March 25, 2019 - Robert John Hadfield

Specialization as a Key to Success

The Root Canal Diary


I have known many people in the dental industry throughout my life. A couple of my best friends have been dentists, and I have known a number of dental assistants and hygienists. The dental field fascinates me, not just because the discipline itself is fascinating, but because I can’t imagine why anyone would want to pursue it.

One of the advantages (and disadvantages) of knowing people in the dental field is that my curiosity about the dark secrets of dentistry can be satiated. I love hearing details, odd things, how things work, etc.

Long ago I learned the details of many dental procedures, and I have heard numerous horror stories about things going wrong. It’s fun to listen to the stories and understand the procedures. The problem is, when I’m in the chair, I know exactly what they are doing. I know the steps, some of the tricks they use, and I know part of their “secret language” too. The language they use so the patient doesn’t know the horrible thing they are about to do in your mouth.

So visiting the dentist is a mixture of fascination and stress.

A few months ago I realized it was my time to go to the dentist. Not because I was being a responsible patient and it was on my calendar, but because I was having a problem with a tooth – #3 to be exact. If you didn’t know, your teeth are numbered 1-32. You can find #3 by counting from the top right (starting with the wisdom tooth) and counting forward. You will know if you are doing the count correctly if 8 and 9 are the front two center teeth.

Many years ago I had a cavity in tooth #3. It was an extremely deep cavity, fortunately at the time it wasn’t so deep that they couldn’t fill it. But the dentist said eventually it would almost certainly need a root canal.

And a few months ago, the tooth started feeling weird and I knew the tooth had reached that point; so I headed in.

A tooth goes through different stages as decay sets in, and a root canal is necessary when the damage reaches the nerve. When the dentist puts that cold swab on your tooth and you jump through the roof, they are testing your nerve. Sensitivity, to cold, hot or neither, tells a dentist a lot about the problem with the tooth.

In my case it was neither. The nerve had finally given up and the tooth was “dead.”

When this happens there are really only two options. You can either pull the tooth or have a root canal. Doing nothing isn't an option because the tooth will eventually become infected and brittle, leading to a host of other medical problems. Of course pulling the tooth is less expensive than a root canal, and when you are dealing with teeth in the back of your mouth, many people think pulling it makes more sense than paying thousands to fix it. The problem is, once that tooth is gone and the root is no longer in place, the bone starts to weaken and disappear. Amazingly, having the root in place, even if the tooth is dead, keeps the bone tissue strong.  So there are very few dentists who will recommend and extraction.

The dentist I visited took an xray and sure enough, #3 needed a root canal. But interestingly, rather than setting up an apppointment to get it done, she gave me a referral.

I’ve had two root canals in my life, both of them were over 15 years ago. In both cases they were completed by the family dentist who found it, so getting a referral to go to a specialist seemed odd to me. I inquired why they couldn’t just do it there at the office, was it that serious? She told me that very few family dentists do root canals anymore, they are almost always referred out to an endodontist (a dentist who specializes in root canals).

This really surprised me. In the 15 years since I had my last root canal the dental field had made a dramatic shift.

So I contacted an endodontist and set up an appointment for the procedure.

When I set up the appointment I gave myself a lot of time. Having gone through this twice before, I knew root canals can take well over two hours to complete.

Root canals are a delicate procedure.  A dentist has to cut through the top of the tooth and expose all the roots. And then one by one the dentist will remove the nerve in each root using a series of files which literally scrape the nerve out of the root. The doctor has to be careful not to penetrate the end of the root or puncture the sides of the root. Doctors actually take xrays throughout the procedure with files in your teeth to see how they are doing.

Once they scrape out all of the roots, they meticulously pack material into the tooth to replace the missing nerve. And eventually they put a little temporary crown on the top of the tooth.

Each of these steps is a slow, methodical process. I was meeting friends for lunch, so I set up my appointment for 8:45 am. That should give me plenty of time.

At 8:35 I walked into the office ready for paperwork. And by 8:50 I was in a chair. An assistant took a few xrays and a couple of minutes later the endodontists walked in. We conducted the obligatory small talk for a few moments and then he gave me a couple of shots to deaden my mouth. By 9:00 he was back in the room, the rubber dam was stretched in my mouth and we were ready to rock!

