Root Canal Treatment

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LizzieS

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Help!
I’ve got a periapical abscess on an upper canine tooth and I’m terrified of the treatment. can anyone tell me their experiences??
The situation is complicated as the tooth is already crowned and is part of a bridge as the adjacent tooth is missing.
 
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Enarete

Enarete

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Hi Lizzie,

we have an article about how a root canal treatment looks like:


the tooth being crowned shouldn‘t be a problem, your dentist will simply get into the tooth through the crown and then close the opening.

Anything specific that terrifies you about the treatment?
 
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LizzieS

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Hi Lizzie,

we have an article about how a root canal treatment looks like:


the tooth being crowned shouldn‘t be a problem, your dentist will simply get into the tooth through the crown and then close the opening.

Anything specific that terrifies you about the treatment?
Thank you for your reply. I dread the thought of having a dental dam placed in my mouth as I’m always afraid of choking - sounds daft I know!
 
Enarete

Enarete

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It doesn‘t sound daft at all, LizzieS! Many people dread the dental dam and it just does look scary! But here is the thing: if you‘re afraid of choking, then the dental dam is your best friend as there won‘t be any water in your mouth and the whole treatment takes place outside of your mouth so to speak.
This being said by someone who, just years ago, would break down in tears just at the thought of the dental dam. I was surprised by how much more comfortable the treatment with it was. I hate how it looks so I asked my dentist to keep it out of sight and let me know before we start so that I could close my eyes and don‘t open it until it’s in place. It was a minute and once it was there, I was fine. We also had a stop signal - a different one than the usual raise of hand (me pointing at the dam twice) - which meant „take it off NOW“ and I had the word of my dentist that he would. He said taking it off was just a few seconds. I didn’t use the signal, but was reassured to have it.
 
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LizzieS

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It doesn‘t sound daft at all, LizzieS! Many people dread the dental dam and it just does look scary! But here is the thing: if you‘re afraid of choking, then the dental dam is your best friend as there won‘t be any water in your mouth and the whole treatment takes place outside of your mouth so to speak.
This being said by someone who, just years ago, would break down in tears just at the thought of the dental dam. I was surprised by how much more comfortable the treatment with it was. I hate how it looks so I asked my dentist to keep it out of sight and let me know before we start so that I could close my eyes and don‘t open it until it’s in place. It was a minute and once it was there, I was fine. We also had a stop signal - a different one than the usual raise of hand (me pointing at the dam twice) - which meant „take it off NOW“ and I had the word of my dentist that he would. He said taking it off was just a few seconds. I didn’t use the signal, but was reassured to have it.
I’m worried that I won’t be able to breathe and that I’ll panic. I’m not great at breathing through my nose! How is the wretched thing kept in place?
 
Enarete

Enarete

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Ok, let me get a bit more technical here, hope I can explain how it works in a still easy way.

So the wretched thing is a piece of rubber that basically hangs on the tooth. Which is silly because a floppy piece hanging down from a tooth won't help anyone and won't create a barrier. So there is a squared frame with only three sides and the edges of this floppy part get fixed to that. Once this is done, it is like a barrier resting on your mouth and a part of it is attached to the tooth (a lot of 3D thinking necessary here and explaining it is already more complicated than the wretched thing itself:)

Now our faces are not flat (thank goodness) so if you would take something totally flat such as a notebook or a piece of cardboard and let your lips touch it, you would find out that the corners of your mouth won't touch it unless you bend it. There is the U-shape that would make the corner of our mouths point away and create a space on both sides. And that's how the rubber dam sits - it is not card, but the frame makes it flat so it will touch your lips in the middle of your mouth, but not the corners so you can still breathe with your mouth. And again, here is the biggest advantage - during treatment, you normally can't breathe through your mouth during drilling because your mouth is full of water (and suction instrument). With rubber dam, any water is behind the barrier so you can breathe and swallow the whole time, no matter how much water is involved, behind the dam.

The best idea is to have a chat with your dentist, agree on a stop signal and let them put it on for a moment and give you a moment to try it out. If you don't like it, you can ask them to take it off and think of how you would like to go about things.
 
