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

welshdent

In northern ireland they do not have the banding based contract that we have in wales and england. It is fee per item so I would say it is feasible that you could get up to this much given the amount of work you are apparently requiring. The price would strike me as a bit low if you were getting private work on the side and not know about it. I guess a couple of the fillings could be private if you are getting white ones.

In summary the £198 ceiling cost is not valid in northern ireland

capomeister

I had a very deep filling a year ago, following a botched job by an emergency dentist (a subsequent X-ray at my normal dentist showed she had only half removed the decay and drilled the rest of it closer to the root).

The filling is large and very close to the nerve. It's an upper back tooth and I can't put pressure on it. It's sensitive to temperature too and the dentist told me the prognosis for the tooth is poor and eventually I'd need a root treatment. I am thinking of getting that done now, not least as the tooth is currently hurting me.

I want the tooth to last as long as possible, obviously, and have heard success is far more likely if the tooth is crowned. Thus the NHS treatment may be a false economy if the tooth only survives for a year or two non-crowned.

What kind of crowning material would be recommended? Obviously I'll have to have this treatment done privately but if, say, a crowned RCT tooth is £300 and lasts 8+ years that's a better economy for me than £198 for a couple of years on the NHS.

Aesthetics (whiteness) is not important as it's a back tooth that already has a gold inlay in it.

welshdent

regards the botched job, I am assuming that you had pain hence the emergency dentist? It could well be normal treatment that was carried out if the decay was that deep. Its actually quite difficult to deliberately drill that deeply as we are guided by the decay and thus softer tooth tissue. When someone presents with toothache that is attributed to an inflammed nerve then we do try and remove as much as we can and then place a sedative temporary dressing. If you were seeing an emergency dentist then that may have been all they had time for. If you did indeed have toothache that required such management then you would have needed a root filling (or extraction) regardlessly. In terms of long lasting crown materials then gold has a very good track record and is less destructive on the remaining tooth tissue. There is no reason why you could not get a metal crown provided on the health service. The alloy will likely be different to a private option as they will be using a cheaper one ... What is likely to make the tooth fail is if the root filling is done badly in the first place. It doesnt matter WHAT you crown it with if you do not adequately clean and disinfect the inside of the tooth. If you are going to have the root filling, WHOEVER does it .... insist on a rubber dam to be used and ideally sodium hypochlorite as the cleaning/irrigation solution. Sodium hypochlorite has a lot of good evidence as an effective irrigant as it not only kills bugs it also breaks down and disolves dead organic tissue such as dead nerve tissue. If rubber dam isnt used however, IMO its not worth doing at all and you may as well have it out.

capomeister

welshdent wrote: »

regards the botched job, I am assuming that you had pain hence the emergency dentist? It could well be normal treatment that was carried out if the decay was that deep. Its actually quite difficult to deliberately drill that deeply as we are guided by the decay and thus softer tooth tissue. When someone presents with toothache that is attributed to an inflammed nerve then we do try and remove as much as we can and then place a sedative temporary dressing. If you were seeing an emergency dentist then that may have been all they had time for. If you did indeed have toothache that required such management then you would have needed a root filling (or extraction) regardlessly. In terms of long lasting crown materials then gold has a very good track record and is less destructive on the remaining tooth tissue. There is no reason why you could not get a metal crown provided on the health service. The alloy will likely be different to a private option as they will be using a cheaper one ... What is likely to make the tooth fail is if the root filling is done badly in the first place. It doesnt matter WHAT you crown it with if you do not adequately clean and disinfect the inside of the tooth. If you are going to have the root filling, WHOEVER does it .... insist on a rubber dam to be used and ideally sodium hypochlorite as the cleaning/irrigation solution. Sodium hypochlorite has a lot of good evidence as an effective irrigant as it not only kills bugs it also breaks down and disolves dead organic tissue such as dead nerve tissue. If rubber dam isnt used however, IMO its not worth doing at all and you may as well have it out.

Thanks for all your advice, Welshdent. About the botched job: I had toothache and saw an emergency dentist as my surgery couldn’t see me for over a week. The tooth was already crowned and the emergency dentist said it required only a filling. The temporary dentist caused me considerable pain in treating me by giving me a temporary filling. I found this unusual as she’d given me a local.

