal or a colonoscopy than bomb Syria.”

At least in the last example, the procedure is considered more desirable than a regional war and on on the same level as a colonoscopy!

And lastly, we have the President of the United States publicly maligning the procedure in his State of the Union Speech seen here:

So clearly, the procedure is believed to be unpleasant. But shouldn’t we all just stop worrying and appreciate root canals for what they do?

How I Learned to Stop Worrying and Love Root Canals

Dr. Strangelove who would not have worried about a root canal

Dr. Strangelove would have loved what a root canal could do (image courtesy wikipedia.org)

While there are different view on this borrowed line from Dr. Strangelove, there is no ambiguity when applied to the root canal procedure. This procedure helps to save teeth and prevents premature tooth loss.

Once you are adequately numb, you feel no pain during the procedure.

So let’s get this straight. You have a broken down tooth, one that you are at risk of losing. A procedure is available, one that does not hurt, that will allow you to save the tooth and not go around toothless!

And despite all the inherent benefits, the procedure is maligned by nearly everyone, including President Obama.

For this Root Canal Awareness week, let’s try to appreciate them. Or, to take inspiration from Stanley Kubrick’s film, let’s stop worrying and love root canals!

 

Dental MythBuster #10 – I’m allergic to epinephrine!

For this 10th Dental MythBuster, I’ve decided to tackle one of the greatest ones out there: The mythical epinephrine allergy!

Epinephrine used at the dentist photo people think they are allergic

Epinephrine for injection.

I consistently hear some variation of the following at least twice a month in my office in Orange, CT:

“Doc, for the shot, don’t use the one with epinephrine. I’m allergic to it.”

Upon hearing that, I always use a dental local anesthetic that does not contain epinephrine. But in all cases, the patient is improperly using the word “allergy.” Let’s see why.

About Epinephrine

Epinephrine, also called adrenaline, is a naturally occurring hormone and neurotransmitter in the body. It plays a critical role in the “fight or flight” response. Epinephrine has a number of different functions, including increasing the heart rate, regulating lung capacity, increasing the amount of available glucose, and many others.

Picture of epinephrine used in dentistry by dentists

Structure of Epinephrine

In addition to being naturally released by the body, epinephrine can be administered by health care providers in many situations. Epinephrine is given in many situations of acute cardiac arrest (a heart attack). It is also given in the treatment of an acute allergic reaction called anaphylaxis. It is frequently sold in an injectable form called EpiPen for those people susceptible to these types of reactions. We have an EpiPen in our office in Orange, CT as part of our emergency kit.

But the critical thing to keep in mind is that every single person produces and releases epinephrine all the time.

Why Dentists Use Epinephrine

As a dentist, I inject local anesthetic containing epinephrine at least ten times per day. Epinephrine is used because it acts to constrict the blood vessels in that area. By doing so, the local anesthetic remains in that area longer, because there is less blood flow to take the local anesthetic away. Simply stated, the epinephrine helps you feel and stay number longer.

As anyone can imagine, a dentist who does not get their patients adequately numb will soon find themselves with an empty chair! And epinephrine is a key factor in keeping patients adequately numb for procedures.

An Epinephrine Allergy?

So how can you have an allergy to a substance that your own body produces and uses every second of the day? The answer is it’s impossible! If you were allergic to it, you would be developing symptoms all the time! I won’t bore people with the technical definition of an allergy, but this is a good summary.

Carpule of lidocaine and epinephrine used by dentists in our Orange CT practice

Lidocaine with epinephrine.

So where did this myth originate? Well, most people confuse an adverse reaction with an allergic reaction. Common adverse reactions to an injection of epinephrine at the dentist can include:

  • Your heart starts to beat much more rapidly.
  • Your heart starts to beat much more forcefully.
  • The skin on your cheek – near the injection site – gets very pale.
  • You become suddenly dizzy.
  • Your shirt becomes wet from sweating (called diaphoresis).
  • You become very nervous.
  • You develop a headache.
  • And many others.

In addition, many other patients are unable to receive epinephrine due to certain medical conditions and/or medications they are taking. But this is NOT because they are allergic to it!

Dental Myth Busted!

Just like the other dental myths that I have written about (dentists no longer use novocaine, the dentist put his knee on my chest to pull my tooth, etc.), let’s bust this myth! So the next time you are at the dentist and you don’t want epinephrine, you should say:

“Doc, for the shot, don’t use the one with epinephrine. I had an adverse reaction to it.”

Until the next Dental MythBuster…

Note: since publishing this post there have been literally dozens of comments and posts which attacked me personally and/or used profanity. These comments prompted me to publish a sequel to this titled More on the Fabled “Epinephrine Allergy”. Please note that any/all comments with personal attacks and/or profanity will not be published.

Dental MythBuster #9 – You can’t get a cavity under a crown

This is one dental myth that I wish I did not have to see.  The myth typically plays out like this:

“Mrs. Jones, I can see both on the x-ray and upon clinical exam that there is decay on this particular tooth.”

She will typically respond by saying:

“How can I have a cavity on that tooth? It has a crown!”

After years of practicing dentistry, I can say that this happens about 98% of the time when there is decay on a tooth which already has a crown. So this dental myth definitely needs to be busted!

