"IT'S A ROOT CANAL IS GOOD NEWS"
by Dr. Jeffrey Galler*

Although I had never met the new patient, his family members had been patients of mine for many years. As his adult children helped him into the office for an emergency dental consultation, I noted that the patient's head was completely bald, his gait slow and uncertain, his posture stooped, and his skin gray and sickly.

The patient was very weak and fatigued, but his mind was sharp and clear. He explained that what had started as prostate cancer had spread throughout his body, that he had endured multiple surgeries, chemotherapy and radiation therapy, but he wasn't doing well and that his prognosis was extremely guarded.

The reason for today's visit was not for a toothache, but for a persistent parasthesia [numbness] in the right mandible [jaw]. The oncologist feared that the patient's numbness might be the result of cancer metastasis [spreading] to the head and neck region, and advised a dental consultation.

A clinical and radiographic exam revealed a non-vital [dead] premolar with an obvious apical radiolucency [shadow at the end of the root] and swelling in the muco-buccal fold [gum, next to the tooth]. I concluded that the tooth needed root canal therapy and the pressure of the endodontic infection on the mental foreman might very well be causing the jaw numbness.

I went out to the waiting room, where I found the patient's children pacing back and forth nervously, obviously deeply concerned about their father.
"I know that your dad is very tired and exhausted, and has been through a lot lately, I began," but I'm sorry to report that the only way he'll be able to get rid of that numbness is by having root canal therapy."

The children looked at me and exclaimed. "Thank God, it's a root canal!"
I realized that to the patient's family, his needing a root canal therapy was extremely good news, since they feared much worse news. Although it was unfortunate that the patient would have to undergo endodontic treatment, it was fortunate that the carcinoma had not metastasised [spread] to the head and neck region.

I learned a valuable lesson that day, about not losing sight of the big picture and not ignoring the proverbial forest for the trees. Now, whenever patients complain about needing a root canal, a crown, …, I relate this story. I tell them that we should be very grateful for problems that are repairable or replaceable and we should be exclaiming, "Thank God, it's a root canal!"

* Dr. Galler is a contributor to the New York State Dental Journal. His comments, used here with permission, originally appeared in the September 2003 issue of that publication