The endodontic saga continues …

I finally feel human again! The root canal misery has finally dissipated – I hope!I have not felt well for about two weeks!

On a blog earlier this week, I chronicled - in somewhat sarcastic form - my encounter with an Endotontist. Though this fine professional saved me from unimaginable pain down the road, the $1,472 cost of the one-hour procedure didn’t sit real well.  To top it off, the little “bump” in my cheek blossomed after the procedure, requiring a return visit to the Endodontist and a change of antibiotics.

It’s been a long ten days of painful, uncomfortable misery, but without an Endodontist, my misery would only be starting. I’d surely end up losing the tooth, and I wouldn’t be a happy camper. So as much as we dread the procedure and rail against the cost, it’s quite necessary and truthfully, I am thankful that Endodontists take the time to study hard and do what they do.

The interesting thing for me was a response to my blog that arrived not long after I posted it. My blog reached an Endodontist in Canada, and he was most helpful in guiding me through the aftermath, sorting through the antibiotics and helping me to understand what it takes to be an Endodontist. He also made me really appreciate this fine line of work.

Through email this week, I “interviewed” him about his profession and working within the Canadian system. He’s a neat guy – check out his website! It’s cool; it’s not the standard Endodontist kind of stuff, though you can find all of that on there. He chronicles a recent concert, posts poetry and so forth. A man that is able to save your teeth appears to have a bent for writing, a sense of humor and a positive outlook on life.

This is the American Association of Endodontists website

http://www.aae.org/

This is his website – He goes by the name Periaplex

http://www.endodontics.ca

 Hi Ann. Thanks again for the invitation to "speak”

Here's my stream of consciousness answer to your questions. Feel free to ask more if you think of any others. I think you might have posted the AAE website on your blog, but here it is again: http://www.aae.org/

Q  What made you decide you wanted to go into dentistry and specialize in Endodontics?

A. My choice of dentistry came about after I decided that I wanted a career that was more clinical and people oriented than either teaching or research. I was a physiology major in university and had spent an extra year there deciding what I really wanted to do with my life. I minored in economics, and took enough courses for other minors in computer science, geology, and geography. I didn't want to have the responsibility of people's lives in my hands, so medicine was out and dentistry called to me more and more. Little did I know that although the practice of dentistry is rarely life-threatening, dentists do need to be aware of drug interactions and basic medicine in order to practice safely. This is the reason that the DDS designation is actively being dropped by many dental schools in favor of the DMD.

( Dentists have to be doctors, essentially. They should be DMD!)

Through dental school, I was too engrossed in learning dentistry to be concerned with a possible specialization. Towards my last year, however, I started to feel drawn to Oral Surgery, Pediatric Dentistry, and Endodontics. I ended up choosing to specialize in endodontics because of the fact that we (hopefully) eliminate pain and suffering while attempting to preserve the tooth. The pace of an endodontic practice also suits my personality (laid back and relaxed) more than most of the other dental specialties and even general practice.

(NOTE: The “mad scientist” that performed my root canal was not “laid back and relaxed,” I think that is a definite attribute!!)

Q  Do you enjoy your profession?

A   I enjoy what I do immensely. As with any job, this one is not without stress but I have checks in place to maintain my level of sanity. I have hired a great staff who make it a pleasure to go to work. The trap that too many dentists fall into is that they work too much and fill the day with too many patients. Fee-for-service (and capitation systems) creates a situation where the more patients you see, the more you make. The faster you see patients, the more you make. For some dentists they end up with a huge workload and stress level, increase their lifestyle to match their income, and then are trapped at that income level. They can't slow down if they wanted to. I often see the quality of work suffer because of this. That's unfortunate for patients who don't know any better about the quality of work in their mouth. If it doesn't hurt, it must be ok...

(Wow! That’s insightful! This experience has really made me think about “quality” of work – if something goes wrong and you need a root canal, you better have the best Endodontist you can find!)

Q How do you handle an anxious patient? Nobody likes a root canal, how do you deal with that?

A  There's lots of talking and explaining, TLC, and hand holding in my office for the anxious patient. There's also sedation for more difficult situations (laughing gas, pills, or IV). The problem patients are more the belligerent, egomaniacal ones. We've kicked some of those out of the office, or refused to see them in the first place. If there's no respect for my staff or for me, they'll need to find someone else who needs their business more than I. Every patient that comes to see me is nervous to some degree. They've never met me before, and they know their case is more complicated than average because they're having to see a specialist.

