What is a Root Canal Like? A First-Hand Perspective

The last time I was in a dentist’s chair, I was being chewed-out for not flossing while they were drilling before the anesthesia had taken effect. That was a decade ago.

Today I went to a doctor who cares and it was totally different. The process is half-over and I’ll update this page as the work progresses

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Updated 8/17/11: Click Here to see what it was like, having crowns put over these root canal fillings
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That Dentist a decade ago was filling #3 (top right first molar) with a big amalgam filling that probably should have been crowned. The filling broke and fell out over the years. It mostly didn’t hurt, until the tooth BROKE while I was chewing one day. Then it mostly didn’t hurt until . . .

July 15: whacked in the face by one of my children, right on the jaw by that tooth.

July 15-25: progression from dull ache to not so dull ache, nothing ibuprofen couldn’t take care of. But it didn’t get any better, and the cheek and a little section of gum started getting puffy. I called during the morning break at work to set up an appointment with a Dentist.

July 25: They thought it sounded worse than I thought it was. 35 minutes later I was across town meeting one of the nicest people I’ve ever met (the hygienist). I filled in two pages of new-patient paperwork and sat down on a dental chair in a pleasant dental suite. The place could have been a breakfast nook in somebody’s kitchen (complete with picture window), but it had a dental chair in the middle and the cabinets are full of dental equipment . . . and there was no back wall, just a wide pillar. We discussed my dental history. She had a look at my hurting mouth and made some worried faces, and broke out a lead apron with a flap to go up under my chin. The digital x-rays took about 3 seconds each, from when she stepped away to when she was pulling out the sensor. Hm-clik, done. BIG image on the screen on a nearby counter top. She busted out a full-size digital camera with a special lens with a white plastic square (flash diffuser) around the lens, and took two pictures. The doctor came in and got the Cliff’s Notes on my dental history, looked at the images, looked at the tooth, thought for a few seconds, looked at the tooth some more, and then (and this impressed me) took a few seconds looking around the rest of my mouth. She ordered another x-ray on another tooth that wasn’t bothering me but she didn’t like the looks of it. And she (billed to me as “the best Dentist in Austin!”) said “I want you to get a second opinion.”

They did everything required to get me set up with The Guy for root canals in Austin. If it can be done, they said, he can do it. Other endodontists send this guy their tough cases. The very best of hands. They called Walgreens and set up a prescription for antibiotic pills, billed me, and I was out the door.

Cost: $165 without insurance, $32 with insurance (thanks God for insurance!)
Generic antibiotics prescription cost: $13 without insurance – I can afford $10 to save my life!

July 27: the Endodontist’s clerk called to confirm my appointment

July 28: Two more pages of new-patient forms and a bit of waiting, and then another room with a big window and no back wall. A shorter discussion of my dental history with another assistant. The doctor came in and got the Cliff’s notes, looked at the x-rays and pronounced it “very likely” that the root canal would be successful. If Confidence could be bottled and sold, it would have been wiped off this guy’s forehead. “I know what I’m doing” rolled off him like dust off Pigpen in the Peanuts cartoon. We talked for a few minutes. My disgusting gumboil had gotten bigger while I was taking antibiotics, and he was dead-convinced that the tooth needed operated on but Now to save it.

Remember: the last time I talked to a dental “professional” it was one step shy of hollering at me while he was hurting me. THIS tooth was the one THAT guy had worked on. I was a.f.r.a.i.d they were going to all of a sudden bust in on a painful spot.

They gave me nitrous oxide to chill me out, then gave me a bunch of shots right in my frikken JAWBONE! Yes it hurt, but when you are high on N2O you don’t mind so much. The assistant gave me some sunglasses to block out their brightazz light and tapped her hand on my shoulder while the doctor shot me up. It was surprisingly helpful for her to do that. The nitrous, by the way, was delivered through a nosepiece, not a mask or up-your-nose cannula. It was like a fat necklace (hoses) with a little tiny cup for the nose. Very light and comfortable, not scary or claustrophobic. Small enough they could leave it on (and charge extra) during the whole operation. They left me to stew in my new juices for a few minutes and then came back in when my jaw was numb from front to back and from the middle of the top of my mouth to halfway up my face.

