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The Myth of Root Canals

Do you know what’s going on in your teeth? I never even thought about it until April, when one of my molars rebelled and my teeth became all I could think about. As anyone who has been in this position knows, the strange inconvenience that the word ” toothache does not imply the incredible misery that toothache can cause; sometimes the pain was so bad it was hard to use my laptop.

After a week of inconclusive X-rays, a pointless course of antibiotics, and a handful of ibuprofen-acetaminophen cocktail recommended by the internet, I was finally referred to an endodontist—a specialist who treats toothaches—to face my tormentor. I had cracked a tooth, which the endodontist was finally able to locate with a CT scan. Moments later I was shelled with novocaine and after a few minutes of drilling the endodontist asked me to see the source of all my pain. “Yes,” I said, mostly through my nose. He held up his tweezers, and at the end dangled what looked like a small, bare tree, rendered in the vibrant red of fresh blood. It looked too perfect, the edges too discreet, like something made for a movie instead of a regular blob of human entrails.

None of this went as I expected. When a tooth ruptures, the oft-recommended treatment is one of the most dreaded procedures in modern medicine: a root canal, so famous that the name has long been a popular metaphor for a long journey through the pain itself. That’s what I sat in the chair that day – to drill open my tooth and extract its nerves and blood vessels. After the CT scan, I had begged the specialist to give me a root canal right away, feeling the courage of utter despair, instead of letting me come back the next day. Then things got weird: The procedure was quick and it was painless enough for me to make sounds of surprised approval at the sight of the freshly removed piece of my face. When the endodontist told me we were all done, I thought he might be kidding — pop culture had forged me for years for an experience that apparently no longer existed. A few hours later, when the local anesthetic wore off, I ate as if nothing had happened.

My story is not unusual from the past year and a half. Through a combination of intense stress, new medications, and what had previously been a mild predisposition to grind my teeth in my sleep, I joined many other Americans in what appears to be a pandemic tooth-cracking bonanza. According to a February survey by the American Dental Association, nearly two-thirds of dentists reported seeing more cracked teeth in their practices during the pandemic than before, and 71 percent reported higher rates of bruxism, which is the involuntary grinding that can lead to cracks. My endodontist said the same thing: Root canal treatment was booming.

Asgeir Sigurdsson, the chair of NYU’s Department of Endodontics, told me that’s still the case, six months after my own procedure. Not only are people stressed, but many people whose problems would have been noticed during a routine visit in 2020 skipped their checkups, for financial reasons or because of fear of COVID-19 infection. When Americans started getting vaccinated, dentist appointment books quickly began to fill up, which may have helped put some patients off even more from getting a cleaning on the calendar.

Checkups are easy to delay — even the most basic dental care is expensive and physically uncomfortable at best, and about a third of American adults don’t have insurance that covers some of it. Submitting yourself to a cleaning opens the possibility of being told you will need an expensive, painful procedure, and there are some unscrupulous practitioners who take advantage of patients’ inability to evaluate their own oral health.

People who need root canal treatment usually know they need it, or know they need it something. Cracks, infections and severe decay show themselves in no uncertain terms. Teeth are extremely sensitive; each tooth has 1,500 to 2,000 nerve fibers at its core, according to Sigurdsson, and most are some sort of receptor that only senses pain. (If you’ve never thought about the total absence of dental pleasure in your life, well, there you go.) Perhaps unsurprisingly, then, at some point in the not-too-distant past, all those nerve fibers shoveled out of your tooth. a lot of pain– enough to gain an understanding of the root canal far beyond its own accuracy. Thank God for the advancement in medicine and technology.

Except when it comes to root canals, not much significant progress has been made. Sigurdsson has been performing the procedure regularly for 30 years, and it’s basically the same now as when he learned it in dental school. “What I think may have changed more is the way we teach our students to approach it,” he said. “To have more empathy for your patient, wait for the anesthesia to really kick in and give extra anesthetic if needed.” If you had a root canal a few decades ago and the pain scarred you for life, you probably didn’t have to — your dentist or endodontist may have just been an old-fashioned type that I didn’t care if it did.

All this does not mean that every patient’s procedure is now pain-free, even if everything is done correctly. The novocaine injections are themselves quite uncomfortable and can be terrifying for patients who are afraid of needles. Some patients with additional complications, such as severe nerve inflammation, will not fully respond to available anesthetics, Sigurdsson noted. And there’s some evidence that people with intense fear of their procedure are more difficult to numb, perhaps because their fight-or-flight response or some other neurochemical response inhibits the effectiveness of the anesthetic. But, Sigurdsson promised me, the majority of his patients are “pleasantly surprised.”

If for decades dental students have been taught to completely anesthetize their root canal patients instead of diving into their pulp, why does the procedure’s reputation persist? It may be because root canals are fortunately rare for most people. Many people who need more than one in their lives go decades between procedures, not knowing their next one won’t be so bad. For people who have never had a root canal, they may recall their parents complaining about a particularly bad one.

Or maybe millions of people were misled by simply growing up in the 1990s. According to Google Ngram, which tracks the popularity of words in books and newspapers over time, the phrase was especially ubiquitous in the media during that decade. A joke about root canals fits the what-is-the-all-airplane food comedy of the day; An delivery of Seinfeld even has the specter of Jerry’s future root canal and the seriousness of the procedure as the reason for arguing with Elaine. But as better-trained dentists enter the field and more people have uncomfortable but dull root canals, the same Google data shows the procedure’s ability to instill fear in our hearts, at least metaphorically, is diminishing. The comedians of the 2020s will have to find another way to tell you how relatively painful it is to go to the DMV.