"It's a lot easier to sell water to thirsty people than it is to try to make people thirsty."
-Seth Godin, Tribeca Smposium New York 2012
How true that is. And so please consider these two radiographs:
Both show the characteristic dark areas surrounding the end of the root that can be indicative of a "LEO"- a lesion of endodontic origin. A root canal infection. I say "can be" because there are conditions that mimic this diagnosis. There are times when doing a root canal treatment would be in error, as the dark area is being caused by something else. However, in these two cases we have already stirred in our patient's history ("apologia" is the ultra-cool Greek-rooted word for our patient's story of their present illness) and our clinical findings and made a definitive diagnosis of a root canal infection.
Here are the two films with the dark areas outlined, just for clarity.
Two of the same, then, right? Not at all. These two problems are very different, for the simple reason that one hurts and one doesn't.
How can that be?
Sometimes, the battle between the germs in the root canal system and the patient's immune system is such that there is no pressure building up and thus no significant pain. People can be blissfully unaware of the whole thing. Other times, pressure does build up. Germs produce gas, or they are dividing at such a rate that the immune cells have a ghastly time controlling them and an abscess forms under tremendous pressure. The pain is beyond intense. Hey, this is going on inside your bone, people.
The treatment for both teeth shown here is the same- root canal therapy. Or extraction. Those are your two choices.
But there's a difference. One person is thirsty. They're in pain and they will go a long way to get out of it. They're going to make it all happen: overcoming understandable anxiety with the help of a caring dentist and staff, getting numb, setting aside some time for treatment and managing the cost. None of it is any kind of barrier when it comes to getting rid of the pain.
The other patient isn't thirsty. There's no pain, not even any awareness. This has important implications for both the patient and the dentist, implications involving human communication.
In the no-pain root canal infection scenario, the dentist has a responsibility to teach their patient why a different shade of gray on an X-ray matters, and why they require treatment. The patient needs to understand that there are many painless diseases that require treatment just as much as the painful ones. Glaucoma, hypertension and melanoma come to mind.
For when a tooth is the source of an infection, the risks to overall health are the same whether there's pain or not.