They placed a big rubber ‘dental dam’ on the tooth and it zinged a little – I am HARD to get numbed-up, according to all the Navy dentists that hurt me (all of them) when I should have been numb. These kind people gave me more laughing gas and a few more shots that were only scary but not so painful, and let it set up while they got the rest of their instruments lined up.

I prayed for myself and kept reminding me that these people knew their work, and they wouldn’t be there if they kept hurting people. Knowing that you are in the very best of hands is cold comfort – but it was some comfort at least. They broke out the horrible-sounding zeeeeeeeee drill and all I could feel was pressure as the thing was grinding away what used to be a perfectly-good tooth. Pressure, pressure, a little cold from the coolant/rinse-out spray, and that was ALL I felt. I kept waiting for them to break through the part where the anaesthesia wasn’t working, but they never did! I could feel the crunch when they poked through into the root canals with their tools, but it did not hurt. To be honest, the very most bothersome part was that I had to keep from swallowing some slightly funky-tasting drool in the back of my mouth until they were done, when they sucked it out for me with the vacuum suction tube thingy. They made a little tiny slit in my gums to let out the pus built up in there and put a couple of little stitches to hold a drain tube in place.

They packed in a chemical to kill the germs in my tooth, packed in a temporary filling, shaped the filling, and rinsed my mouth. The endodontist gave me the old familiar “bite down and grind really hard” line, made one tiny adjustment to the temporary filling, and we were done. They pulled off the spit/bloody bits-catching bib and gave me some simple instructions. I went and paid at the front desk and they gave me some prescriptions to take to the pharmacy. I was able to drive home.

Cost: $1600 without insurance, $500 estimated with insurance (thanks God for insurance!)

I went home and took a handful of ibuprofen (note: TAKE IBUPROFEN BEFORE GOING FOR A ROOT CANAL) and found my medical insurance card. I took my scrips to Walgreens, waited a half-hour, picked them up, and went home.

Cost for pain killers, antibiotics (stronger ones) and special mouthwash: $42 with insurance (call my insurance company to see what it would cost without, they said).

Pain: not as bad as yesterday, even after the ibuprofen is worn off. The spot where they lanced my gumboil hurts because it is cut, and the one spot that bothered when they were placing the dental dam hurts because they probably cut that, too. My face hurts a LOT less, and the gum hurts LESS even with the cut they gave me. The tooth was dead enough already that it didn’t hurt, so it still doesn’t. A couple of tiny spots I can feel where they gave me injections of pain killing drugs, and that’s it, and that’s AFTER all the pain killers are worn off.

The Plan: Go back in a few days to remove the drain. Call if it gets crazy swollen but otherwise show up as planned. A few days later, go in for the other tooth, which turned out to also be infected, dead, and in need of a root canal. Then a little later go in and finish the first tooth, then the second tooth, then get permanent fillings on both teeth. This sounds . . . expensive.

Stay tuned!

Update August 1st: I went in to get the drain removed and the doctor was very happy with the way my mouth was healing. He gave me some topical (smeared on the gums) anaesthetic and pulled the stitches and was done in a minute. He asked if I were ready to get started on the other tooth. Sooner is better when it comes to root canals, he said and I agreed. The other tooth is the one right in front of the molars on the bottom/left (bicuspid, #20) and it also used to have a big amalgam filling. The filling was so old I had forgotten about it – I thought I had a dead tooth because it was gray! Then one day I noticed a Starburst a child had left in my truck and thought “why not” and ate it. It went from chewy to crunchy and I figured out there was a filling there. After seeing the x-rays, it makes sense why that tooth would sometimes hurt quite a lot.

