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

Toothsmith

I can fully understand why he feels he needs this extra charge - but under the terms of his NHS contract, it's not allowed.

All treatment required by an NHS patient is available under the NHS, and in your case, all available for the Band 3 charge of £198.

The extra £250 he is not allowed to charge, unless you have agreed to have it as a private alternative. BUT the key word here is ALTERNTIVE it sounds to me like this wasn't a choice.

Complaining to the practice should be your first step, but take it to the PCT if they still insist on this charge.

If the tooth is really important to you, then the specialist referral might be your best bet.

kjl26

Hi Toothsmith,

Thanks so much for getting back to me so quickly. My husband thought he wasn't able to charge the extra fee but I wasn't totally sure whether there was some sort of exclusion for complicated things (the dentist says it's very difficult because it's at the back and has three nerves and two roots - or the other way around? - and says that's how he arrived at his fee).

I am not keen on the idea of persuading him to do it for me on the NHS now as I'm worried he won't do the best job. I have an appt on Friday to do the three fillings and think I will go ahead with that, but ask him to refer me privately for the RCT - or just say I am going private and choose my own dentist (?). I really would like it done asap as it hurts so don't want to get into a protracted argument with him.

Thanks again
Katie

BexInLondon

Hi Toothsmith,

I hope you don't mind me asking for your advice too!

I am 26 but still have a milk tooth. It was filled in December last year (on the NHS) and I don't think it was done very well - the dentist seemed nervous and was rather clumsy. In September (a week before my wedding) the filling fell out and the only dentist who could see me at short notice was at a local, private-only practice. The practice was much, much nicer than the NHS dentist had been adn the dentist was excellent btu unfortunately it hurt a bit while she was cleaning inside the filling-gap and she suggested that my nerve may be involved. She gave me a temporary filling which has now been in place for 7 weeks but said I should go back soon after for further investigation. Since then it hasn't hurt as such, but is a bit sensitive to hot and cold and in the first few weeks (but not now) felt slightly nervy when poked in a certain place, which makes me think that the nerve is indeed involved. Is it likely, do you think, that I will need RCT? I'd like to avoid extraction at all costs as it's the 5th tooth back at the bottom so fairly visible!

Toothsmith

If it's a baby tooth, it won't RCT very well at all.

It's a good 10 - 12 years past it's sell by date now. I think the discussions you will need to have will be about it's extraction and replacement. The fairys should have had it years ago!

If your position is correct, then it's a baby molar that's retained, and it's adult successor - the second premolar - is absent fairly commonly. (3rd most common tooth to be missing after wisdom teeth and upper laterals). It really wouldn't be as visible as you think.

BexInLondon

Oh gosh - I guess I always associate missing teeth with poor dental hygiene. Is there anything I can paint it with so I can experiment with talking and laughing and see how noticeable it is? I don't want to spend £300-600 on RCT only to have to have it out anyway, but neither do I want to attack the two happy teeth either side with a bridge so I guess I should save up for an implant. Dentist G. Oogle suggests it's my second premolar, but annoyingly my baby tooth is bigger than the adult tooth (two sections rather than one).

I really do wish the fairies had taken it

Toothsmith

I don't think any dentist would suggest spending any money at all on getting it root filled. It simply wouldn't work.

It would either be have it out and accept the gap, or get it out and replace with an implant. ( You're right not to want to have a drill taken to the healthy teeth either side.)

If it were me, I'd probably live with the gap, but I'm male & mid 40s - not young & female!!:D There really wouldn't be any problem with a gap there though, either functionally or aesthetically - only in your mind!

A Maryland bridge might provide a decent, lower cost solution for only a tiny bit of tooth damage to the supporting teeth. But the reliability of these restorations is questionable, and it might be more trouble than it's worth if you have a strong bite.

Avant960

Hello Toothsmith can you advise me please?

Four weeks ago I went to the dentist due to some swelling around the gum area of a lower left hand side molar that had RCT in 2002.

The Dentist took X-Rays and advised that he saw no problems with the tooth but if I was to feel any pain in future to come back. However, before I left I was advised that I needed two fillings replaced on the right side (lower Molar). These two Molars already had metal fillings and they were not cracked and I was not in pain. I figured that he could see something that I could not and as he was the expert and I arranged to get them replaced a week later. The fillings were done and I opted for white fillings at a cost of £180.

