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Painful Tooth? Why Pointing at It Isn’t Enough for a Dentist to Help You

For most Americans – 80%, according to a 2009 survey by the American Association of Endodontists – going to the dentist is a scary thing. Over half say it keeps them from seeing getting dental care, despite the fact that regular visits for exams and cleanings help them avoid the things they fear: pain and procedures like root canals.

But tell that to a person who’s just heard their best friend describe a bad dental experience or read one of the strange and/or horrific dental stories that crop up in the news from time to time – even as these stories can just as much be a source of motivation to take good care of your teeth and gums, and reduce the chance you’ll need extensive, intensive (and expensive!) treatment down the road.

And they can cast light on important concepts. For instance, consider this story that made the news a couple weeks ago:

A dentist who pulled the wrong tooth from a patient had it retrieved from a medical waste bin and replanted it two hours later.

Kim Green, who was in agony from a root canal infection, did not know that her healthy tooth had lain among bloodied tissues, saliva wipes and needles used on other patients.

Dentist Justin George sewed it back in, left her rotten one in place and suggested she take painkillers until another appointment was arranged.

According to the Mail, Mrs. Green eventually went to the hospital. A surgeon removed both teeth and then reported the Dr. George to the General Dental Council. Mrs. Green alleges that the dentist didn’t consult her x-rays before pulling the tooth: “Instead, he relied on her pointing to the throbbing tooth.”

Problem: As research published last year in the journal Pain demonstrated, when a tooth hurts, our brains have a really hard time figuring out exactly which one it is.

In the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy — and brave — volunteers as they experienced tooth pain. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth in the subjects. These bursts of electrical stimulation produced a painful sensation similar to that felt when biting into an ice cube, Forster says, and were tuned such that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable.

To see how the brain responds to pain emanating from different teeth, the researchers used fMRI to monitor changes in activity when the upper tooth or the lower tooth was zapped. “At the beginning, we expected a good difference, but that was not the case,” Forster says.

Many brain regions responded to top and bottom tooth pain — carried by signals from two distinct branches of a fiber called the trigeminal nerve — in the same way. The V2 branch carries pain signals from the upper jaw, and the V3 branch carries pain signals from the lower jaw.

* * *

Because the same regions were active in both toothaches, the brain — and the person — couldn’t tell where the pain was coming from. “Dentists should be aware that patients aren’t always able to locate the pain,” Forster says. “There are physiological and anatomical reasons for that.”

And this brings us back to the matter of x-rays. While there’s growing concern about over-exposure to x-ray radiation, they remain a vital diagnostic tool. The key is in using them wisely – for instance, not “routinely” but when clinical need demands it. Digital imaging, which I’ve used for years, helps reduce risk, as well, since it requires less radiation than film does.

So why didn’t Dr. George refer to Mrs. Green’s x-ray before going ahead with the extraction?

When The Mail on Sunday spoke to Dr George at his home in Taunton he admitted responsibility but claimed there was ‘pandemonium’ at the surgery. ‘It was a really weird day,’ he said. ‘We didn’t have our regular nurse, there was pandemonium in the practice, and then the nurse left the X-ray in the machine.

‘People are all coming in with pain and I’m the only dentist in the surgery trying to see everybody, and yes, in the pandemonium, the wrong tooth was pulled out. It was an accident but everything was failing around me. I’m a new dentist. I was very stressed-out that day . . . I could hear people grumbling downstairs.

‘The nurse said the tooth was still in the surgery and so I thought she had not disposed of it. I didn’t know it was in the bin.’

You have to wonder about the role of inexperience here. It’s not hard to imagine a young dentist feeling the need to prove himself capable of working through “pandemonium” instead of acknowledging that he’s having trouble coping and it’s interfering with his work. Of course, there’s still the weird matter of how he “fixed” his mistake: calling back the patient and “sewing in” the tooth that had been fetched from medical waste, yet still doing nothing for the infected tooth.

Unsurprisingly, Dr. George has been suspended and awaits his GDC hearing.

Stories like this catch our attention precisely because they’re so off the norm and seldom jibe with our own experience. In fact, dentists provide a wide variety of methods to minimize pain. And where anxiety is an issue, we can provide things like nitrous oxide or oral conscious sedation to help you stay calm and relaxed. I make both methods available to my patients. And for those who prefer more natural sedation remedies, there are calming botanicals, homeopathics and other options we can recommend.

Learn more about dealing with dental fear.

Images by westpark, via Flickr, and Michael Ottenbruch, via Wikimedia Commons

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