The Girl needed a root canal on a lower left molar and so I was voluntold to do it.

I’ve had some previous experience doing dental work in her mouth. We’ve come a long way since those early days.

She still needs nitrous, but is now ok without oral tranquilizers and we don’t yell at each other as much. In fact there were no raised voices yesterday.

The procedure went well. I had to numb the crap out of the tooth because it was undergoing an irreversible pulpitis.

We went out for dinner afterwards to celebrate a job well done.

Because her tongue, cheek, and lip were still numb on the left side, she tried to do all of her chewing on the right so that she wouldn’t accidently chomp down on her tongue or cheek on the left without realizing.

Instead she chomped down on her tongue on the right and definitely realized. That’s a pretty ugly hematoma that has developed.

She’s not in too much discomfort at the moment. Although I do sympathize with her, my happiness at coming through the whole experience unharmed, myself, is something that money can never buy.

She: You know, eye doctors have this thing where the patient lies on their back and it rotates.

Me: Uh huh?

She: Yeah, maybe dentists should look into something like that.

Me: Uh huh?

She: It’s like the thing that mechanics use. You know, where they lie on it and then it slides under the car.

Me: Uh huh?

She: So the eye doctor rotates the patient so that they are lying upside down and the eyes fall forward and the doctor works on them from underneath.

Me: Hmm. Uh huh?

She: So wouldn’t that be easier for dentists and their patients too?

Me: Working from underneath you like you’re a car?

She: Yeah…like that…

Me: Except you’d drool all over me. No thank you.

She: Oh, you’re right. Hmm.

Me: Uh huh.

I enter the consultation room.

Me: Hi, I’m Peri Apex.

Him: Hi.

We shake hands.

Me: Your dentist has asked me to evaluate three teeth on the bottom that have had root canal work. Apparently you need some major restorative work done on them and there’s a question of whether or not the root canal status is stable.

Him: Yes, but let me ask you a question first about teeth that are impossible to freeze. One of the teeth that I’ve had a root canal on is impossible to freeze. At least 4 dentists have tried, but none of them have been able to get it numb and they all start off by saying that they’ll be able to achieve what the previous dentist wasn’t able to. So I had to have general anesthesia to get the root canal.

Me: Yup, sometimes teeth are difficult to numb up because of things like anatomic considerations or nerve inflammation in the tooth.

Him: No, this tooth doesn’t numb up.

Me: Well lower molars can be especially difficult to get fully numb.

Him: No, it was an upper tooth.

Me: Oh.

Him: My lip and cheek and gums were all numb but not the tooth.

Me: Getting teeth that are that sore fully numb is a challenge sometimes.

His voice now starts raising a notch.

Him: No, the tooth was not numb at all.

Me: The tooth was probably a little numb, just not enough to work on.

Now he sits up straighter, voice raises another notch.

Him: No. No. The tooth was not numb one bit. The dentists have told me all about where the nerves run, how they are supposed to be frozen in specific places, but I have a medical condition that prevents that particular nerve from getting affected by anesthetic.

I started raising my voice now because this silly, pointless conversation is dragging out too long. It’s not even one of the areas I’m supposed to check out.

Me: Have you had trouble getting frozen anywhere else?

Him: No, the condition is just with that one nerve in the area there.

Me: Someone told you that you have this medical condition?

Him: No, I know I do.

Me: What’s it called?

Him: I don’t know what it’s called.

Me: So how do you know that you have a medical condition?

I now realize that we’re both really getting pissed at each other.

Him: Because I’m telling you this is what happens when anesthetic is used on the tooth!

Me: How can you say that you have a medical condition like this when you don’t even have a name for it?

He looks at me with this incredulous look now.

Him: What are you talking about? There are lots of medical conditions without names.

Me: Well anyway this conversation is pointless because I’m looking at different teeth today anyway. They shouldn’t have a problem numbing up better if they need work.

Him: No, you don’t get it, the tooth didn’t numb up at all!

Me: The only way you can tell me that the tooth was completely unaffected by the anesthetic was if they tried to drill into it without freezing, then froze you up and then drilled into it again.

Him: Well it was not numb at all.

