It is all low tech. I've been undergoing significant dental work over the past year and I always come back to this same thought. The reason the "brutal" techniques works is because of the amazing resiliency of the mouth. Wounds heal quickly, and teeth are rooted so deep they take a ton of punishment before giving out.

I've been lucky to find an orthodontist whose not afraid to do something advanced. Previously, I had 5 or 6 consultations from different orthodontists who, in some cases, wanted me to return within the hour to install metal braces.I knew that my mouth was a bit of a special case (impacted canine), but I refused to believe that metal was the end game. I always asked for Invisalign, but they all said it wasn't possible - until I met my current orthodontist. After a quick consultation, he comes back saying "we're going to try something different".

The man is a genius, as far as I'm concerned. He proposed a solution to straighten my teeth with Invisalign while making space to pull the canine into place with a cantilever. The cantilever is hidden behind my teeth, attached to my molar and secured with trans-palatal arch. He actually bent the wire around the top of my mouth to minimize its obstruction of the tongue. Painful, simple, but effective. I barely notice it. He cuts my Invisalign retainers by hand so they still fit in.

In the dental world, this is really advanced. I had to repeat the procedure several times to my oral surgeon (who did great work) before he understood that the chain pulling my tooth into place isn't destined for a metal bracket, and must be sutured to my gum pending installation of the cantilever. Quick call to my ortho cleared everything up. Likewise, my dentist was equally surprised. Both said it was a great idea. According to my orthodontist, my treatment would be the subject of a paper, if he was still inclined to write them.

None of it seems very modern to me.

I had the same diagnosis 20 years ago. And I had the old-fashioned treatment for it: oral surgery to expose the tooth, metal braces, canine winched into place by means of weekly tightenings over several months. Glad to hear things are beginning to improve.

And sad that the improvement won't become common practice because the practitioner doesn't feel the need to publish it...

Comparing frontal lobotomies (FLs) with cavity fillings is not an appropriate comparison, IMHO. FLs were always quite controversial because of the serious impairment side-effects and the danger inherent in the procedure (5% death rate during procedure). The operation caused serious brain damage to most - that was its modus operandi.

On the other hand, drilling holes in teeth seems like a low-tech solution (though I suppose that humans from years past would view it as a marked improvement from tooth-pulling), but it ultimately gets the job done, more or less, with minimal negative side-effects.

> It all seems so low tech.

This is because the alternative is very high tech. A living part of the body that isn't self repairing needs to be regenerated somehow. The tooth -under the enamel- is a complex living structure that doesn't self-repair. Much of our medical practice, esp. w.r.t. trauma, is based on the premise that the body can repair itself if perhaps given some assistance. But that premise fails with cavities.

At first blush, I was hoping that this work was going to be an advance that would promote repair in the deeper layers of the tooth. Sadly, we're not there yet.

At least dental techniques work, even if they might not be very sophisticated or pleasant. Lobotomies just destroyed people. They were only successful in that they made the victims more compliant and less of a hassle for their caretakers, they didn't actually fix the problems.

When you get a chance, take a look at a photo of an orbitoclast (think ice pick). Hammer it in behind the eye socket, give it a good whack, and swing it around a bit. Walter Freeman, the asshole who invented the device, used to drive around the country in his little van performing lobotomies for $25 a pop. He had a nasty tendency to kill his patients; he even killed one when he stopped to have his photo taken with the pick in the patient's brain and accidentally rammed it in a bit too far. These things, of course, happen when you can't see what you're doing.

http://projects.wsj.com/lobotomyfiles/?ch=two

https://40.media.tumblr.com/995323300444f99ee37ffffaa834cfb1...

http://www.sculptorshop.com/oddities/lobotomy-walter-freeman...

People like to say that "learning is fun," but I find that with the internet this is often not true.

All too true at times.

No need to wait. A few decades ago in Russia, anesthesia wasn't used during dentistry. That was a fun time period to grow up in.

No need to even go that far, in 2006 I had a root canal in Germany with no anesthesia or pain killers given. Made worse by the fact I didn't understand what it was being done. My German was terrible and the dentist's English was worse.

Are you talking about anaesthesia in the sense of general anaesthesia (loss of consciousness and all that)?

