An article on root canals (Lifeline, Feb. 5) contained an incorrect phone number for the Dental Society of Northern Virginia. People seeking referral to a dentist can call 703-642-5297. Staff members do not provide information on insurance or fees. (Published 2/ 12/91)
It all came back to me the moment I walked in the emergency clinic door. The Muzak. The back copies of Sports Illustrated.
The distant sounds of drilling.
The anticipated pain.
I suddenly realized, with nauseating clarity, why I'd avoided the dentist for so long.
Now it was too late. The feeling that had begun two days earlier as a dull throbbing in my right lower jaw, the pain I'd deluded myself into believing was a harmless shift of my wisdom teeth, was now so severe I could barely focus enough to drive.
I thumbed through the Yellow Pages and found the 24-hour emergency dental clinic nearest my house. I made an appointment. The pain blinded me to everything, including the fact that I had no dental insurance. Nobody I know has dental insurance.
In the waiting room, I gulped back my anxiety and pondered worst-case scenarios. I could smell a root canal the way tourists can smell the canals of Venice. The warning signs were all there: The pain was severe, it would not go away and it was sensitive to heat and cold. This was the kind of thing my friends warned me about when I embarked on a freelance writing career. One dental emergency and the bottom falls out.
They were right. The dentist grimly surveyed my molar and pronounced the nerve and pulp tissue dead on arrival. He advanced on me with a syringe that looked as big as a basketball pump. He drilled. He removed the dead pulp and replaced it. He said he would perform the root canal on my next visit.
That emergency visit cost $197. Happily free of pain, I paid, then made my next appointment.
On my second visit, the dentist began the root canal but stopped abruptly when the metal tip of his drill broke off inside one of my molar's four canals. He showed me on the X-ray and, rather than complete the job, referred me to an endodontist, a root canal specialist. He only charged me $28.
The following week, the endodontist took more X-rays, surveyed them and assured me that drill breakages were not uncommon. He said my molar's four canals were calcified, or too rigid and bony. They also were thin and curved (front teeth have fewer and more cooperative canals), making conventional equipment unsuitable. He wanted to start over. He said the entire procedure, from removing the sliver of drill to completing the root canal, would cost $580. I'd already spent $225 -- car repair money for a month.
In shock, I agreed. The alternative was to have the molar extracted. I want my teeth.
The root canal surgery, or endodontology, saved my tooth by removing and replacing its insides. It required making an opening in the crown, removing the diseased or damaged pulp and cleaning and medicating the inner pulp chamber and the canals that extend down to the root. The canals were widened with tiny instruments called files, shaped to a form that could be easily filled with a rubber-like substance and closed with sealer cement. Surgery may be necessitated by long-term decay that exceeds a simple cavity, or by physical damage to the tooth. In my case, it was an injury from a basketball game.
Four visits later, the root canal was completed. Normally, the work is done in two visits, but it took two just to remove the sliver.
I paid the $580 with my credit card.
Now, I needed a crown to cover my root canal. Back to dentist No. 1. I thought it would be a breeze -- you just throw some metal over the molar -- but the drilling, pecking, poking, gauging and clamping was just beginning.
To make a crown, the dentist is required to shape the remaining enamel into a base for the metal cap to fit over, a procedure called post and core. It feels like major surgery, but with Novacaine, the pain is more psychic than real. Nevertheless, after seven visits I found myself wondering, "How much more can my little molar take?"
On the final visit, I got my temporary crown. The post and core cost $150, and the temporary crown another $193. To get the permanent one, made of gold, I am told to return in two months and be prepared to pay an additional $450.
Eight weeks after I first walked into the emergency clinic door, I'm out $1,048, and it's still not over.
My experience highlights a Catch-22 of health care. People avoid dentists because of experiences like mine, and yet these things happen because they avoid dentists. I have learned, however, that money isn't the only excuse. Another is fear of pain.
But as the American Association of Endodontists notes, it's generally better to save a tooth than to yank it. In addition, root canal surgery is not painful, nor does it kill the tooth or cause it to turn black. In fact, it saves the tooth to fight decay another day.
As one might expect, the best medicine is preventive: brushing, flossing, avoiding sugar and making regular visits to the dentist.
Third, the cost of a root canal usually is less than the cost of removing the tooth and replacing it artificially.
For people who are strapped financially but need the dental work, government-run clinics are available.
Some university dental schools will do work for free or at modest cost. Howard University is the only Washington-based institution with a dental school, now that Georgetown's has closed.
Alan Bisbort is an Arlington writer.
The following government-run clinics offer emergency dental service to low-income patients, with fees based on ability to pay.
Alexandria Adult Clinic, 517 N. St. Asaph St. (703) 838-4420
Alexandria Children's Clinic, same address (703) 838-4430
Arlington County Clinic, 1801 N. George Mason Dr. (703) 358-5026
District of Columbia clinics: 2250 Champlain St. NW, (202) 673-2113; 1328 W St. SE (202) 767-7886; 601 L St. SE (202) 724-8648; 46th Street and Benning Road SE (202) 767-7569; 702 15th St. NE (202) 727-0405; 4130 Hunt Place NE (202) 727-0530; 3855 8th St. SE (202) 767-7876; 601 Mississippi Ave. SE (202) 767-7922; Fort Totten Drive and Hamilton Street NE (202) 576-8578; 10th and R streets NW (202) 673-7243; 4300 13th St. NW (202) 576-8523; 850 Delaware Ave. SW (202) 727-3617; 4200 13th St. NW (202) 576-6376; 1100 1st St. NW (202) 727-3640
Fairfax County clinics: 3750 Old Lee Hwy. (703) 246-7117; 1850 Cameron Glen Dr., Reston (703) 481-4242; 6301 Richmond Hwy., Mount Vernon (703) 660-7100
Montgomery County Clinic, 2000 Dennis Ave., Silver Spring (301) 217-1875
Prince George's County clinics, 9314 Piscataway Rd., Clinton (301) 599-2211; 6505 Belcrest Rd., Hyattsville (301) 209-2480
If you have insurance but simply don't know where to go, local Dental Society offices offer a referral service, staffed by volunteer dentists, but you still must pay their fees:
District of Columbia, (202) 547-7615
Northern Virginia, (703) 642-5298
Southern Maryland (Montgomery, Prince George's, Charles, Calvert and St. Mary's counties), (301) 345-4196
Howard University Dental Clinic, 2400 6th St. NW (202) 806-0008