Tuesday August 23, 2011 – The evening of my birthday, August 22nd, a dull pain began to emanate from my tooth. One of my upper right molars started to ache. The pain first surfaced as a stinging sensitivity to cold, something that I had gotten used to since I had a filling replaced on that tooth a while back. This time a twinge continued to linger. It was so light that I wasn’t sure it was really hurting, or if I was imagining that it was hurting; either way it was all in my head. Gradually the pain increased, pressure building more and more, until I was in real agony. Eventually the pain became unbearable, so much so that I couldn’t sleep.
The throbbing even started to spread and the whole right side of face hurt. I generally don’t keep any medication on hand and I suddenly thought this was probably unwise, as I would have killed for something to lessen the aching, just enough so that I could sleep. Since it was the middle of the night, even the Seicomart was closed and there was nowhere I could go to even buy something. “If I was in Seattle, I could buy something at the 24-hour QFC,” I told myself. “Shut the hell up,” I replied.
I went through my shaving bag, which I always take traveling, hoping to find something that I could take. I found only generic Claritin and a pair of NyQuil liquid-gels, which were most likely expired. In desperation, I took the NyQuil. Sometime later, I managed to achieve intermittent, restless sleep.
When I awoke the next day, the pain wasn’t troubling me, and for a moment I wondered if I had just imagined the whole thing. It didn’t take long before the agonizing aching resurfaced. It seemed to fade in and out at random throughout the day. I went to work at the junior high, dreadfully tired.
As my tooth began to throb in the teachers’ room, I turned to Yusuke and casually asked about what dentist he goes to. He told me that he last visited the dentist in his previous town. Since he was new to Shakotan as well, he didn’t know about the area. Other teachers overheard the conversation and they jumped in, offering their opinions. I was told that the local dentist was very good and that the clinic was conveniently close. As I described the sudden pain I was experiencing, everyone adamantly agreed that I needed to see the dentist today, as soon as possible.
The Vice Principal made a phone call to the Board of Education for me, as my schedule was to work there in the afternoon. He told them about my toothache, and got the OK for me duck out of my responsibilities and go to the dentist. He even gave me directions to the dental clinic, and informed me that they opened for the afternoon at 2pm. What a great guy!
Throughout the teaching day, the pain would return occasionally, putting me in agony for a time. It would eventually fade again for a time, giving me some respite. Some of the students were expecting me to play soccer with them during the lunch break, but at that time I was suffering another period of tooth pain, and simply packed up my stuff and exited the school. On the way out, the Vice Principal came over to the doorway to tell me a joke.
“Do you know what place has people with the best teeth?” he asked. “Hawaii.” When I was slow to pick up the punch line he said it again, slowly. “Ha… wa… ii.” Then it clicked and I understood his bilingual pun: 「歯はいい。」 ‘Ha’ means tooth or teeth; ‘wa’ is the subject-denoting particle; ‘ii’ literally means good. If ‘Hawaii’ was a Japanese sentence, it definitely would sound like “the teeth are good”. I genuinely laughed so hard that I forgot I was in pain. You’ve got to appreciate a good pun.
Shakotan’s Dental Clinic is a relatively small, one story building, across the street from the nursery school. Entering through the sliding glass door in front, I removed my shoes at the entrance and put on slippers that they had provided. I walked up to the window and was greeted by a familiar face, one of the mothers I had met at the Fire Festival. She looked surprised to see me.
I explained that I had come because my tooth was hurting, which was maybe the only thing I managed to say in proper Japanese. They asked for my health insurance card (保険証 – ほけんしょう), which I gave them, and then they had me take a seat in the lobby. In no time at all, the woman came out to help me with paperwork.
She asked me a few questions in Japanese, or in as much English as she could manage, and with my answers she filled out a single sheet of paperwork for me. Immediately, I was led inside and directed to sit in the dentist’s chair.
The dentist was nice fellow, and seemed very confident, which was comforting. He and I struggled to communicate with the language barrier, but I manage to describe the pain and where it was located. Laying me back in the chair, the dentist searched for sensitivity by blowing cold air on my back teeth and tapping them with something hard. Next, I was led to the corner of the room to do a quick x-ray of the troubled area. Within a minute or so, there was a photo-booth-sized x-ray photo of my teeth for me to see.
The Dentist tried to explain something about the procedure and options, even using laminated visual aids, but I wasn’t quite clear on the details, except that there was potentially a problem with my tooth’s roots. I was also asked is I was fine with needles and shots, which of course I was.
The dentist gave me an injection of Novocain, and walked away for a moment. The dental assistant must have thought that I looked confused because she then told me that we were going to do some drilling today, presumably as soon as the numbing kicks in. Considering the pain I had been in for last 18 hours or so, I was totally down for whatever they wanted to do.
The dentist got rolling, and just I sat back and Zen’ed out. I’ve had my fair share of dental work over the years—thanks to my English teeth—and I feel like a dental work veteran. Interestingly, I don’t think I’ve ever encountered anything as painful as the orthodontic work I had had for my braces; just thinking about it gives me chills. But other dental work, even stuff involving needles and drills, I’ve found to be pretty easy to tolerate. In fact, I’ve come damn close to falling asleep while getting fillings done, I was so relaxed.
As he drilled into the troubled tooth, the familiar chemical smell of composite resins (the natural-looking white fillings) hit my nostrils, and I was reminded of that fact that I just had a filling done on this same tooth only 10 months ago. I had gone to Advanced Dentistry at Century Square in Seattle last November and had a lot of dental work done in preparation for leaving the country. How could they have missed the fact that this particular tooth was rotting on the inside? That left a bad taste in my mouth.