Because that's really not needed for a root canal. I've had many and generally the dentist will make an injection to numb the nerve, have you wait 15 minutes, and start working. In case of discomfort they'll give an extra injection.

This can't be real. I've had a couple root canal procedures done, and even with local anesthesia, sometimes a jolt of pain comes through. It would be impossible to take, I would think.

I actually lived through all the stages described here (I'm mid 20's) and I live in the Eastern Europe. When I was a child 20-15 years ago, local anesthesia/numbing would not even be even put on the table as an option, then good 10 years ago the doctor would ask if I wanted the numbing - I haven't refused once since then because I knew what the experience was like with no anesthesia. Recently they have been giving anesthesia without asking, which is good.

It really matters at what stage the tooth is in. If the tooth is dead (e.g. you have pain that intensifies to heat, and cold helps)[1] then anesthesia won't make much difference you won't feel a thing anyway.

If you're getting root canal, because cavity is close to the nerve and your dentist don't want to use amalgamated filling then you will need anesthesia, because the nerves are alive.

[1] It gets a bit complicated with molars, which have multiple nerves, if one nerve dies, you'll still need anesthesia for the remaining ones, and you do need root canal, since you can't save part of the tooth and you do need anesthesia, because the tooth is not completely dead yet.

Hmm. Both of mine were on molars and certainly alive, so that explains that.

But I don't know how a dentist could possibly tell the nerves are dead before drilling in. And the way they know is that you say ouch that fucking hurts.

They do hurt you but they don't use a drill at first. I had a root canal done recently and the dentist briefly touched a piece of dry ice to my tooth. He did to a an undamaged tooth first, I guess to see if I could feel pain?

Correct. The doc did it to me.

I had a very dead tooth, and a very alive tooth. Worked like a charm.

My mother had a few done without any kind of anesthesia just few years ago. Painful, but definitely possible to take.

I've had one done without. It's definitely not pleasant.

Must be a thing in German speaking countries? Last year i was asked if i wanted local anesthetic when the dentist was about to drill a back tooth for a crown in Zurich. I blinked with incomprehension - I couldn't believe anyone would NOT want anesthesia. But apparently I had understood correctly and according to the dentist quite a few ask to forego it.

They may have asked because having dental insurance isn't as common in Switzerland (medical/accident insurance is mandatory, but not dental), so many people pay for everything out of pocket. They might opt-out of the anesthetic to save money.

My dad doesn't do anesthesia when getting fillings (we're in the US). He doesn't like the numbness afterwards and the pain doesn't bother him too much, I guess. I tried it once and made it through, but it was a pretty miserable experience.

Drilling and getting a filling isn't that painful and for some people getting a shot is less pleasant.

There even are some dentists in Germany that drawing teeth without anesthesia, but with the help of hypnosis.

Indeed, some people are way more afraid of needles.

And the pain (for drilling+filling a regular cavity) really isn't that bad. The biggest unpleasantness about it is that it's in a weird place, at the back of my tooth, and that it happens at pretty much random intervals beyond my control. Most of the time you don't feel a thing, until the dentist "hits a nerve", sharp pain, but also subsides within the second.

And as far as I've understood they don't actually hit the nerve with the drill, just that the tooth locally heats up from the drill friction, which the nerve feels as a sharp pain, anyone know if that is actually right? I just ... read it somewhere :)

I used to do without (it wasn't offered, I was young and didn't ask either), but nowadays I usually opt for the anaesthetic, I don't mind needles at all, and there's no downside to it, afaik.

How was it possible to hold still while having a large nerve drilled out?

I can't speak to dental stuffs, but some local anesthetics don't work on me. I found it remarkably easy, though extraordinarily painful, to maintain stillness while having my foot stitched back together. The grip I had on the bedframe, however, I'm surprised I didn't break it or tear something apart in my arm.

I can't really say how I did it, because I'm not sure. I just knew I had to and didn't move.

I feel like dental work is harder. I've had an ingrown toenail worked on, and every painkiller injection was a) incredibly painful, b) barely useful for dulling the pain. After about seven shots, I decided that the knife-work on my toe was going to be less painful than subsequent injections, and toughed it out.

It's much harder when having dental work done; I've had painkillers not-quite-take, and I always ask for additional injections, unless they're minutes from being done.

