cartoon illustration of a dead tooth with a sad toothbrush, toothpaste, and dental floss mourning
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According to the grief and loss experts, there are several phases people navigate when they go through the bereavement process; Denial, Anger, Bargaining, Depression and Acceptance. I can attest that a dental patient who's been told that their tooth has "passed away" also experiences a combination of these when they're sitting in my chair.

I understand that tough news is hard, and I've heard a lot of pleas from reluctant patients, so let's look at what is actually happening in this dental scenario and what types of things patients often ask when they're trying to come to terms with handling this bad news from their dentist . . .

"If My Tooth is Dead, Why Would it Hurt?"

Denial is a powerful thing, but it's true, if something is dead, isn't that supposed to mean a cessation of pain? If it's dead it wouldn't hurt, right?!

Well, Yes and No. A tooth is made up of three layers; enamel, dentin, and pulp. It is the pulp that houses the "touchy feely" stuff; the blood vessels and nerves.

The nerve inside a tooth is responsible for telling us that coffee is hot (or cold, if the iced iteration is your inclination). When a nerve is dead (meaning no blood is flowing to it) it's considered 'non-vital' - so we often refer to it as a necrotic pulp or a pulpless tooth. A dead tooth is not normally painful by itself, because obviously at that point, there's no nerve to transmit pain.

Michele Gardini, via Wikimedia Commons

It is actually the necrotic tissue in the tooth placing pressure on the periodontal membrane that causes infection, inflammation and then pain!

In dentistry, we call that "apical periodontitis." To illustrate, it's the "pocket" (the inflammatory lesion around the apex of the tooth root) you see here in this x-ray. This can be a slow-to-burn pain process, which is also sometimes why patients don't believe me and maybe think I'm just trying to sell them an expensive dental procedure (a root canal).

What I am really trying to do is not participate in supervised neglect and witness you become the not-so-proud owner of an abscess. An abscess is basically when a collection of pus forms up there at the end of that root and I will tell you that an abscess is truly painful (think throbbing toothache that doesn't go accompanied by a fever and swelling).

"But I Brush and Floss Every Day and I Barely Eat Any Sugar!"

It can be very frustrating to practice good habits and still wind up with a problem. Isn't that the whole point behind practicing prevention and delaying gratification? However, it's also true that a tooth can die for all sorts of reasons, not just the result of an addiction to Red Bull and Twinkies.

Physical trauma comes in many forms and can leave a collection of fractured teeth in it's wake. Any kind of contact- a younger sibling's elbow to the chin, rough housing with an overly excited puppy, or a nervous pen chewing (or tooth grinding) habit can bring about the demise of a tooth. Trauma can also include a tooth that has been worked on and/or has extensive restorations.

There is no denying that any time a drill has to make contact with a tooth it has the potential to create trauma to the overall structure. Believe me, I get that you're mad, I feel the same way when I just eat salad for a week and don't lose any weight, it's just not fair!

"What If I Just Wait Until It Hurts And Then Schedule a Root Canal?"

So, we did not have a crystal ball reading class during dental school because examining an x-ray tends to give a more accurate picture of what's going on. Patients are certainly free to take a gamble and refuse treatment, they just can't refuse the reality of a diagnosis.

The problem is, even though a tooth will eventually fall out by itself, it's generally a really bad idea to let nature take its course in this situation because an infection can worsen and spread to other teeth and the jaw. I really am trying to prevent you from dealing with an even-worse-case scenario like an abscess. (See that paragraph above.)

I have honestly found in my own life that it's usually better to plan ahead of a crisis than to try and solve it when I'm all spun up and panicked (this typically results in a lowering of my patience, ability to problem solve, and retain polite manners with anyone unfortunate enough to be on the other end of the phone).

While I have not collected scientific data to back it up, I swear these kinds of dental issues (when your face looks like a hibernating hamster and the never-ending throbbing toothache has got YOU all spun up and panicked) tend to occur after 5pm on a Friday, going into a long weekend, when I just happen to be out of town for a conference the following week.

Greg is pretty creative at working the schedule, but even he can't turn straw into gold. I mean, wouldn't you rather come in when the timing is in your control and you get to decide what works best with your schedule (and you don't feel like clubbing yourself over the head with a sewing machine just to make the pain stop)?

"This Is So Devastating"

I've had several patients burst into tears in my chair either right after I break the bad news or right before we start the procedure. They're sad that they need a root canal and scared of what it involves, i.e. (more) pain. The actual root canal itself isn't painful (I swear I'm not lying), it's the pain that often leads up to needing one that is what most people associate with the procedure.

"Confirming My Appointment For A Root Canal Tomorrow"

It can sometimes be hard to find the serenity to accept there are very few things in life that we do have control over. However, as I said before, being able to manage the circumstances in response to an unplanned (and unpleasant) situation can often help mitigate some of that anxiety.

The good news is, you have an awesome support group in the room to help you get through the appointment. And despite my best efforts at lively political debate or recounting self-deprecating stories, I cannot tell you how many times I've had a patient actually fall asleep during a root canal procedure. My assistants tell me I need to get some new material.

Rest In Peace (of Mind)

comic dead tooth illustration with a grieving toothbrush, toothpaste, and dental floss

I'm no therapist, but a dental chair is not unlike the therapist's couch. I can promise that by the end of your appointment you will definitely be experiencing a reduction in symptoms.

So if you've been avoiding calling us because there's a tooth that's been bothering you and are concerned it might need a root canal, or if we've already told you that a root canal is recommended, give the office a call so we can help get you out of physical (and mental) pain, BEFORE it gets worse.

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