After lot of drilling, my tooth was reduced to a hollow stump. The dentist gave me a hand mirror so that I could see the damage for myself. At the point, it was time to remove the nerves from the center of the tooth, all the way down to the roots. Interestingly, the nerves of a tooth aren’t really important to its functioning, so they can be completely removed. This makes me wonder why teeth even have nerves at all. Using an instrument that is essentially a wire covered in barbs (called an “endodontic file”, I’ve discovered), the dentist ground away the pulpy insides of the root canal. I assume the image of this instrument is where fear of the whole procedure originated, but I can assure you, after you’re suitably numb, it’s really not as bad as advertised.
After the infection was cleared away, the dentist capped the tooth with a temporary filling. I was given pain pills, complete with handwritten directions in English, and made an appointment for Friday to continue the procedure. I was out of the clinic within two hours and my bill for the day was only 2930 yen.
The following Friday, I appeared for a second appointment and actually had to wait a bit. The dentist was already working with another patient. When I did get in, the dentist said that it would take a few more appointments to work on my root canal. I told him anything was fine with me and he got to work on my tooth. I’m fairly sure he didn’t use any Novocain that time, yet there was not pain at all. Perhaps the nerves were already all gone.
One difference I have noticed between the Japanese dentist’s office and the ones I had visiting in the States is that Japan has convenient little spit sinks beside each chair. The sink has a clever faucet that automatically fills up a Dixie cup with the proper amount of water, using a weight sensor underneath the cup. After the dentist would do a little work on my teeth, he’d raise the chair and instruct me to rinse. I’d swig a little water and spit it into the basin. As soon as I placed the cup back, it would automatically refill with the amount of water I had just used. With frequent rise breaks, the procedures were easy to handle.
At the end of second session, he put another temporary filling in and I made an appointment for the next week. My bill for the second session was on 220 yen.
Wednesday August 31, I went into the dentist’s for appointment number three. My appointment times were kind of vague, just anytime in the afternoon, so I ended up arriving at 4pm. Like my first appointment, I was seen right away. Again, the dentist used no anesthetic, but again I felt absolutely no pain. He removed the temporary filling and cleaned out the inside of the tooth, with both a drill-like apparatus and pipe cleaner-like instruments. Afterward, we took another x-ray to review work he had done.
At that point, we talked about my options for the crown that would be needed to cap my tooth, and we had the conversation in a funny mix of English and Japanese. To prepare, the dentist had taken some Japanese sentences and translated them into English. When our conversation would get stuck, he’d reference his cheat sheet of translations to help me understand. Even though the translations weren’t perfect, I was easily able to understand what he wanted to say from a few key words.
Since I was American, the dentist assumed that I would prefer a ceramic crown that would blend in with the rest of my teeth. For most Japanese folks, a sliver crown works just fine. As the dentist explained, a ceramic cap would not be covered under the national health insurance and would cost me 60000 yen (around $780). The silver cap would be covered and would only cost 3000 yen (around $39). Considering the price for ceramic was 20 times that of the silver cap, and the fact that the tooth was an upper molar, hardly ever visible at all, I told him that silver would be just fine. I added, 「日本人みたい。」(“like a Japanese person”).
The dentist filled in the hollow shell that was my molar to recreate the facsimile of a tooth. As yet it was still a bit stumpy, needing that cap to finish the job. However, that would have to wait for another appointment. The bill this time was 1060 yen.
Monday, September 12, back from my week-long, surprise visit to the US for my brother’s wedding, I showed up at the dentist office for more work. On this fourth appointment, we were making molds of my teeth that the dentist would use to forge my metal cap. This involved biting into a kind of plaster, something that reminded me of my braces days at the orthodontist. The plaster that the dentist used seemed more plastic and less goopy than the gross stuff I’ve had before. Perhaps the technology had improved.
My teeth made a good first impression on the dentist, and we made plans for one last appointment at the end of the week. My bill was 590 yen.
Friday, September 16, was my fifth and final visit dentist’s visit for my impromptu root canal treatment. We got right down to it, installing my new metal cap. To find the right fit, the dentist would put the cap in, have me bite down on this colored paper-like material, then take the cap out and grind down part of it a little. We went through this a few times before the dentist started asking me how it felt. Was it too high? Was it not quite right yet? He worked with me to make sure that it was comfortable and implanted properly.
Once we the metal crown was sized, the dentist glued that sucker in there. Eventually I was sitting on the dentist’s chair, biting down on a bit for four minutes waiting for the cap to set. After that, it was all done; root canal complete!
Leaving the office, I actually felt a little bummed by the fact they I didn’t have another appointment scheduled with these folks. They were so kind and welcoming, and had helped me out in a despite time when I had been in extreme pain. I told them, “Thank you for taking care of me” (お世話になりました), but it honestly didn’t feel like enough to express my genuine gratitude.
The bill for my last visit was 1720 yen. I thought that there would be another 3000 yen charge for the price of the cap, but I was given a final receipt saying everything was paid for. That means that my total bill after five appointments was 6520 yen, or approximately $84.77.
It’s worth noting that I’m enrolled in Japan’s National Healthcare. The cost of this insurance is only 2000 yen a month, which is equivalent to about $26 US—pretty damn affordable if you ask me. Plus, the treatment I received was painless. Overall, I have to say that my root canal was a surprisingly pleasant experience.