So far for dental work anesthetics have always taken for me (or I've been knocked out, like when my wisdom teeth were pulled). I only brought it up because the foot happens to be another particularly sensitive area of the body. It's possible to get by without anesthetics, and you may (though I hope no one here ever has to find out) surprise yourself by how much you can tolerate while still remaining still for the procedure.

But in general, I think you're correct that dental work is harder. A bunch of stitches on the bottom of your foot, however, is still some sort of torture. The ones I've had on my head or arms or torso with other non-functioning anesthetics were far easier to take.

Holy crap am I glad I'm extra sensitive to painkillers' effects. For tooth work, I can easily get by on half a shot.

One thing few writers focus on, in terms of the post-apocalypse, is dental care. A cavity can literally kill you if it progresses far enough. David Brin actually addressed this in The Postman; maybe this is why everyone in post-apocalyptic television and most films has shiny white teeth - they know!

Whenever I read or hear about "preppers" or people preparing for a catastrophe, I've always wondered what their plan was for dental care. When I was in my early 20's, my wisdom teeth became impacted. My only symptom was a horrible upper respiratory infection that turned into pneumonia. Without antibiotics and then surgery to remove the teeth, I probably would have died.

And The Postman was a wonderful book.

The way root canals were handled is by usually killing the nerve via opening up the nerve, putting arsenic in and sealing it with a temporary filling for 2-3 days. After that's all done, there's very little pain felt except when the doctor goes far enough to poke at the gums. The procedure does take longer than with anesthesia in that you need two visits for the whole process, but that's how they did it.

That explains a lot. I had one of these improperly done on a molar about 10 years ago. After the anesthetic wore off from the first visit, the pain slowly grew over the next few days until it was of brilliant, blinding, bang-head-against-hard-object make it STOP!! intensity.

After they took off the temp filling, the smell was nauseating. Apparently it wasn't cleaned very well.

Never went to that guy again.

The foul odor may well have been from an infection.

That is absolutely not normal.

Arsenic? So they not only using mercury in fillings but arsenic too for killing the nerve, nice :(.

That's terrifying; I'm guessing that the language barrier resulted in a serious miscommunication?

Today if you go to the dentist in the Netherlands they'll ask you whether you want anesthesia. At first I was like 'wtf, is that even a question' but it's not that bad. It just compresses discomfort into a smaller time window. I'd estimate the 'total' discomfort to be the same.

Only have experience with fillings, btw. I guess extracting a healthy molar (e.g. to make room for other teeth), or a wisdom tooth, would be significantly more uncomfortable when done without anesthetics.

What the hell?

Frankly, I would consider foregoing anesthesia if they wanted to hack one of me members with a kitchen knife. But would never, ever, opt out of anesthesia for dental work.

Those tooth nerves seem to have realtime priority or something. These things HURT, and I haven't even done anything other than wisdom teeth extraction and normal cavity drilling. I cannot imagine a root canal therapy done without at least local anesthesia.

It's still not used by many poor/old patients here because mandatory insurance don't cover it.

That's terrifying; isn't it just discouraging people from going to the dentist? How much can dental anesthetic injections cost, anyway?

About few hundreds of roubles.

At least there was vodka :)

The problem is that the anaesthetic dose of alcohol is close to the lethal dose.

The problem with new techniques is that, being new, they are (1) hard to find and (2) more expensive. Combine that with miserly dental insurance and it's hard for advances to get traction.

I actually have an example of this from my own life. I grind my teeth while I sleep, apparently, and since none of the dentists I saw during the first 30 years of my life ever figured that out (grr) my teeth are pretty ground down. These days I wear a dental appliance while I sleep to reduce the damage, but it is only a case of "reduce", not "prevent." The teeth are still getting worse, just not quite so fast.

The word I'd gotten from several dentists was that this was as good a solution as I could realistically hope for. But last year I switched to a new dentist, and when I was telling him all this his eyes got all big, like I was telling him that the plan had been to drill a hole in my head to let out the Evil Spirits. Modern dentistry, he told me, actually had a way to stop the grinding altogether using a course of mild, painless electrical stimuli. Do a few rounds of that, he said, and it'd be problem solved.

