Extremely painful root canal

[giggle]

Today my dentist finally started a root canal on one of my top molars. It's had a persistent infection which has not responded to antibiotics at all and as a result my dentist could not numb the tooth, despite several shots of anasthetic directly into the tooth itself. Two of the roots were dead anyway so didn't give me too much trouble but the third one was incredibly painful. He managed to drill and clean everything out and patched it up with a temp filling and I am waiting now to see if it settles down. Despite the pain, I feel generally ok about it - he wasn't happy about causing me so much pain, he always stopped when I yelled and I think if I'd told him I'd had enough he would have stopped completely - and although it was very painful, ten minutes of this was still, in my mind, preferable to losing a whole day to being knocked out! However I remember looking at various pages for dental phobics with assurances about things not being painful and I have a slight nagging doubt - I am aware that infection will prevent local anasthetic from working properly and I took several courses of amoxicillin/metronidazole beforehand which simply had no effect on it (although I had the full pleasure of the side effects to enjoy). My question is - was my painful experience today an inevitable result of the circumstances (which I am willing to accept) or should I think about changing my dentist?

 

[brit]

Very sorry to hear of your bad experience. Good one this and I think you answered your own question.
As a self-confessed painophobe, I know to cope with pain it has to be under my control, so as you described someone stopping as you demand might work for me. I'd definitely need my 'raised hand' signals (breaks) being acted on to be able to continue in such a scenario.

However I also know that it is my goal to never get myself into these situations by choosing a dentist with options - so if this happened to me...I like to think I would call a halt and opt for sedation/nitrous instead, despite my unassertive tendencies in the dental environment. In fact I like to think that knowing me, my dentist would actually say...we need to rethink/re-arrange, this clearly won't work for you.

It could be that a different dentist could have got you numb with an appropriate technique but at the end of the day it's whether you feel you were given all the options or whether you were railroaded into carrying on regardless....an endodontist doing a root canal should be more used to coping with hard to numb situations and maybe the dentist should have offered to refer you on.

It would be a shame if you went through all that pain for the rct to fail anyway...it's hard for dentists to do their best work if the patient is not com fortable..they are human and will tend to rush, skip corners in these difficult situations...assuming they are not of course which most are not.

So you see adequate anaesthesia is not just for the patient's benefit at all. I think you are entitled to adequate anaesthesia...NHS or private. In fact I know someone whose child had a tooth the dentist couldn't get numb, so they were referred for nitrous at hospital oral surgery dept - they freaked out under nitrous and so were referred for GA instead....so a lot of care time and expense was taken to give her child an experience where their need for comfort and control was respected.

Obviously in a toothache situation you may decide some pain is an acceptable trade-off rather than go away and take antibiotics; but the decision should be yours and you should be free to change your mind and withdraw your consent at any stage. I've never heard of injections directly into the nerve not working before but the caveat is these are painful injections apparently.

Glad you got through it...I do know how unsettling it can be particularly if you were just beginning to build up trust. For me I think it would represent a breach of trust as it seems you were railroaded somewhat so lest you were unsure of my view, I'd probably be finding a reputable endo and a new dentist.

 

[giggle]

Thanks for your reply Brit. To be honest I was a little wary about posting about this at all because I guess for some dental phobics it probably sounds like a nightmare scenario so I really want to stress that I did not feel at all like a breach of trust had occurred - in fact it was quite the opposite in that I felt able to trust my dentist to continue despite the amount of pain I was in at times - or more importantly I am pretty sure that if I had said to him "stop! no more!" which I had ample opportunity to do, he would have done.

This is in contrast to a situation I had a couple of weeks ago when I had to see an emergency dentist about the same tooth, who I had serious issues with. He caused me some pain, although not on the same level (it was mere discomfort in comparison really) but completely ignored my "owws" after arrogantly saying "I know it hurts but this will make the toothache better" (which, incidentally, it didn't). He also spent the whole time squishing my eyeball while he worked but I had no way of communicating this to him because, well, he just wasn't listening. I wouldn't let him near me again, no matter how bad the toothache is. In fact if I'd seen a dentist like that at the start of all my recent tooth problems, I don't think I would have ever gone back.

