I'm a Dentist, that's what I do.

Guest Blogger: Neal

So there were several questions about dentistry. First I guess I should explain what I do. I went to dental school and graduated in 2004. From the time I started dental school, I knew that I wanted to be a specialist, but even up until the summer before my third year, I didn't know which one. Well, actually I did know which ones I didn't want to do--periodontics, oral surgery, pediatric dentistry, dental radiology, oral pathology, prosthodontics, or dental public health. So that left orthodontics and endodontics. So when the time came to apply for residency, I still didn't know which one. So I chose neither--I applied for and got into a General Practice Residency at UCLA. GPRs are usually hospital-based programs with an emphasis on providing care to medically compromised patients. The dentistry is pretty much the same, you just do it on people who can't be treated in a conventional dental practice. That pretty much bought me some time during my fourth year to decide between endo and ortho. Obviously I chose endodontics. So that's where I am know--finishing my second year of a three year program.

So what exactly is a root canal, you ask? Basically, the inside of your tooth is hollow--from the crown all the way to the ends of the roots. This space inside the tooth is where the nerves and blood supply (pulp) are housed. When the pulp is insulted (usually by decay or trauma) the pulp becomes infected and ultimately dies. Since there is no longer any blood supply inside of the tooth, it becomes a sort of hiding place for bacteria that your immune system cannot reach. This can cause abscess formation, and a chronic inflammatory reaction around the roots where the canals exit and can cause bone destruction, root resorption, etc. So when you do a root canal, you make a hole in the tooth so that you can reach the pulp chamber, you clean and enlarge the canals in the roots, and seal up the roots to keep the bacteria out. Then your immune system can take care of the inflammation/infection that is around the roots. Then you need a filling and usually a crown to fill up the hole and strengthen the tooth against fracture. So in a nutshell, that's what I do every day. Here are some examples of my work:


So on to your dental questions: Elizabeth wrote: "So I have a couple of friends that swear all you have to do to keep your teeth clean is use mouthwash." Obviously this is not true. Here's the deal--have you ever heard of a biofilm? It's when a collection of microbes organize themselves into a film that makes them resistant to degradation by your immune system, other bacteria, chemicals, etc. Well, you guessed it, plaque on your teeth is a biofilm. The only way to really remove it is to mechanically disrupt it. Mouthrinses can be beneficial as adjunctive treatments, but they won't completely eliminate the biofilm. A couple of years ago, Listerine had a campaign saying that they had studies showing that rinsing with Listerine was a good as flossing. Well, come to find out, the publications weren't peer reviewed, were solely funded and conducted by Listerine, and pretty much didn't hold water, so under pressure, they yanked the ads.

Ginger wrote: "I want to know what grosses him out when he works on people's mouths." Believe it or not, I can't really remember the last time I got grossed out. I do remember the first time someone's mouth made me gag, though. I was doing dental exams at this Missions of Mercy thing and I had to do an exam/cleaning on this guy that had massive amounts of decay in his teeth. Even better was that he had tons and tons of food/plaque/crap stuck in all of these big holes in his teeth and I had to pick it all out. It was gross. That was before I was even in clinic in dental school so I hadn't really experienced that yet. It was also the first time I ever dry heaved behind the mask. Now I'm pretty much over it and it doesn't make me sick.

More than getting grossed out by patients, I get annoyed by them. Like today, I had three annoying patients. The first lady acted like she was dying during the whole procedure. She kept making these coughing noises and making these faces the whole time--which was about an hour. And it wasn't because it was hurting, she repeatedly told me she couldn't feel it. I think this was a topic on a previous blog post of Leslie's but here's my take. I know it isn't fun going to the dentist--especially when you have to have a root canal. But come on, you're an adult--you are capable of just sucking it up and getting through it without making it more difficult for yourself or the person working on you. Then my second patient was this 18 year old girl who apparently fell down the stairs and hit her front tooth. I'm guessing she was probably drunk when it happened. The best part about her was that her teeth looked like she hadn't brushed in at least a week. Note: even if you don't normally brush your teeth, how about you try it the day you have to see the dentist? I really wonder about young, normal-looking people who don't brush their teeth. Maybe they think no one notices. Again, not so much gross to me anymore, but annoying. Then there was my last patient who apparently thinks that if you wear enough cologne, you don't have to use deodorant. Small room, poor ventilation, Drakkar Noir, decayed teeth and BO--not the best combination.

Chel wrote: "I've really always wondered why someone would WANT to be a dentist, when if they are going through all the schooling to be a doctor... they could be any sort of doctor." This a good one. I considered both medicine and dentistry and one of the major factors that steered me toward dentistry was the difference in the lifestyle of a dentist vs. a physician. Length of training and pay are similar in the two fields, but the lifestyle of the dentist seemed to fit more what I envisioned my professional life to be like. By lifestyle I mean average hours worked per week, vacation time, call schedule, stress level, etc. I think I made the right choice.

OK, I still haven't mastered the short post thing. I have more that I can say on this subject, but I guess I'll wrap this up. Feel free to ask any dental questions you might have that I didn't address.