Which sounded great! Except that my dental insurance refused to cover even one dollar of such a procedure, which meant it would have cost me about as much out of pocket as a small car. And I, being a layman, have no way to tell if this one dentist is really right, or if all the other ones were and this one is peddling snake oil. So I ended up not doing it, out of fear of a worst case scenario where I went broke paying for treatments that didn't actually do anything.

This outcome is sub-optimal for everybody -- even the health insurance company, since the more I grind my teeth down the more often they'll end up having to pay for extractions, root canals and the like as the teeth crack and fail. But combine lack of information with high costs and change-averse insurance, and it's difficult to see how you get to any other outcome.

People still get their wisdom teeth taken out without being put under. I heard one person describe the process inside your mouth sounding like a tree trunk being snapped in half.

I am one of those people. The oral surgeon offered me the option of being put under for an extra $600 for the 45-minute operation. There are probably things I'd pay $800/hr for, but that wasn't one of them. He seemed kinda irritated; that meant he had to give me something like 16 shots to properly numb everything.

Personally, I didn't mind it. It was an interesting experience. I knew I was made of meat, but the smell of bits of it cooking really brought it home. And as you say, the sound was kinda freaky. But it was a good opportunity to practice keeping the mind centered and following the breath. Plus now I can joke that I learned to transcend dental medication.

I also recently had my wisdom teeth removed without sedation. I took some pills that the dentist prescribed to me that were supposed to really put me out of it, but I was 100% with it until about the time we got in the car to leave the dentists office. I pretty much hate having my teeth worked on. It causes me quite a bit of anxiety when normally I'm not very anxious. Whilst numbing my face, he hit a nerve 2-3 times that sent what felt like a powerful electrical jolt through my body. After that, it was a quite a physical process with the dentist even propping himself against my arm at one point to rip those suckers out. I had put the process off for about 6-8 years, but I am really happy its done and in the past. Now every time I have to get a filling, I wince quite a bit waiting for that poked nerve sensation...

I have always been a champ at the dentist probably because I was used to it growing up with all the orthodontic work. As an adult I had a wisdom tooth removed. At one point he said he had to crack it, brought out an awl-type device and leaned on it with all his weight. A tremendous crack; I saw blood squirt out of my mouth like a jet, and thought it was hilarious.

However, I can't put things into my eye at all. Karmic.

But is it safe?

For me this is one of those things that I would definitely spend $800/hour on! Not to mention that the drugs they use to put you under are amazing.

Ironically I had my 4 wisdom teeth pulled without it - wasn't even offered to me at the time. I only had the anesthesia once for a minor dental procedure.

> the smell of bits of it cooking

Can you explain this part? I'm considering my wisdom teeth pulled out.

I had crown lengthening done once. The procedure is basically cutting away your gum to expose more of the bottom of the tooth (gives more surface area for a crown to attach). The "cutting" with a laser, so it's basically just burning away the gums. I could see actual smoke rising out of my mouth and it distinctly smelled like cooking bacon. It was very surreal because I didn't FEEL anything.

Cauterization of the wound, I'd expect. Stops bleeding via cooking you.

Huh, that's actually pretty accurate.

In fact, 'normal' molars sound the same.

In a former life, a nice American chap yanked one of mine out whilst in Kandahar and it sounded like that - only he also broke a part off the jaw too, so that could have been some part of the sound.

He informed me with a slightly embarrassed: "I'm sorry but I think I just broke your jaw bone."

In a later development, the bone began to be rejected by my gum and was pushed up and out. Broken bone is surprisingly sharp and rather than carry around the little calcium razor one of my Corporals kindly volunteered to pull it out with a pair of needle nose pliers.

Happy to say the latter operation was a complete success.

I'm from Scandinavia, where this is the norm.

I've had 4 wisdom teeth removed with local anaesthetic. I felt absolutely nothing during the procedures, though the sound of my teeth being hammered into pieces (two were lodged horizontally and had to be manhandled) was certainly unnerving.

After it was done I got up and got home, no side effects. I have no idea why it's apparently so common for a general anaesthetic in the US. (On the other hand, without it we wouldn't have hundreds of YouTube videos featuring hilariously rambling, drugged-up teens.)

