Q&A With Dr Emma
Hi Dr. Emma, I recently went to a new dentist. I was in pain and she started root canal treatment and it all happened so fast and my mouth was open in the chair and she was working away and I realised I did not have a dental dam put on me. I remember when I spat and rinsed out I almost swallowed a little piece of something. It was on the verge of going down my throat but I managed to blow it back out through my mouth and down the bowl. I had severe pain before she started and pain for a few days after. She said there showed no infection in the x-ray that she took after Stage 1 root canal. My tooth hurt to touch with my tongue and to bite down. I ate mashed vegetables and yogurt that day. The pain finally went on day 3. Should I worry that she did not use a dental dam? It did concern me. I go back for the final stage of treatment in 10 days. Thanks, Tara - Carlton North (Victoria). PS Thanks for the great articles!
It's common to have some tenderness or pain following the first stage of root canal therapy. If you think of the dead pulp of your tooth as being like a splinter in your finger, you'd expect your finger to be sore for a few days afterwards the splinter is removed. I always warn my patients that they will experience some tenderness after starting root canal therapy, but it should feel significantly better than the pain they came in with and resolve within a few days.
When it comes to root canal therapy, rubber dam is considered the gold standard for treatment. It keeps the tooth clean and dry while it is cleaned out, and keeps small objects and bad tasting chemicals out of the patient's mouth. However, there are some instances where it's just not possible to use it:
If the tooth is not completely through, or is a certain shape, the clip will not stay on.
If the patient can't open their mouth wide enough, it's not possible to fit the clip and applicator into their mouth.
If it's difficult for the patient to breathe through their nose, rubber dam may not be an option if it's going to block their only other means of breathing - their mouth.
If a patient is prone to claustrophobia or finds it difficult to swallow, the rubber dam can create a lot of anxiety.
If the tooth is heavily broken down, there may not be enough left to attach a rubber dam clip to.
If the patient has an allergy to latex, an alternative material must be used which may not be readily available in some practices for an emergency situation.
If there is decay or a filling going below the gum line, rubber dam will sometimes get in the way.
If you're unsure about why your dentist didn't use rubber dam, then ask. It may be as simple as one of the reasons above, or she may be happy to use it at your request.