After the anaesthetic had worn off I noticed that things felt different and not in a good way (filling felt very tight and the teeth felt strange). However, I just put it down to the fact that work had been done. After about a week, I started to experience severe dental pain (on a scale of 1-10 about a 8.5). I was unable to eat or sleep. I again thought that it was my jaw getting used to the new changes so I took pain killers for a few days. I then went back to the Dentist to get checked out and he said that the fillings needed to be filed down as they were too high. Afterwards, I felt some relief from the pain which had subsided a little.

A few days of mild pain followed but then the intense pain returned again. A relative recommended that I go to their Dentist.
At the new Surgery, I explained what had happened and she thought that I may have an infection and prescribed antibiotics. This solved the issue that I had with the pain.
I went back after a week and I was advised that an x-ray showed that the two molars on the right (the ones that had just been filled) needed RCT and the molar on the left that had RCT in 2002 needed doing again.
I don’t know what to think now regarding paying for more treatment as I went on the advice of a first Dentist and I ended up in a lot of pain and a dent in my finances. I also noticed that one of my upper molars is chipped and it happened when I went back the second time to get the fillings filed down.

If anyone can help please can you advise? Should the first Dentist not have noticed that I required RCT on the right molars rather than advising that I needed fillings?
I have now paid £180 for fillings that will be taken out after 6 weeks. I've kept an open mind about the whole thing and I am hoping that the first Dentist carried out only work that was necessary. However, I just don’t feel right about the whole episode. Sorry that it was so long but I need some advice because I have a feeling that he did not even do the fillings right. When, he was doing the fillings the assistant questioned why he was doing them a certain way (the white fillings have greyish/metal underneath which is actually visible). She thought that he should have used white material throughout (I think).

I have googled for information but I am unsure about what to believe. The second Dentist has said that she will do the two molars on the right but she will refer me to the Dental Hospital for the one on the left.

Fork86

Avant960 wrote: »

Hello Toothsmith can you advise me please?

Four weeks ago I went to the dentist due to some swelling around the gum area of a lower left hand side molar that had RCT in 2002.

The Dentist took X-Rays and advised that he saw no problems with the tooth but if I was to feel any pain in future to come back. However, before I left I was advised that I needed two fillings replaced on the right side (lower Molar). These two Molars already had metal fillings and they were not cracked and I was not in pain. I figured that he could see something that I could not and as he was the expert and I arranged to get them replaced a week later. The fillings were done and I opted for white fillings at a cost of £180.

After the anaesthetic had worn off I noticed that things felt different and not in a good way (filling felt very tight and the teeth felt strange). However, I just put it down to the fact that work had been done. After about a week, I started to experience severe dental pain (on a scale of 1-10 about a 8.5). I was unable to eat or sleep. I again thought that it was my jaw getting used to the new changes so I took pain killers for a few days. I then went back to the Dentist to get checked out and he said that the fillings needed to be filed down as they were too high. Afterwards, I felt some relief from the pain which had subsided a little.

A few days of mild pain followed but then the intense pain returned again. A relative recommended that I go to their Dentist.
At the new Surgery, I explained what had happened and she thought that I may have an infection and prescribed antibiotics. This solved the issue that I had with the pain.
I went back after a week and I was advised that an x-ray showed that the two molars on the right (the ones that had just been filled) needed RCT and the molar on the left that had RCT in 2002 needed doing again.
I don’t know what to think now regarding paying for more treatment as I went on the advice of a first Dentist and I ended up in a lot of pain and a dent in my finances. I also noticed that one of my upper molars is chipped and it happened when I went back the second time to get the fillings filed down.

If anyone can help please can you advise? Should the first Dentist not have noticed that I required RCT on the right molars rather than advising that I needed fillings?
I have now paid £180 for fillings that will be taken out after 6 weeks. I've kept an open mind about the whole thing and I am hoping that the first Dentist carried out only work that was necessary. However, I just don’t feel right about the whole episode. Sorry that it was so long but I need some advice because I have a feeling that he did not even do the fillings right. When, he was doing the fillings the assistant questioned why he was doing them a certain way (the white fillings have greyish/metal underneath which is actually visible). She thought that he should have used white material throughout (I think).

I have googled for information but I am unsure about what to believe. The second Dentist has said that she will do the two molars on the right but she will refer me to the Dental Hospital for the one on the left.

I may as well have a crack at this until Toothsmith offers his expertise.

Before I do, I must stress that without seeing your x-rays and having a look, I can't give you an answer with any certainty, so I will just explain the possibilities.

1) Teeth that have previously contained large amalgam (metal) fillings, can pick up a greyish stain (even when the whole filling is removed), and if this particular part of the tooth is hard and supported, some dentists would leave it in place as there isn't any decay. This stained tooth structure can 'shine through' parts of the tooth where the previous metal filling was in contact, even through white composite filling (this also depends on the type of white filling material system used to an extent too).