When I got mine done (in the US) they gave me an IV of something that took care of the pain but didn't make me unconscious, and afterwards it gave me amnesia, so I can remember the fact of being aware, but not the details. Kind of like when you wake up from an epic dream, then ten minutes later you can't remember anything but how epic it was.

Yes. I did. Full extraction of upper right #2 molar.

They did topical numbing, then 4 shots in numbed area. The extractor device is 2 prongs on one side, and 1 on the other. It mates with your tooth's root. There's also a gum separator so they don't cause tissue damage.

The actual extract, if the tooth doesn't break, is about 2 minutes. And yep, it sounds like wet wood snapping, like that tree sound/feel described. If it breaks, it's called a "surgical extraction". Then they drill and pull the pieces as they come out. That can add a few minutes. Mine was in 2 pieces. They drilled for 3 seconds, and used a tweezers or something like that size. Little noticeable sound on that.

After that, you put gauze in your mouth so the area stays moist. Simple, crude, and effective.

I was in a great deal of pain with that tooth, as I had infection/cavity down to the root. I was glad to part with it, given the extensive damage.

Had two of mine out last year, one impacted, one cracked.

Both under local, first came out in <20 minutes and was entirely routine, 2nd took 40 odd minutes and was on the upper limit of the torque the dentist could apply, it fought her every step of the way - after it was done she asked if she could put it in bleach and send it to the Uni as it was (her words) the largest wisdom tooth I've ever seen.

Neither was fun but the dentist was lovely and the local worked well, I took her a box of chocolates and a card a few days later to say thank you for taking care of me.

I had to have a cracked tooth pulled a couple years back after it led to an abscess. They did the procedure under local anaesthetic only.

Oh my god, did it hurt. I have a pretty high tolerance for pain and even I was praying for it to be over as soon as possible. I can only imagine what people who are more sensitive go through.

(I would have happily taken general anaesthetic instead, but they didn't even offer me the option.)

Reading some of these makes me grateful to have gone to an oral surgeon to have all four wisdom teeth removed at once while under general anesthesia.

Yes it's loud. Since my father is a dentist, and he was keen to encourage my sister to follow in his footsteps, he had her "assist" during the procedure. (She was in high school at the time. She's now a very good dentist.) My clearest memory of the procedure is the comment, "hey let's see if he can get by with less lidocaine than usual."

I did, and even though it wasn't impacted or anything, it was still one of the worst experiences of my life. I hated every second of it. I was especially annoyed because I was 16 or 17 at the time and begged my mom to let them put me under, but she was paranoid about the anesthesia and wouldn't let me. Being a teenager, a gave her crap for a really long time afterwards, and she eventually relented and let all my siblings be put under.

I sometimes wonder if being put under is really all that much better, since it seems a large component of the experience is the amnesia drug they give you. I had some weird experiences after an oral surgery after I was awake but the amnesia stuff hadn't quite worn off yet. My sister had a similar experience after an orthoscopic surgery. It's a weird idea—can a somewhat traumatic surgery affect you if you can't remember it?

> I sometimes wonder if being put under is really all that much better

For me, it was fantastic. My wisdom teeth had to be pulled just as they started to surface, because letting them grow out all the way would have just wrecked years of brace work. So they had to cut into the gums to fish them out. And apparently the guy said one shattered in the process and they -really- had to dig that one out.

From what I remember, I counted from 100 to around 90-80, and the next thing I knew, "okay we're done." Was a bit out of it for a while, but very little pain. Kept on the pain medication for the next few days; worked great.

Aside from the mandatory cleaning you have to do after having wisdom teeth removed, I didn't really experience much pain at all. And I'm the kind of person that's extremely on-edge even about simple cleanings (very low pain tolerance.)

I would wholly recommend the general anesthesia. I don't even care if I ended up being awake for the whole thing but just don't remember it. Ignorance is bliss :)

It amazes some people when I tell them I had my wisdom teeth removed with only the local anesthetic, and managed the pain for the next few days with over the counter painkillers. It actually wasn't that bad. I had more pain from the braces I wore half a decade before.

Of course, my case was totally routine. Your mileage may vary.

