root canal treatment - NHS and private costs & pros and cons

rembrant

thank you toothsmith for your prompt and informative response, which again is much appreciated.

Is the tray method you mention an alternative to brite smile? I got the impression from the dentist that they were part of the same thing - i.e. it would be done manually by the dentist and then the patient would take home the trays as a 'top up'.

Toothsmith

Yes, it is an alternative.

The Brite Smile system gives you the instant 'wow' factor, and the tray method will stabalise the result over the next few weeks.

You can just have the tray system though, and get the result more gradually.

You may well get a slightly better final result with the instant Zap of Brite Smile kicking things off, but again it depends on where you want to get to.

A bit lighter, or George Michael!!!

Bear in mind though that no system will ever get them to match the fridge!!!

mda99das

Theres no guarantee that the RCT will be sucessful, due to anatomical relationships within the canal system.

There are other risks that are invovled

1) possibility of instrument separation
2) Post of pain
3) ID nerve parasthesia / OAC
4) Tooth brittle after RCT, prone to fracture

and the list goes on and on
...

Ted_Hutchinson

VIDEO UPDATE -- Why You Want to Avoid Root Canals - MERCOLA reviews the reasons why root canals can destroy your health and some practical alternatives.

You will need your speakers on to listen to the item. It did take a little while to comprehend his pronunciation of "Root Canal"
There is some information on the page as well it you can't bear to listen to it all.

To save anyone not familiar with Mercola's selling technique here's Wiki's item on Mercola
and the Quackwatch item on Mercola bearing in mind Quackwatch's Stephen Barrett isn't as squeaky clean as might be expected.

I wondered if Toothsmith would like to comment on this. I suspect it's as reliable as his scaremongering on almalgam but would be interested to hear if there is any grain of truth in the item.

Toothsmith

Tricky one Ted.

There is some truth in there, and there's some complete rubbish. And some of the conclusions he comes to, even from the 'truer' bits are not exactly the main stream view.

Bugs are bad, no doubt, and the theories of focal infection or focal sepsis have been around for ages and come in and out of favour.

It is quite possible that an active infection around a dead tooth (Root filled or not) may cause harm in other parts of the body. This is why dead & broken teeth in a mouth should not be ignored 'until they hurt'.

After a successful root filling though, you can actually see on X-ray the dark area where the infection was getting smaller and smaller. In my opinion, this would not happen if bugs were still active, and causing a response in the body.

Is the tooth 100% sterile after root canal treatment? Probably not, but there has to be a certain amount of bacteria before problems occur, and none of us are sterile in other areas anyway!

I have no idea what he's on about when he talks about the bacteria mutating into other kinds! I've never heard that before.

Further down the page, there is talk of hidden tribes with perfect teeth as they have not come into contact with modern foods.

A lot of this is true, apart from the gum problems.

Indigenous tribespeople who do not have a modern life have terrible gum problems, although very little decay.

Think of all the National Geographic type programms you've ever seen. Although the tribespeople have good looking white teeth, they are rarely gap-free.

xadoc

Thought I'd add to this cheery litany of root canals, ibuprofen and pain, although I'm a bit late to the party.

Observation 1) Toothsmith's patients must be very lucky. He/she likes his/her job enough to talk about it for free outside of work! This can only mean he/she enjoys the job and is probably therefore pretty conscientious about it. If only everyone (and not just dentists) were so! While I've not been the recipient of your advice, I am nonetheless grateful that you are here to provide it so willingly!

Observation 2) I've been very lucky. I'm 30, and until this year had not been to the dentist since I was 15. Precipitated by bad experience with evil orthodontist witch, who caused me pain for 3 years (and had the worst teeth of anyone I've ever met) and obviously hadn't listened to me when I'd told her the reason I'd gone to see her in the first place... I was so gutted when my braces were finally removed and the wonky front tooth I have was still wonky. "Oh, we can't change that," she said, "the tooth has grown at an angle to the root." That was all I'd wanted fixed all along, and I remember being fairly clear about it!!! Arrrrgh. And she seemed to enjoy causing all of us pain, too. Anyway, I digress. One of my teeth crumbled approximately 6 months ago, and I thought I'd got away with it until it became infected and I was not a happy bunny.