(Another great answer! NOTE: My youngest son needed a root canal five years ago, he was only nine years old. NO ONE in Southern New Jersey offered laughing gas, pills or IV! It was a nightmare! He grew up pretty fast that day!)

Q You diagnosed me with a “flare up.” How do you handle flare ups?

A  Problems like flare ups are a part of our practice. We try to prevent them as much as possible in the first place, but after that, we manage the best we can with various tools at our disposal. Emergencies are always handled individually because their management varies. They do disrupt the day somewhat though.

Q  You are Canadian, how does practicing endodontics in Canada differ from the US?

A  I am Canadian but obtained my DDS in the US. I then specialized in Canada in the only endo program here (takes 3 people a year). Almost every dental school in the States has an endo program.

(You know this Endodontist has to be among the very best – I’m going to Canada the next time!)

Dentistry in Canada is completely private. It's fee for service and most patients have some degree of insurance coverage from employment benefits. The government has its hands full with medicare, so they don't set fees or pay dentists. The exception to that is for patients under welfare assistance, but dentists can opt out of any such programs.

Q You have a blog – it’s cool! How did you get started?

A  As in any profession or job, politics abound, as do differences in treatment philosophies. I originally started my blog up in order to vent about some of that stuff. It's turned into more of a personal journal with a smattering of dental stuff. I'm still in the process of transferring it from blogger.com so some of the older posts might look strange.

Q We don’t have a big choice in Endodontics in our area. Is this the situation in Canada?

A We could do with more endodontists in Canada. Most of the ones who practice here are in just a few major urban centers. The other areas are underserviced. That's probably true for the US also. The shortage is impacting dental schools negatively. There are not enough endodontists willing to teach. Teaching tends to not be lucrative enough and so when we do teach, it's usually part time for a small stipend. Full-time instructors are hard to find and often have to be imported from other countries.

Q  OK, sorry this is the biggie. WHY is it so expensive to get a root canal? I mean I understand how intensely trained you are, but …  Given the alternative, you are worth it in spades. But, ugh …  it’s a lot of money!

A  One of the reasons our fees are so high (and I do agree that they are high) is because we don't run hygiene services. A typical dental office can generate half or more of it's daily production from hygiene. The work that endodontists do requires unbroken concentration often for much longer periods of time than other dental procedures, so it's difficult to double book or shorten treatment appointments without compromising treatment. So we see less patients in a day than a typical office. To make the average amount of money that a regular office makes, we need to increase our average fees.

(NOW I get it! I do understand. I’ll try to be brave when my $690 co-payment on my Visa arrives next month. Let’s see – a piece of furniture, a vacation, a root canal?)

Q Just how hard is it to save someone’s tooth?

A  IMHO endodontics is one of the most technically challenging aspects of dentistry. I'm not saying that because I'm in it (I would love if it were easier). We work in smaller, more confined spaces of the tooth than regular dentists or other specialists need to. We also work blindly for the majority of the time that we're actually in the canals. We can't see what our instruments are doing inside the roots. We are judged on our work more critically than any other aspect of dentistry because errors and deficiencies in endo are so unforgiving.

(Boy, you can say that again! It must be tough, if you’ve ever had a root canal you can imagine what it must be like on the other end!)

I spent 5 years doing my bachelor's degree (it was a 4 year degree but I found myself after an extra year), 4 years of dental school in Cleveland, 1 year of an AEGD (advanced education in general dentistry program) in Cleveland through the dental school and the hospital, 2 years of specialization in Toronto (it's now a 3-year program), and then endless hours of on the job learning. I felt like I finally really knew what I was doing after working in endo for 5-6 years. We are constantly reading and attending continuing education seminars to keep up to date on the latest research.

I am also on the examining board (am an examiner) of the Royal College of Dentists of Canada. We are responsible for certifying dental specialists throughout Canada.

To summarize, the job is tough, the training is long and arduous, the money is good, but you'll be very, very unhappy if you go through all of this just to chase after the money.

Hope that helps!

WOW!! Helps? It was fascinating! The really cool thing for me is that my blog reached someone so knowledgeable, obviously successful in his career – and willing to take the time to help me!! If I lived near him in Canada, I’d be in his dental chair if – Heaven forbid – I ever need this kind of help again!! I’m sure I will, but next time around I’ll understand a whole lot more how all of this works!

Thank you, Periaplex!!!!

ttp://www.endodontics.ca