I had two wisdom teeth removed in one session and it took the dentist just a couple of minutes, with local anesthesia and I didn't feel that much. Not sure why anyone would want general anesthesia unless it's a complicated case. As always, try to find a good dentist who has a lot of practice pulling teeth.

I have had the same exact experience. I even toughed it out with no pain killers after. It only was bothersome the first night. Needless to say I recommend this dental surgeon to anyone when the subject comes up. He was awesome.

That would be Europe. Sounds awful indeed. Especially if they won't budge and an extra tool is placed under the wisdom-tooth to be used as a lever… Root canal is done with local anesthetics as well by the way...

US as well. I was able to be put under for my most recent extraction, but only after shopping around and strong and continual insistence on my part.

Where I live in Europe dentists are pretty effective, I got 2 wisdom teeth pulled out under local anesthesia and truly did not feel a thing. Was even able to eat a light meal a few hours after.

I had mine taken out while awake (all 4 at once). I was 28 at the time.

Surprisingly, it wasn't that bad of an experience. I was back at work briefly the next day and then fairly normal within 48 hours.

Personally the idea of going under seemed like an unnecessary risk given that being awake was an option. Price didn't have much to do with.

I had mine removed and opted out of being put under. I get pretty nauseous coming out of general anesthesia.

Local anesthesia and very loud Flogging Molly did the trick for me (and a lot of patience, it took awhile). Didn't really feel anything.

I had mine out without general anesthesia, but they were fully erupted and about halfway out into position. The uppers came out in less than a minute (after local anesthesia), but the lowers took a lot of pulling.

I had a heavily impacted wisdom tooth removed from my lower mandible.

Local anesthetic only, was a lot of work and as the surgeon got his leg up to get leverage I could feel my front teeth moving a little from the pressure.

> without being put under

Local anesthetic is more than sufficient.

The way they treat depression is still very low tech. They make it sound modern, but electroshock therapy still has the the highest rates of remission. I'm a nobody, so listen to your psychiatrist though.

I do agree they have a long way to go in dentistry. A year ago, I was browsing a scientific grant site. They still don't know why fluoride ions seem to protect teeth.

As to keeping your teeth as long as possible, I'm an old dude who's missing one tooth. It could be genetics, or luck, but here's my regimen. Brush with a electric tooth brush(the original one, that one that vibrates. Get in the habit of using tooth picks. I'm a former smoker, so the habit came easily. (Don't throw the tooth picks on the ground. Birds can swallow them, and other trash concerns. I won't mention a company. They are all the same.) Try not to eat sugary stuff before sleeping, even napping. Buy a few dental scraping instruments. (if you are somewhat coordinated, you can scrape your teeth. You can even get 1 to 2 mm below the gum line. Because you are doing this extra work, just believe you are saving your teeth. (Yea, why not use the placebo effect on your own body?). Drink tap water.

When I was younger, I looked into making chewing gum, but with a safe substance in it that would neutralize the acids on you teeth. Never got around to it. I recall a French company hit the market with a gum like the one I wanted to make, but unsure if it was successful, or even worked.

There's a part of me who believe's tooth decay is more about enzymes, and immunity, but who know?

Yep yep yep yep. The fact is that this will "heal" the tooth rather than effectively putting a cork in it. This will also eliminate root canals because rather than a cork pushing against the nerve, you will have calcium replacing lost... calcium. Boom. Real healing.

Remember when a bad cut = cut the arm off? Now we have so much treatment that it is very rare to remove healthy tissue.

Similar things are coming with that new artificial eye lens. "Why would we cut off healthy tissue, when we can just replace the bad tissue"

More than anything it shows how terrible a lot of modern diets are for health. Virtually no one would go around eating lemons, but we've found a way to combine it with sugar to create the worst of both worlds for our teeth.

Sugar isn't easy to come by in the natural world but it's in so many foods now that bacteria in the mouth never go hungry.

I dislocated a limb, once, while playing some sports ball. The fix at the ER? A heavier doctor wrapped some ropes around me and leaned back with all of his weight, while the other doctor grabbed my limb and pulled really damn hard. Some medical treatments feel absolutely medieval...

Well, there's no modern way of solving what's essentially a misplacement of your limb

It's going to involve pulling and readjusting

Stents and angioplasty are pretty low tech, too, in much the same way. Bodies are messy.