The only thing that is casting some doubt in my mind is, I am wondering whether the pain yesterday was really necessary - the implication being, I guess, is my dentist good enough? If it truly was a case that nothing short of a horse tranquiliser would have taken the edge off it, I am happy with that as I would sooner consent to 10 minutes of pain than go through the hassle of getting knocked out (for me the fear is about loss of control rather than pain). I don't feel unhappy or uncomfortable about the way I was treated because I was able to communicate the whole time. The same dentist did another root canal a few weeks ago which was totally painless - I was beginning to wonder what all the fuss was about...

 

[brit]

It might be helpful if Gordon commented....I think the phrase is 'all teeth can be got numb but not all dentists can (be bothered to) get all teeth numb all the time'

I get the impression that ....if LA isn't working, you can top it up but if you top it up in exactly the same place using the same technique and it still doesn't work, many patients think that's my lot I'll just have to put up with it, when the reality is there are lots of other things you can try...different stronger percentages of local for example, different injection techniques eg Cow Gates, Akinosi, Mylohyoid, Stabident, X-Tip, PDL, different gadgets TheWand, STA, infiltration in addition to blocks.
From personal experience I've noticed, having topped you up too many dentists don't go looking for trouble and leave it to you to assert yourself and say well actually that didn't work either....
So in all probability, not all avenues were exhausted in your case - one top up of the same LA type is definitely not exhausting all avenues.

I think people who have had bad aversive dental experiences (I include myself in this although I have never been in an emergency toothache situation) have to make a decision as to where their limits are...it is pointless to set yourself back on a pattern of avoidance for lack of adequate anaesthesia.

What you say about the attitude of the person inflicting pain is already documented elsewhere on here...and it's true it is easier to take from someone with no malicious intent but failure of anaesthesia and being under the impression that what you've got is the best on offer, still seems to happen too often and it's the reason so many people still say 'I hate the dentist'.

Even those of us with many positive experiences still always wonder at the back of our minds whether our luck will hold out. I think a good endo is probably a safer bet for a painfree root canal than a good general dentist as a general rule.

I'd tell this dentist if you stay with him that you'll try anything once but you never want a similar experience again....'if I'm not numb, you can't work on me' - even just nitrous to breathe would have helped you such a lot...pain's not very 21st Century is it?


Just wanted to add - it is not always the case that teeth with infection are resistant to numbing - it's just that it can be a reason for LA not working as well as the dentist might want..it is an indication that more advanced LA injection techniques are in order. Probably too many dentists hide behind the 'infection' excuse for not doing 110% to get patients numb.

 

[Razzle3]

First and foremost, I truly commend you Giggle and wish you all the very best. I read this earlier but declined to comment for fear of sounding judgemental towards you--which is the last thing I'd want to do. That said, I'll take the risk by saying that in my opinion, your dentist breeched all ethical practices not too mention basic caring ones by knowingly inflicting pain on you. Whether you gave him the okay or not, he had no business continuing once both of you were aware of the fact you were not numb.

I have had many issues over the year with standing up for myself with doctors. Last year when I was seeking out a dentist who had TMJ knowledge, I made the choice to continue an appointment where the doctor was from almost the beginning an unprofessional jerk but truly hurt me. There are moments, I think of this, that I feel a tightness in my throat and wish to all heck I had not allowed him to treat me that way.

I now have a TMJ doctor who couldn't be any nicer. Lol, most of you on here know what I think of my regular dentist. I am so lucky.

Point is, just that you are the patient, the paying party both in $ and trust and the appointment should always be about meeting your dental needs with comfort.

To you, my and again all good luck.

Mona