They gave me Nitrous Oxide again and this time I remembered it was for pain I was about to go through and these are trustworthy people, so I went ahead and sucked the laughing gas down. Once again with the reusable stainless steely syringe and shots in the jaw, with the pats on the shoulder. Did I mention I am hard to get numbed in my teeth? They started drilling and it was somewhere between pressure and ache, so I made a noise. They broke out some more anaesthetic shots and after a couple more injections the doctor said “Tell me when you can’t feel this anymore.” After a few more seconds, I couldn’t. He kept shooting me up. At one point he said to his assistant, “He’s anesthetized.” As he was saying this, he was giving me what would probably have been a pretty painful injection. He went to adjust his grip on the syringe that was stuck in my gums, and when he let go the syringe didn’t move. I had to agree with him that I was numb. They ground out my self-placed temporary filling, the carious icky old tooth material, and down through the pulp. This time I could feel the rasping action when the endodontist was filing the inside of the root canal with his special files. It did NOT hurt, but I could feel the vibrations in my head; it was odd but not so bad.

Another temporary filling. More bite-bite-open, adjust, bite-bite-open, adjust, and we were done. Rinse. The next appointment was changed to “finish the first” instead of “start the second” and the doctor gave me a couple of ibuprofen to take (duh-me, I forgot to take ibuprofen before going!). They hadn’t finished the paperwork so I walked out without paying anything (yet).

That was at 09:00 this morning. My jaw and tongue were numb clear into the middle of the afternoon, so I was super-careful at lunchtime so I didn’t chew my tongue to ribbons. After supper I realized that I hadn’t taken my next dose of pain meds, and I only took it because pain annoys me, not because it was really hurting. My mouth feels better now than it has in YEARS, the day of my second root canal in the space of a week. I am surprised.

Update August 4th: I went back in and they finished on #20. More nitrous oxide, more somewhat-painful shots in the jaw made less-bad by the nitrous. More waiting for the shots to take hold. I was pretty tired so I actually took a nap while they left me alone to get numb. They removed the temporary filling with the zeeeeeeee drill and picks, then cleaned out the root canal a little.

They have a special electrical tool that beeps to tell them when they have reached the bottom of the root canal. They want to plug the tooth, not leave a plug sticking out the apex, and not leave a hole in the apex so the tooth can get re-infected. So they measure. The endodontist said it was 22, which I take to mean 22mm or just a hair shy of an inch. The little probe connects to a metal tool they were using and when it reached the apex of the tooth it gave a bit of a zing, not really painful.

The doctor shaped the root canal with the drill and some files and more drilling and filing, and then put a sealant in the root pocket. It felt like getting another injection (which it was) but I was surprised by the zing because I was pretty well numb to everything else they were doing in there. They placed some gutta percha (read: a rubber plug) in the tooth with a liquid sealant. They took an x-ray. They put more stuffing in the root and took another x-ray. Then another x-ray because the first one didn’t show the apices of the teeth. Then they packed in a temporary filling and took another couple of x-rays, one for them and one for the before/after images that will get sent to my regular dentist.

Pain: a little. They were poking around in there quite a bit. It hurts most where they injected pain killers – the tooth has no nerve and doesn’t hurt. My jaw hurts right in the joint in the back where it got a shot or three, and it was held open for quite a while. If you have TMJ dysfunction you will recognize this pain: it hurts to open wide, but wide enough to eat is not too painful. I expect the joint pain to resolve by tomorrow.

Cost: $1018 before insurance, maybe $3-400 after insurance; they will get back to me after the insurance gets back to them. Oh, and there was a mistake on their records. Always double-check the records. I’ll have to take a good look at the billing record when we are all done at the endodontist’s office to be sure it is all correct.

Insurance: running out fast. These teeth will need crowns which do not come cheap. My company insurance pays out a max. of $2,000/year and picks up the majority of covered procedures. With another couple thou$ands worth of work still to be done (permanent fillings & crowns) I will be coming out of pocket probably a couple thousand ducks. This is not good, but it is better than losing a chunk of jawbone to infection, or not having a tooth.

