The root canal
I am very sensitive about my teeth. I am a nervous wreck in the dental chair, and suffering dental trouble while living in Japan was long one of my greatest fears, and so for many years I saved dental check-ups for my annual vacation time in Canada. Lacking any Canadian dental insurance my visits there were expensive. But I felt reassured with the confidence of English consultation. And then one day, eight years ago, I was forced to pay an emergency visit to a neighborhood Japanese dental clinic because I accidentally broke a tooth while eating popcorn.
The tooth had probably been compromised by years of nocturnal grinding and just by bad luck on Boxing Day (it was Christmas caramel popcorn) I happened to clamp down on a hard kernel in just the right spot to shear off a third of it. The dentist took one look in my mouth and asked in English,
“Are you in pain?”
“You should be.”
That experience turned out okay. I received a cap. And, since dentistry is partially covered by Japan’s social health insurance (called the “kokumin hoken” - national public health insurance - or the nearly identical “shakai hoken” - or the employees health insurance) it was not too expensive. I decided to shift my dentistry to my local clinic, a husband and wife team. Sometimes I have Mrs. Dentist, but more often I have Mr. Dentist. Again, it has turned out satisfactorily.
In May this year I endured my biggest medical procedure to date, a root canal here in Tokyo. It was even bigger than the extraction of two wisdom teeth (under general anesthetic) by a dental surgeon in Cambridge, Ontario, in the 1990s. The trouble with one of my upper left molars began in March 2009 when the tooth became infected following a routine cleaning. Periodontal gum disease and gum recession were the prime culprits. It was at that time that my dentist first mentioned the options of A) extraction, or B) a “pulpectomy.” I did not favor either. They both sounded bad. I knew right away that “pulpectomy” meant a root canal. And, although I didn’t really understand what a root canal is, I could figure it out just by the words. Anyone can, in English, like this:
“Root. Root of the tooth. Canal. Digging. Digging the root of the tooth. Okay, I got it.”
I checked it on the internet and my image was confirmed by what I saw and read there. I also could have consulted a cousin who is a dentist in Toronto. But I hesitate to do so because he is not a corresponding kind of guy. In fact, in 20-years in Japanhe has only written me once to correct my mistaken notion that it was Anthony Quinn who co-starred with Richard Burton in the movie The Robe. (It was Victor Mature.)
Well, I was very lucky and caught a break. My aching molar was successfully treated in 2009 with antibiotics. Mr. Dentist acquiesced to give me 10-days worth of antibiotics - 3-days longer than the normal 1-week protocol, he told me. But that did it for me. While I could still feel my gum receding I had no more pain. Then in January 2010 an abscess was indicated by the leaking puss and I thought,
Back to the dentist for another regular cleaning in spring 2010, a visual examination confirmed that the molar was dead. My choices were still A) extraction, or B) pulpectomy. For his own reasons, Mr. Dentist chose (B). I think I am almost certainly facing an extraction in the future. But the contemporary thinking seems to be to keep the natural tooth in place as long as possible, which is why we pursued the root canal option.
It is extremely frustrating that no Japanese can figure out the meaning of a root canal just by the name of it, “konkan,” like what we can do in English. Blank faces greeted my announcement that I was having a “konkan,” even the faces of educated people. Even my wife, who has had it done herself! So I drew pictures - pretty good pictures, too, I thought - showing the hollowing out of the entire tooth right down to the roots, and the severing of the nerves. People would say, “Oh! Mushiba!” (cavity).
“No!!! Not mushiba. Konkan. Konkan! Look!!”
Are people so stupid that they don’t know the difference between the shallow drilling of a cavity and the excavation of the entire pulp of the tooth? Apparently they are. Once again I am amazed how unaware most people are of what I consider Public Information. Or, maybe it is a sign of the extent of illiteracy in Japan, contrary to the myth of the educated public. Or, maybe it is a sign of the difficulty of the Japanese language, which does not have an alphabet. With an alphabetical language like English one can pronounce and read unfamiliar words and deduce meaning from context. But in Japanese, with its reliance on Chinese kanji characters, if you do not recognize the kanjithen you cannot read it.
The surgery proceeded in six weekly appointments. At first it was four - every Thursday in May 2010. But at the end of that protocol Mr. Dentist added two more appointments for mid-June - six in total. It was not so much painful as uncomfortable. After each appointment except for the last I walked away with a soft, temporary filling to stop the gaping hole in my tooth. I don’t know, but maybe in Canada dentists do it in one long session. But that’s not the way here. I didn’t complain about the original 4-appointment protocol. But when it stretched to six I began to think that things were getting a little out of hand. And, you know, it’s not just dentistry that is stretched out in Japan. Frequent appointments for minor things - in addition to unnecessarily long hospitalizations - are typical of all Japanese medicine. Just ask any foreigner who has visited a doctor or experienced medical procedures here. The prevailing opinion among foreigners is that it is a money grab. Doctors schedule frequent appointments for minor matters as a strategy for generating income by billing the government for more time and service. The health insurance system is structured to be that way. (An economist might call it a microcosm of the cash-flow problem [which stems from chronic near-zero interest rates in addition to debt structure] that persistently plagues the Japanese economy in the macrocosm.) Well, the strength of my grounds for criticizing Japan might always be weak, so I ought to conserve my judgment on this point. Maybe it wouldn’t have taken so long if I had gone to the doctor sooner, but it’s too late to think about that now.
Here’s how it went: first, he anesthetized the gum and drilled out the pulp and severed the nerves. Receiving the anesthetic was equally uncomfortable as the sensation of the drill and the scraping themselves. After numbing my gum with a paste applied with a Q-tip he poked around - and around and around - with his syringe. It didn’t hurt but it was SO uncomfortable.
Second, he scraped out - not drilled - a root.
Third, he scraped out another root.
Fourth, he did the third and last root, and capped it.
I received anesthetic for the first and fourth sessions.
I paid at the end of each appointment, dutifully presenting my health card. The second and third and fourth sessions cost only a few dollars out of pocket each. No anesthetic those times. But the first and last sessions cost only about $35 each - very reasonable. So the total I paid in cash myself was less than a hundred dollars for a procedure that might cost several hundred without insurance back home. Or here, for that matter.