Like a first-round boxer out of the corner he jumped right in. The drill started spinning and things were happening! It wasn’t more than a couple of moments before he verified there were four roots. Yep, four roots. Ugh. That’s about as time consuming and messy as you can get.

The drill kept spinning, and then beeps started sounding in different varieties. He told me not to worry about the beeping, they were signaling him how close he was to the end of the root. That’s right, there was a laser and a computer giving him precise, real-time feedback on his work, millimeter by millimeter!

He got up and walked out for a few moments while the assistant made some adjustments. He came back in and the same beeping and drilling commenced. It was noisy and kind of amazing!

The next thing I knew the doctor was looking through some sort of microscope-looking-thing into my mouth. He stood up and left for a moment while the assistant took an x-ray, he came back in and looked through it again.

Then he started using some other tool. And shortly made a comment to me about getting the medicine and packing material into the tooth.

And I thought whoa! Wait a minute, we just barely started. Why are we talking about packing material?

After a moment or two the doctor stood up and walked out while the assistant made some adjustments. He came back in, ran the tool for another moment or two. Then he told me he would give me prescriptions for the pain and the infection that was around the roots.

Then he stood up and walked out. Within a few seconds the dental assistant sat me up and took all the dental paraphernalia off of me.

I thought, hold on! We’ve been here for what…30 minutes? We can't be done, are we going to a different room?

And that’s when I realized why dentists refer out root canals to specialists today. Endodontic medicine has become so advanced, it makes more sense to allow specialists to perform those procedures. It's no longer effective for generalists to do it.

Like so many areas of technology today, the tools and procedures of dentistry have reached astonishing levels of exactness and precision. The rate of advancement has moved at a lightning pace; it’s almost impossible to keep up with all the changes. In the world of dentistry, the knowledge and tools have become so highly-specialized, it makes more sense for the medical professionals to follow suit. When generalists can't keep up with advancements in technology, tools and understanding, industries make way for specialists.

It’s not a new trend either; it’s just accelerating. And we see that same trend in almost every growth field today.

Last year I attended a seminar with a friend. At one point during the event I was introduced to a colleague and was told, “he’s a programmer.” I smiled and looked at the person and asked, “what kind of programming do you do?” and innocently my friend jumped back in and said, “you know, computer programming.”

The response was fascinating to me. There was a time not long ago when “programming” was something of a broad idea; when there were only a handful of things that the word “programming” could mean. But today, the word “programmer” is almost meaningless because it can refer to hundreds, perhaps thousands of different things. It reminds me of my Feb 11 blog called, "The Art of Collaboration." If someone says they play football, you have almost no idea what they do until they tell you the position they play. Modern industry across the board is becoming the same way.

When all is said and done, specialization is often at the heart of progress.

One of the beauties of living in a very small world is that specialization can thrive. In the past specialization was difficult because your audience was often limited to your geography.  But in our world of hyper-communication tools, fast networks, robust shipping, etc. your specialty can be supported almost everywhere. Even in medicine geography is shrinking! Just two months ago a Chinese surgeon performed a surgical procedure remotely with a robot over a 5G network.

Specialization is more important, more possible and more necessary than ever. Trying to be everything for everyone is a fool’s errand today more than it has ever been. Whether you are an employee or a small business owner, you would do well to focus on your area of expertise and find other "experts" who can handle everything else.

And this is what Audiomover can be for you. We are true specialists in our field. We have the modern tools needed to get you a professional digital recording of your audio and video tapes. We create results that meet the highest standards of quality and give you something permanent. Reach out to us and let us be the specialists in your digital world.


Back to the root canal…

By the afternoon the anesthetic wore off and I could feel my mouth again. And unlike the more time-consuming and invasive root canals I had over 15 years ago, I experienced no pain or swelling at all this time. That was the cherry on top for me. It was an astounding demonstration of our world of constant improvement and specialization.

A few days later I found myself discussing my experience with a friend. I actually felt an incredible sense of gratitude that I live in a time and place where this technology and expertise is available to me. Where surgical procedures are constantly improving and becoming less invasive; where surgery itself is practically pain free. Where specialization is alive and well. And where R&D constantly sheds light on new methods and new tools for specialists in all fields.

Compare that to the world only 50 years ago. Then imagine the world 50 years from now!

Advancements are so prolific and change is so rapid it’s almost impossible to comprehend. And specialization is one of the keys to staying on top.

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