2) The decay may have been very deep and in very close proximity to the 'pulp chamber' (nerve). Now depending on the circumstances, some dentist's can initially try to be conservative and leave the tissue structure overlying the root, and place on top of it a calcium hydroxide based paste to 'strengthen' the tissue and protect the pulp.

Now the issue here is that if this was the case with you, and I was going to charge you a large amount for these fillings, I would have intially temporised these teeth to see how you got on with the treatment. If no issues presented, I would have replaced the temporaries with the permanant white fillings.

Ofcourse if I thought there was no chance or arresting the decay, or that the decay DEFINATELY involved the pulp, I wouldn't hesitate in commencing root canal treatment on the tooth.

3) If the dentist indeed did leave some of the previous metal filling in place, that would be wrong. The reason you needed replacements was obviously because of some sort of decay, and there would be no way to remove all of the decay without removing the whole filling. Obviously I cannot speculate as to whether your dentist did do this or not.

If it is true that the pain from these teeth subsided after taking a course of antibiotics, it does tend to suggest that there is some sort of infecton in them which would probably mean they do require root canal treatment or extraction. BUT, and this is important, if you were also taking pain killers and there was no obvious decay present in the roots of the teeth on the right hand side, this may have been confused with some sort of infection 'clearting up'. There is a chance that the 'decay' that is being seen in the x-ray of these teeth is just a empty or slightly underfilled area under the white filling (which will also show up as a dark area). This can also cause some pain, sensitivity or discomfort. Again, if he is doing this privately and spending time, the filling should be packed well without any voids!

Which then begs the question, did the x-rays your original dentist take indicate any decay within the pulp chamber/nerve of the teeth on the right, and if they did, why he didn't either notice it, or not commence the appropriate treatment? And why did he not notice anything to suggest the root filling on the left tooth had also failed?

As for the chipped tooth, unfortunately accidents do happen, but if you are sure this was the fault of the dentist, and he didn't explain about accidentally damaging your tooth during the procedure, that would also be quite unprofessional.

If the second dentist is sure about her findings, I would speak to your first dentist and confront him in a calm and collected manner, and express your concerns. Explain that you have had a second opinion on your treatments/teeth, and that they deem the intial treatment to be innappropriate and that are also quite upset your tooth was damaged without any aknowledgement. Then you have two options depending on what he says. If you are comfortable with him treating you again, offer him the chance to give you the appropriate treatment minus the cost of your composite fillings, as well as recourse for the damaged tooth. If he doesn't agree or you are not comfortable with him, ask for reimbursement.

If he refuses, all dental practices should have a complaints procedure in place, so it may be worthwhile to ask how you would go about lodging your own in this dental practice. If the result is insufficient, you can lodge a complaint higher up the chain, but that's another topic!

It does sound like there's something fishy going on though.

Fork86

Did your dentist take a x-ray after he completed the root filling or commencing the treatment for the crown? How long did he wait before placing a crown on the tooth after the root filling had been completed?

Everything Toothsmith has suggested is correct.

If there is a possibility that the root filling itself has an obvious fault in it (can only tell from the x-ray), the other option could be to re-do the root canal treatment through the top of the crown... But ofcourse the dentist would have noticed that in his x-rays.

labyrinth_2

Thanks for the replies.

Yes, X-rays were taken straight after the root canal was done. It was pressure sensitive straight after the RCT, it was felt that the crown would help and I also clench my teeth at night sometimes so perhaps my dentist felt that protecting it was a good idea. I didn't notice any temperature sensitivity at that time, I've only noticed that after the crown prep and crown placement. I THINK it was more after the crown placement (bite has been checked) I went back 2 weeks after the RCT for a check up and she was pleased with how it looked (no x-ray that time) then I was booked in for crown prep and then 2 weeks later the crown was placed. So there were 6 weeks between the RCT and the crown placement.

I have noticed that the crown doesn't go right up to the gum line, apparently that's healthier for the gum. It's when I put something cold or hot on that gum line where you can still see the original tooth that it hurts and it then radiates to the teeth in front.

Is that all part of the inflammation that's still there? Is there a chance all that will heal?

Being so scared of dental procedeures is making this situation very traumatic, I've had a problem now for almost 9 months and am exhausted by it all and am now on anti depressants as it's affecting my life.

Could it still heal? Is the hot and cold sensitivity part of the inflammation?