Observation 3) While my new NHS dentist is lovely and very understanding about my nervousness, it's hardly surprising dentists have a reputation for being sadists! He kept whacking the top of the crumbled tooth with a metal thing to ask if it was causing me pain?

Observation 4) Anyway - I was lucky, as I said. He said my teeth were in great shape (crumbled tooth excepted) and thought that if the infection cleared up I wouldn't need a root canal (I had to ask him to explain what that is, which he dutifully and patiently did), so he patched me up with a temporary filling and I went back the following week, where he whacked the tooth a few more times for good measure. Still didn't cause me any pain, so we went with the filling. Which was fine initially... packing that in deep wasn't pleasant. But I had agreed to go for it without anaesthetic... remember the needles being awful, and until the very end it didn't hurt, and the pain subsided quickly, so probably was right choice for me. Anyway, I then got a nice new white filling.

Observation 5) All this on the NHS cost me about £42. That was for both consultations - I paid £15 or so the first time and £27 the second. I think that's pretty impressive for such a highly-trained, specialist job; two appointments, probably nearly an hour (or did it just feel that long?) of someone's time, plus the hygienist/nurse's time too. I will go back. I am determined to be the sort of person who looks after their teeth now. I had always wondered what I'd say when my children asked why they had to go to the dentist yet mummy didn't - not that I have any yet.

Observation 6) How is it that my teeth aren't in that bad shape after 15 years of neglect? I'm ashamed to say that while a student I wasn't even that particular about dental hygiene (and that's an understatement). Am I blessed with good genetics? Is it the fluoride tablets my parents gave me as a child? Is it because I've used a fancy sonicare toothbrush for the last 8 years or so? I rarely floss, use mouthwash only occasionally, like fizzy drinks, and even recently have sometimes been a bit slovenly and don't bother to brush. Is that fair? Or should I mend my ways further?

Observation 7) In writing this I feel a bit of an ungrateful brat. Mrs Peace (the orthodontist witch) obviously saw me and friends of mine many, many times over several years... and it didn't cost me or my family a penny. That really is impressive. Can't help but feel short-changed though. My front tooth is still as wonky as it ever was, and I don't remember thinking there was a problem with any of the others she rearranged!!

Wow, what a ramble. Sorry, was cathartic!

Toothsmith

xadoc wrote:

Observation 4) Anyway - I was lucky, as I said. He said my teeth were in great shape (crumbled tooth excepted) and thought that if the infection cleared up I wouldn't need a root canal

I'm afraid tooth infections don't 'clear up' xadoc.

They can quieten down, but the cause is a dead nerve in the middle of the tooth (which is probably why it didn't hurt much when it was filled) and dead nerves don't come back to life again.

Antibiotics can calm the infection that leaks out of the tooth down, but it can't get into the tooth as there is no blood flowing round the dead meat to transport the antibiotic.

I think you will need to have it root filled or extracted at some point in the future.

xadoc

Toothsmith wrote:

I'm afraid tooth infections don't 'clear up' xadoc.

They can quieten down, but the cause is a dead nerve in the middle of the tooth (which is probably why it didn't hurt much when it was filled) and dead nerves don't come back to life again.

Antibiotics can calm the infection that leaks out of the tooth down, but it can't get into the tooth as there is no blood flowing round the dead meat to transport the antibiotic.

I think you will need to have it root filled or extracted at some point in the future.

Eeeew. Oh dear.

Dentist showed me an xray with a small blob under the root (under the point at the bottom). So strictly speaking gum infected not tooth? (I'm clutching at straws, obviously).

I wasn't given any antibiotics - was told enough it was probably small enough to clear up on its own once the temporary filling was in to prevent it getting re-infected - about half the tooth was missing - pretty deep area I'd been cleaning throughly for the 6 months since it had collapsed...

Said if I had *any pain* during the week (and he was quite specific about this) I was to come back immediately to get it sorted. (I did point out that when he said any pain... it had been throbbing since he'd put the temporary filling in! Apparently he meant after that wore off).

When I went back a week later the abcess had gone... so he did the permanent filling.

He did say something about the waiting/whacking etc was to check the nerve wasn't infected/damaged? or something like that? He seemed satisfied. It's not that I couldn't feel it at all. It just didn't give me any pain - same as if you whacked any of the rest of my teeth. He said something about something (the hole?) "not touching the nerve"? Or was that rubbish?