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LizzieS

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Thank you, that’s a perfect explanation x
 
letsconnect

letsconnect

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Ok, let me get a bit more technical here, hope I can explain how it works in a still easy way.

So the wretched thing is a piece of rubber that basically hangs on the tooth. Which is silly because a floppy piece hanging down from a tooth won't help anyone and won't create a barrier. So there is a squared frame with only three sides and the edges of this floppy part get fixed to that. Once this is done, it is like a barrier resting on your mouth and a part of it is attached to the tooth (a lot of 3D thinking necessary here and explaining it is already more complicated than the wretched thing itself:)

Now our faces are not flat (thank goodness) so if you would take something totally flat such as a notebook or a piece of cardboard and let your lips touch it, you would find out that the corners of your mouth won't touch it unless you bend it. There is the U-shape that would make the corner of our mouths point away and create a space on both sides. And that's how the rubber dam sits - it is not card, but the frame makes it flat so it will touch your lips in the middle of your mouth, but not the corners so you can still breathe with your mouth. And again, here is the biggest advantage - during treatment, you normally can't breathe through your mouth during drilling because your mouth is full of water (and suction instrument). With rubber dam, any water is behind the barrier so you can breathe and swallow the whole time, no matter how much water is involved, behind the dam.

The best idea is to have a chat with your dentist, agree on a stop signal and let them put it on for a moment and give you a moment to try it out. If you don't like it, you can ask them to take it off and think of how you would like to go about things.

:goodpost:
 
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KittyKat

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I may have to have a root canal at some point and your post, Enarete, is really informative. Thank you. I had no idea you could ask your dentist to stop and take the dam off. I'd been told that wasn't possible and that I would not be able to close my mouth, for a rest, for the entire procedure. This is something that really worries me as I have TMJ and can't keep my mouth open for long periods. So, is it possible to do those things? If it's not then I don't think I can have RCT.
 
Enarete

Enarete

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@KittyKat, this is a little tricky. You can ask your dentist to stop and take everything out of your mouth at ANY point during the treatment. This is a part of the informed consent and as General Dental Council mentions in their Standards for dentistry (see point 3.3.), the consent is not a one-off event (you agreed to have a root canal and now you have to lie there for an hour come whatever comes.. ) but a process and you can withdraw it at any time. Now the reality is, that while you can interrupt a procedure at any point, there will be parts of the treatment where interrupting may be a bit inconvenient for the dentist as it may involve repeating a step another time or simply would disturb the flow of the treatment so you surely will find dentists who say "no, once we start we can't interrupt".

As everything in dentistry, this is all about trust and communication with your dentist. Having the security that you can stop at any time is hugely reassuring and even more if you have issues such as tmj. It is sensible to agree on breaks with your dentist beforehand so that they allow you to take a rest whenever they feel the treatment can be interrupted for a while and of course to have a stop sign to remove the dam and give you a break whenever you feel you need it. It's about communication and about a dentist who is willing to accomodate your needs.

My dentinst would be willing to take the dam off whenever I want. He would also be willing to remove an impression tray immediatelly whenever I can't cope (and he let me know beforehand, that if we do so, it may get a bit messy and the stuff will be all over the place, but he would still remove it). I know the dentists who post here on the forum and most of those who enjoy working with nervous patients would do that too. So if your dentist is reluctant to give you this control, my suggestion would be to find one that would be willing to take the risk. It would be a shame if you wouldn't save the tooth just because of having the wrong dentist..
 
letsconnect

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There’s a good thread on this topic here:

 
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KittyKat

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Thank you so much, Enarete, for the reply. That's really helpful to know and to have that link you provided. I always thought it sounded a bit much that a dentist would refuse you a break or would refuse to remove the dam if you asked. I've already lost teeth due to my fear of RCT and my dentist hasn't allayed my fears or explained the process like you have. The last time I discussed it with her, when I explained my problems and my fears, she said, on the subject of taking rests, "You won't be able to close your mouth because you'll have a dam on." That really did nothing to reassure me, in fact it had the opposite effect, and I became more convinced than ever that I could not have RCT. My problem is if I lose any more teeth I am going to have a problem eating and would be looking at a partial denture. She was less than helpful there too and just said "You don't want that. You don't want a bit of plastic in your mouth" which makes me wonder what she says to people who have no choice but to have a partial denture.