Photograph of a cavity under a crown

Seeing is believing, so let’s take a look at a photo I took of a patient in my dental office in Orange, CT.

Photo showing a cavity, also known as dental decay, under a dental crown

A cavity, known more formally as dental decay, evident underneath a crown on a lower molar on a patient of mine in Orange, CT.

The decay is visible in the above photo at the gum line. Treatment will most likely involve a new crown. Without treatment, this patient will lose his tooth eventually.

By looking at the photo, you can see that it is possible to get decay under a crown. So the myth is busted! But let’s look at how it happens.

What are dental cavities?

Dental decay photo showing a cavity on an upper canine tooth

Decay on an upper canine near the gum line.

Dental decay (known less formally as dental cavities) occurs when bacteria inside the mouth ingest certain foods and then attack the teeth. This leads to a weakening of the tooth and can ultimately lead to an actual hole (a.k.a cavity) in the tooth.

Decay can occur on any part of any tooth in the mouth. It can occur on teeth that have never had a filling before. Or the decay can start on teeth that have had fillings, crowns, or root canals.  It can start at age 2 or age 100! For a more detailed explanation, you can refer to a page I authored on my main practice website.

How teeth with dental crowns can develop decay

As stated earlier, decay can develop on any tooth. But cavities are more likely to occur in certain areas.

Dental x-ray radiograph showing decay or cavities under or below a dental crown

The red circles indicate the decay at the margin of two different crowns.

When it comes to teeth with crowns, the area most susceptible to developing decay is the margin. The margin, as you would guess, is where the crown meets the tooth. It is the weak spot. It is the Achilles Heel.

Food and other debris can collect right at the margin. A crown that was poorly made will collect even more food. If you combine this with a diet rich in sugar or acid, along with home hygiene that is not ideal, you have a perfect storm. That perfect storm affected the two crown to the upper right on the x-ray, resulting in decay.

Another Dental Myth Busted

The above photos, descriptions, and x-ray show that even with a crown, a tooth can still develop a cavity. So it bears repeating:

Crowns will protect an already weakened tooth but you still need to brush and floss sensibly. If you don’t, you can develop decay just like you would on any other tooth.

 

Dental MythBuster #8 – Having an Eye Tooth Pulled Will Cause Blindness

I have only come across this dental myth a couple of times in my career. But this fable is out there and some people actually believe it! In this Dental MythBuster, we bust the following crazy myth:

Having an eye tooth (canine) pulled will lead to blindness

Let’s explore how this dental myth originated and then we will thoroughly debunk it.

Why a Canine tooth is called a Canine

Lower canine teeth on a dog

Long lower canines on a dog. Photo courtesy Flickr Creative Commons.

Before we explore this myth, we need to understand why a canine is often called an eye tooth. But even before that, why is a canine tooth called a canine? A canine, also called a cuspid, earned its name because of the resemblance to the long, sharp canine tooth of a dog.

Now unless your last name is Dracula, your canines do not look like the dog on the right. If you look at your own teeth in the mirror, you should see slightly sharpened tips on both your upper and lower canines. And they are also in the same approximate position as the canines in a dog. So for all these reasons, those teeth are called canines.

Why Canines are Called Eye Teeth

Canine is called an eye tooth on this photo because you draw a line from the canine to the eye

Upper canine with a line drawn towards her left eye.

When you smile, your upper canine is oriented in such a way that a line drawn along the long axis intersects with your eye on the same side. This is true for most people. If you can see a prominent tip on your own canines you should try to visualize this on yourself.

The photograph to the left demonstrates this nicely with a red line going from the canine towards the mid point of the left eye. We could do the same on her right side too.

It is because of this anatomical orientation and relationship that a canine is called an eye tooth.

Removal of a Canine and Blindness?

So how did this myth originate? I have three theories:

Photo of a canine or eye tooth for the dental mythbuster on how losing an eye tooth causes blindness

Loss of this tooth leading to blindness? I don’t think so!

  • Since a canine is called an eye tooth, you could incorrectly assume that removal would lead to loss of sight in that eye.
  • The nerves and blood vessels supplying the eye tooth are similar in location and origin to those supplying the eye. You could incorrectly conclude that if you remove the tooth, the nerves and blood vessels going to the eye would be removed too.

These two theories don’t make a lot of sense. But, I suppose some people could have believed them at one point. My final theory is based on a fact:

  • In the era before antibiotics and modern medicine, upper tooth infections often did spread to the eye as well as the brain, leading to blindness and death in some cases.

This fact could also lead people to incorrectly believe that loss of the canine could make you go blind.

Dental Myth Busted!

The three theories posted above show why people may have incorrectly believed in this myth. But you can’t hide from the truth, which is:

There is no physiological relationship between an upper canine and the eye that would cause blindness upon removal of that tooth.

There are consequences to tooth loss but none of them involve your eyesight. In my practice in Orange, CT, I always recommend a dental implant when a patient is going to lose a tooth. But my treatment recommendation is based on facts and not on hearsay, and certainly not on a dental myth like this!

I hope you enjoyed this latest Dental MythBuster.