Is Private dentistry the only option?

northern_star

My 21 year old daughter has crowns on her bottom 4 front teeth. These were done four years ago on the NHS She has been getting a lot of discomfort from these teeth and has never been happy with the cosmetic appearance of them. She has consulted a dentist and endodontist as to her options all of which are costly. Two of the four teeth were root filled prior to crowning and it now appears that these root canal fillings have failed and become re-infected, one of the remaining two is also infected. The endodontist feels he can re-treat the 2 root filled teeth and root fill the other two but then they will need re-crowning and the cost of this treatment is quoted at 4k. Despite working full time and being sensible with money, she has limited resources and will have to borrow hugely to follow this course of treatment. Another option seems to be having these teeth removed and a denture fitted but she is reluctant to do this because of her young age and the finality of this choice. The NHS dentist who did the original work has long since moved on and the practice has become private but I wonder if she would be able to get treatment for the infection done on the NHS anywhere (doesn't expect to get cosmetic work done that way)? Or is taking out a loan for private work her only option?

stamford

Hungary ????

http://www.k-gdental.hu/en/prices.html?site=b8eb8e4abf52143a62d3718899d5de40

omelette451

Have you tried finding an NHS dentist somewhere? There are actually quite a lot of them around, especially up north where we are. In any case, from what you described it seems it's a medial problem not just a dentistry one (to me infection is a medical problem!) so you should also look at getting treatment from or via a hospital/your GP - unlike normal dentistry nowadays, emergency dental care is universal and unconditional.

brook2jack

The only possibility for re root treatment on the NHS will be at a dental hospital (she will need to be referred by a dentist). There is likely to be a long waiting list and treatment may well take a long time .

It is technically difficult to achieve a sucessful result when re root treating a tooth and no health authority i know of has contracted endodontic specialists for NHS work.A general NHS dentist is not going to want to remove 2 crowns ,re root treat 2 teeth and root treat 2 others.

In short your daughter is very unlikely to get treatment on the NHS for this in a timely manner or at all other than by taking the teeth out which by strict definition would secure her dental health.

Teerah

I agree with brook2jack, your daughter is extremely unlikely to find an NHS dentist willing or able to undertake the required treatment, not to mention that at this point it really is all or nothing to try and save the teeth. Another option would be extractions and implants which would cost more money again. If she values the teeth she shoudl try and save them, a denture at her age will not only be potentially damaging to the remaining dentition, it will also probably affect your daughters general confidence which is hard to put a value on.

Toothsmith

Why were these teeth crowned in the first place?

The lower incisors are such small teeth, that something as destructive as crowning will almost certainly kill one or more of them.

I avoid crowning these teeth wherever possible even on elderly patients. I can't think why a 21 yr old would have no other option other than crowning. Apart maybe from an accident which broke them?

PLEASE don't tell me it was done 'because they were crooked'.

Would agree with Teerah that etraction followed by 4 implants would be the treatment of choice for someone who's planning to be on the planet for another 60+ years. Anything else would just cause more and more problems over that time span.

Don't be tempted into going abroad. Get it done well, by someone you can see regularly and make sure they are maintained well by someone who knows what they are doing.

northern_star

Thanks to everyone for your helpful replies.

Am I right in thinking that should she elect to have implants, she would need to have extractions and wear a temporary denture for a while?

The x-ray showed infection beneath three of these teeth which I believe would go with extraction but wouldn't the site/bone need time to heal before implants?

Having listened to the endodontist explanation of the procedure and prognosis for re root-filling and re-crowning these tiny teeth, I am beginning to think that it wouldn't necessarily be her best option.

We haven't consulted anyone specifially about implants as yet, as we believed them to be beyond what she could afford. However, with the quote for the root canal/re-crowning work currently at 4k, perhaps that level of investment would go better towards implants?

Are implants permanent or do they need replacing after a period of time?

Thanks again.

presh_2

I sympathise with your case Northern Star. I feel Dept of Health does not encourage quality, the spinmasters in the Dept of Health do not really believe in providing the right treatments, they are more interested in statistics. Long term implants make sense as pointed out by Toothsmith. In my opinion re doing the root canal treatment is not impossible even for a general dentist especially if this is on anterior teeth. I cannot advice specifically, but as a generalisation if you trust your dentist, you should follow his/her advice.

Also in my personal opinion, long term private dentistry will be cheaper for you and everyone as it eliminates the constraints imposed by the National Health System....the constraint being 'TIME'.

I wish you luck.

brook2jack

There are many types of implant and implants are not suitable for everyone. They work best in non smokers with a good quality of bone.

The type and timing of implant can only be recommended by an implantologist some requiring a healing period before teeth are added and some can have teeth placed straight away.

No one knows how long an implant will last as they have not been widely used for more than 15 ish years but there is no reason to think a well placed and maintained implant will last even longer. They require meticulous oral hygiene because they can be lost to gum disease just as an ordinary tooth can be.

As an estimate locally implants including superstructure(the tooth on top) cost around £2000 each.

Toothsmith

There's growing evidence that implants work all right in smokers now as well.

The problem with smokers is that the soft tissues don't heal very well.

So - you can stick implants in, and you can attach teeth to them, but you can't get all fancy and artistic remodelling the gum and making the pink bits look nice.

But so long as the smoker in question isn't too fussed about that, the they can have implants.

VfM4meplse

Toothsmith wrote: »

Get it done well, by someone you can see regularly and make sure they are maintained well by someone who knows what they are doing.

How can the lay person be expected to discern this? Checking on the GDC site merely confirms registration. PCTs are focusing on contracting rather than quality, dentists escape the same professional scrutiny that GPs are subjected to, Darzi advocates a "light touch"...

There are lots of good dentists about but equally plenty of horror stories abound. A GP or pharmacist with unmet learning needs is unlikely to do as much harm during a consultation because their work is by nature less physically invasive, there are always resources to hand before action is taken etc.

BTW my dentist is ab fab and I wouldn't change her for the world.