I struggle with dental appointments and treatments because of my TMJ. My mouth doesn't open very wide and I need breaks every now and then to rest and to check I can still close it properly. That's my main fear, that it will lock and I won't be able to close it or to open it. I also suffer from fibromyalgia and I'm on medication that causes dry mouth which leads to dental decay. I did not know about this until a couple of years ago when I found out I needed seven fillings. Since then I've been taking measures to try and combat the dry mouth. I lost another tooth a few weeks ago and the one next to it is the one that will need a RCT sooner or later.

I'm going to discuss this further with my dentist and see what she says. If I don't get the response or reassurance I need then I guess I will be looking for another dentist.
 
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KittyKat

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There’s a good thread on this topic here:


Thank you. I wish my dentist was as accommodating!

The length of time is something else that worries me. 45 minutes is about my limit for any dental procedure. 30 minutes if the longest I've ever spent in the dentist chair, for an impacted wisdom tooth removal, and I just about managed that. The thought of something taking over an hour is really not something I could cope with. My jaw would seize up. That's what happens to me because of my TMJ. I've been told the RCT would be about 45 minutes but any longer than that and I think I would have to stop the treatment. Would I be allowed to do that? What would happen if at a certain point during the procedure I said I could not continue? Would the dentist have to abandon the RCT and pull the tooth if she hadn't completed the treatment?
 
Enarete

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Thank you. I wish my dentist was as accommodating!

The length of time is something else that worries me. 45 minutes is about my limit for any dental procedure. 30 minutes if the longest I've ever spent in the dentist chair, for an impacted wisdom tooth removal, and I just about managed that. The thought of something taking over an hour is really not something I could cope with. My jaw would seize up. That's what happens to me because of my TMJ. I've been told the RCT would be about 45 minutes but any longer than that and I think I would have to stop the treatment. Would I be allowed to do that? What would happen if at a certain point during the procedure I said I could not continue? Would the dentist have to abandon the RCT and pull the tooth if she hadn't completed the treatment?

They certainly wouldn't have to abandon the treatment and pull the tooth just because you can't cope for the moment. RCT gets done in several visits anyway so they can close the tooth temporarily and you come back at any point. I was wondering whether simply having breaks and being able to get up from the chair for a moment if you need it, may actually make you (and your jaw) more able to cope with longer visits.
By the way, tmj is a dental issue too so taking that into account when it comes to treatment is one of the things your dentist should take care of. You don't have to deal with this alone.
I was sorry to read how your dentist was communicating to you, it sounds somewhat like "this is how it is, just deal with it". It really doesn't have to be that way.
 
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KittyKat

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They certainly wouldn't have to abandon the treatment and pull the tooth just because you can't cope for the moment. RCT gets done in several visits anyway so they can close the tooth temporarily and you come back at any point. I was wondering whether simply having breaks and being able to get up from the chair for a moment if you need it, may actually make you (and your jaw) more able to cope with longer visits.
By the way, tmj is a dental issue too so taking that into account when it comes to treatment is one of the things your dentist should take care of. You don't have to deal with this alone.
I was sorry to read how your dentist was communicating to you, it sounds somewhat like "this is how it is, just deal with it". It really doesn't have to be that way.

Thank you. Yes, that was the sort of attitude I was getting from the dentist. She said that it wouldn't be pleasant and that nobody likes getting root canals but it's just something that has to be done and put up with. I explained about my fear of my jaw locking and she said she would be able to sort that out if it happened but it's still a scary prospect and one that I really want to avoid happening if I can by taking the necessary rests, etc. It's a difficult one with my TMJ because while I do need rests and to be able to close my mouth, even if it's just for a very short time, if I do too much opening and closing it seizes up and opens less wide each time.

Your post is reassuring though. It's the first time I've been told that taking rests and even maybe abandoning the treatment and starting again another day would be possible if needs be. I did think there must be some backup plan if treatment has to be halted for one reason or another. If only I'd had a dentist explain all of this before I might have felt able to have RCT on the other teeth I've lost.
 
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