Me: You know, we’ve got lots of theories about teeth that are resistant to anesthetic; things like pH imbalances, receptor up-regulation, central facilitation and neuroplastic changes that affect receptive fields, but not one medical condition that describes one tiny, single nerve bundle to a tooth that is completely resistant to anesthetic.

Nodding the “whatever” nod at me.

Him: Uh huh.

And so the entire waste of a consultation appointment went. My insight into his argumentative nature became more detailed during this exchange:

Him: What forms of sedation are available here?

Me: Laughing gas, with freezing of course; a pill with or without a little bit of laughing gas; IV sedation via a dental anesthesiologist.

Him: Is freezing included with the pill?

Me: Yes, it’s included with all the sedation modalities. Don’t worry about freezing it’s a given.

Him: But you said laughing gas and freezing, you didn’t say it with the others.

Me: Don’t worry, no matter how deeply you are sedated, you’re getting freezing.

Him: Because of my subconscious maybe feeling stuff still?

Me: Yeah.

Him: Is General Anesthesia an option, do you do freezing with that?

Me: Inhalalation anesthetic is not an option here, but you would get freezing with that too if it were.

So…please do me first and make it quick before he needs to come back for work in that upper area where the medical condition lies.

Patients ask me that sometimes as they sit in the chair. Depending on my mood I’ll joke with them and ask them how long they’ve got.

Remember that convict that I saw for consultation a while back? His first of two treatment (retreatment) appointments was today.

Him: So how long am I gonna be here today?

Me chuckling: How much time do you…have?

I realized the context of that statement after I said it. He looked at me sadly.

Him with a shrug: My whole life.

Me: Oh. Well you’ll be done here before that.

The Guards: *chuckle*

I didn’t ask any more silly questions for the rest of the appointment.

I saw an 11 year old boy yesterday for a root canal.

This was his second appointment with me, but the first appointment for treatment. When I had previously seen him for consultation, I met his dad. His Dad, a really nice guy who wants to do what’s right for his 4 children, told me how he recently found a job after not having a stable one for a couple of years. He’s finally got some money to take his family to the dentist but one daughter needs 3 root canals and this son needs one. The daughter is older and the root canal work is fairly straight forward, so their family dentist will do the work. The root canal for the son is more complicated. All of this work, however, is costing quite a bit and you could see how the prospect of having to pay for it really worried Dad.

Although the root canal was needed on a 6-year molar and the boy is 11, the distal canal was still quite wide, and the pulp chamber huge. At the consultation I wasn’t able to obtain any reliable vitality readings from this tooth or the adjacent ones. The root canal was needed because of approximation of caries to the pulp.

I informed Dad that endodontic therapy was necessary, but I’d assess the pulp once I got into the tooth and decide at that time if definitive treatment would be done or if I’d do a direct pulp cap.

Today after I got into the pulp chamber, I found a vital, uninfected pulp that was not hyperemic. I decided to do a modifed Cvek pulpotomy. I unroofed the chamber, folded some pulp back onto itself and then capped it with white Mineral Trioxide Aggregate (MTA). I’m hoping that this will allow for continued dentinal thickening of root and pulp chamber. Full root canal work might be necessary in the future, but we’ll assess this as necessary.

Dad was very happy that things went so well. After I debriefed him in the reception room, I noticed him pulling out a wad of 20′s to pay for treatment. I made my retreat back to my private office to write my treatment notes (and finish dropping my daily entrecards).

AssistantGirl came in with the post-op xray shortly after and proceeded to ask me about Cvek Pulpotomies. As we were talking, OfficeMom and ReceptionChick both walked into my office together.

“Close your eyes,” OfficeMom said to me.

“Huh? Why?” I said.

“Just do it,” she said.

So I closed my eyes and soon felt her putting something near my nose.

“Smell this. What do you smell?” she said.

So I did. It smelled like pot (how I know this is irrelevant to this post).

“It smells like weed,” I said.

“Open your eyes,” she said.

So I did and it was the wad of 20′s that our Dad had paid with.

I took a deeper sniff and their was no questioning the aroma of marijuana. In fact, it was so strong that if we had rolled just the bills themselves and lit them up, we would probably have gotten stoned.

So this is how I accepted drug money as payment for work done. I feel like a greasy mob criminal attorney now. But at least the Cvek pulpotomy is much less expensive than a full root canal…I wonder what the bank is going to think when we make our deposit.