Update August 10: Back in to finish #3, this time in the afternoon. I did remember to take ibuprofen before heading out from work. I took off sick from work and showed up 15 minutes early (Marines would say “on time”) and was seen 15 minutes late, so a half-hour of waiting was involved. The assistant smeared topical anesthetic on my gums and let it sit for a few minutes while she got their equipment lined up. They gave me more nitrous oxide through the nosepiece and by now I had realized that sucking that stuff down does help, so by the time they broke out the big stainless steel syringe, the shots were uncomfortable but bearable. The endodontist was kind enough to apologize in advance, as well as after each injection he knew was painful. They left me for a few minutes while the shots went to work on my nerves. When the doctor came back in, he asked how I was doing, so I asked if it were normal for me to be able to feel #1 and part of #2 on my gums, but be numb out to #6 or #7. He said “we’ll give you some more, just in case.” and gave me some more. No nitrous this time, but my jaw was pretty well numbed by then, so it was more a sting than a bigfat PINCH like the first shots.

A few more minutes for the shots to set up, then they got to drilling. The old temporary filling was drilled and picked out, then the root canals were cleaned out again. All FOUR of them. They used their electric beeping sensor to measure the canals and then did some shaping with hand and powered rotary files. They measured again with the beeping thing and the canals measured a little longer which was apparently expected. Mine came in at 20, 21, 22, and 24mm long. This time I did not get a zing from the measuring. The doctor had a funny long-straight-sided ring on, which I noticed as he was removing the temporary filling. It turns out that ring is a ruler. He measured each gutta percha to the exact-right length on his ring ruler, dipped it in sealant, and then jammed it into a root canal. This did not hurt, but there was some minor squeaking involved. Another x-ray was made, to be sure the fillings were placed properly. This film was at an angle and hurt a little to hold in place while they shot the picture, but it only took a moment.

They packed in another temporary filling and there was something done with a little butane torch on their workbench; I’m not sure what that was about but it seemed like a normal part of their deal. Bite-mash/grind on the marking stuff and no adjustments were necessary on this filling. Another final x-ray was taken so they could give my dentist a before/after shot.

I went and talked to the front office lady and she showed me my bill. Turns out they had charged me $245 to place the drain into my nasty abscess, and billed in error (and removed) a charge for the nitrous oxide I didn’t use during the actual procedures.

Pain: not so much. A little tiny bit sore in the gums, but NOTHING like before the procedures. I keep reminding myself to take ibuprofen for the swelling to help it heal faster, because I don’t need to take it for pain.

Cost: About $2800 all-up, with insurance “estimated” to pick up $2k.

The Plan: go back in 6 months to make sure it is all copasetic with my jaw. As soon as possible but no later than two weeks, get a crown on each tooth or have to get them done again.

Scary parts: The shots in the jaw. If you have the option of nitrous oxide gas to suck on while they are injecting you with novacaine, do it. The shots do hurt, but it is like somebody with sharp nails is pinching you in the jaw. Very small spots of pain, moderately-intense, but with a little bit of self-control you should be able to deal with it. You might want a stress squeezy ball or something, or maybe squeeze your hands or the arms of the chair. Don’t jerk your head, it would probably make it worse.

Scary part: The drill. After you are numbed-up properly, this is “only” a horrible sound. There ought not to be any pain but there is some mild to moderate pressure, and you might notice some vibration when they use low speeds, or a funky ringing in your skull when they use high speeds. If you use nitrous oxide the whole time, or are otherwise sedated, this should be no problem at all.

Tip: try as well as you reasonably can to keep your lips out from between the dental dam and your teeth. They can’t see your lips under there and your teeth will be used as a rest and as a fulcrum for leverage for their tools. If your lips are in the way, they will be bruised and/or cut.

Tip: don’t read the waiting room magazines. One time I saw a dude sneeze into his hand, then place his hand right back on the cover of the magazine. In fact, just try not to touch anything in a doctor’s waiting room. Ew.

Two root canals, and I am pleasantly astonished to say it was actually not that bad, and I felt better after they were done than I felt the day before.

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