Is it a case of you get what you pay for? In a couple of year's time I'll be in agony and go through the whole thing again? :eek:

Toothsmith

That small blob on the x-ray is definitley an abscess.

I'm quite surprised he's explained it to you in such accurate detail, and so well, and yet has not gone on to do the correct treatment.

It could well be that he is behind his 'target', and as I explained in another post, he gets exactly the same amount of points for a quick filling as for a complicated and time consuming root filling.

I very much feel that this is a case of a good dentist being ground down by the system, rather than a bad dentist.

If he was a bad dentist, he'd have just told you the tooth had to be removed and got his 3 'points' in 10 mins with no possibility of any comeback.

Maybe this way, he was hoping to put off doing the root filling until either this NHS contract has been scrapped and a better one put into place, or he was in a better position with respect to his target, or he had gone private and could then charge a realistic amount of money for the work involved.

In the meantime however, you are left with a tooth that could flare up at any moment.

Either go back to him, or get someone else to look at it. If you go back to him, he should do it at no extra NHS charge, as it's within 2 months. I suspect if you let him do it, he will do it well, as he sounds like a good dentist. If you find somewhere private, it will obviously cost you more, but it should be done well if you pick carefully.

(HINT - ask if the dentist does root fillings using rubber dam (a way of isolating the tooth so that bugs can't get in whilst it's being done) not all dentists do, but it's by far and away the best way of doing it, so it's a good way of finding a conscientious dentist)

xadoc

Wow, thanks for the advice.

I now feel rather guilty as obviously I was keen for him not to do a root canal either. (this was backed up by every one I mentioned it to saying "Oh no! You don't want one of those!!") but maybe it is a case of the right medicine being difficult to swallow.

He did say something like, if this clears up, no pain etc, then we'll do a filling. If not, we'll do a root canal, but I think we can fix this with just the filling. When I asked what a root canal was he explained about it being a complicated and difficult procedure, taking a long time... Didn't mention anything about dead nerves and filling not being a long-term solution, though.

I wasn't reading between the lines and thinking oh - more efficient for him; cheapskate option? I was thinking oh great, less time and pain for me. I didn't think at any point about what would be the best option, as obviously I don't know anything about it. Now reading back I'm thinking no antibiotics, cheaper for him, no anaesthetic, cheaper for him, quick filling, cheaper for him. Hmmm.

A filling isn't the same price as a root canal on the NHS though, I didn't think? The posters in the waiting room said something about £15.xx, £42.xx and £192.xx, and that the £192.xx included "difficult work such as root canals" or something like that? So he would get more (but I'm guessing not enough?). Maybe he thought I couldn't afford it? I have to admit I was pleased I wasn't having the pricey option.

He was a nice guy, don't get me wrong. I agree with you. He was very patient and happy to explain everything. He felt like a good dentist. I didn't feel like I was being too much trouble (I probably wasn't, but I was very nervous and am now starting to feel icky just typing about it! Stupid aversions. All it would take would be for there to be a spider on the dentist's shoulder and I'd probably have a full-blown nervous breakdown).

If I understand you correctly are you saying that this flaring up again is quite likely, but it's impossible to know when? Could happen next week? Or this patch-up could last me 20 years? Could it last longer than that, but there's simply no way of knowing?

I now need to get my apologetic yet assertive hat on and go back for a second opinion/discussion.

He didn't suggest at any point that he remove the tooth (which is probably a good thing because I might well have gone for it to get everything over and done with quickly, and then never returned to the dentists again). It's the first of my molars on the bottom right hand side. 'I could probably do without it' would have been my thinking.

Could you point me in the direction of your other post about 'targets', I don't want to ask you to repeat yourself, you've been more than kind enough. I didn't know dentists had targets! Is it a bit like traffic wardens!?

One other question - my wisdoms (and the ones that come through later than the rest, but before the wisdoms) were really late. Some came through only a couple of years ago (and hurt like hell). But when he was counting out my teeth to the hygienist, he described the back teeth at the top (where the wisdoms should be?) as 'missing'... yet I've never had them removed? Where are they?