When I saw my own dentist for the proper filling a few weeks later she x-rayed the tooth and showed me how bits of the decay had been left in the tooth, some pushed right up against the nerve in front of the temporary filling material. She was not impressed. She wanted to do a root treatment there and then but I had gone in expectation that a filling was only needed, and wanted to try that first to attempt to save the tooth long term. However, the filling (fitted with no pain) is so close to the root that I can’t use the tooth and the pain level goes up and down through the year. Get quite a few ulcers and inflammation on that side of my mouth too. An x-ray later in the year showed the filling was doing it’s job, however: roots not infected. I don’t want a sudden pain flare up, as I’ve had the last few days, and I don’t want a gap, as it’s my largest back tooth, so I’ll try root treatment.

I’m seeing my dentist tomorrow. I’ll ask her if she uses a rubber dam and sodium hypochlorite. I hope she does not think I’m impertinent for asking questions about her treatment methods (she’s not a great talker about what she is doing). If she doesn’t use a rubber dam I guess I should find a surgery that treats with that? She's a very young dentist but her treatment so far on me has been good.

The surgery (one of a national chain) say they offer metallic, including gold crowns, on the NHS, so I’ll go for a gold one on the NHS if I can get one. I have other gold inlays that have lasted 20 years, so I’m impressed with that material.

welshdent

I would say yes ask if they do it and if not ask to be referred to someone who does. It sounds like you have a so called vital case so success is normally good with those but it needs to be for properly in the first place. I don't think I have ever done a root filling without a dam and hypochlorite. If they don't have hypochlorite then pop
To tesco and get some thin bleach for them
For 25p!!! It's the same thing ;-) Milton also does the trick

capomeister

welshdent wrote: »

I would say yes ask if they do it and if not ask to be referred to someone who does. It sounds like you have a so called vital case so success is normally good with those but it needs to be for properly in the first place. I don't think I have ever done a root filling without a dam and hypochlorite. If they don't have hypochlorite then pop
To tesco and get some thin bleach for them
For 25p!!! It's the same thing ;-) Milton also does the trick

Cheers again, Welshdent. Maybe I should go to Tesco before the surgery It's an upper back tooth - the largest one in the middle of the row of molars, so I'm not sure what the success rate is like with them, but touch wood with a gold inlay it'll last me many years. But she did warn me root filled teeth are brittle and may crack and fall out so I'll have to watch out.

welshdent

At the risk of offending a couple of the dentists here ... If it is up there I Would even be inclined if it was me to see a specialist for that tooth. They are notorious for having tiny hidden little canals. I have been using a microscope for a year now and there is no way I would even attempt one without one having grown accustomed to the advantages it gives me. Its unlikely your own dentist would have a microscope as they cost a bomb! Finding all those canals may or may not make a difference but if you are looking for the best long term solution for it then I personally wouldnt take the risk if it were my tooth ... you may want the full crown corverage option rather than inlay if its brittle

capomeister

welshdent wrote: »

At the risk of offending a couple of the dentists here ... If it is up there I Would even be inclined if it was me to see a specialist for that tooth. They are notorious for having tiny hidden little canals. I have been using a microscope for a year now and there is no way I would even attempt one without one having grown accustomed to the advantages it gives me. Its unlikely your own dentist would have a microscope as they cost a bomb! Finding all those canals may or may not make a difference but if you are looking for the best long term solution for it then I personally wouldnt take the risk if it were my tooth ... you may want the full crown corverage option rather than inlay if its brittle

Wouldn't know where to begin in finding a specialist. Wish there was a way I could find a recommendation for one who does good work. I'm based in Greater London not Wales or I'd be inclined to try your surgery!

How much would a specialist typically charge for a root canal treatment with a gold crown? And you would recommend a full crown rather than just an inlay with a root treatment to a large upper back tooth? I think it's going to double the cost (£400 v. £198 to go for full gold crown) but worth it if means my chances of keeping the tooth longer, ideally over the course of my lifetime, are signficantly enhanced.

welshdent

Your own dentist should know of specialists near you or at least people with a special interest and the rigth equipment. Its difficult to give a price guide as everyone will charge differently. I would expect upwards of a couple of hundred though. Also I cant really give an absolute recommendation for a crown over an inlay/onlay as I cant see your tooth unfortunately. That said, if you have been told that your teeth are weak then it is something to bear in mind. I would say however you need a "cusp covered" restoration to disperse the biting forces more and protect the underlying tooth this would not be an inlay. It would be a crown or an ONlay (like an inlay but covers the biting surface. If you want it to last then getting it done properly the first time around is IMO the key.

capomeister

welshdent wrote: »

Your own dentist should know of specialists near you or at least people with a special interest and the rigth equipment. Its difficult to give a price guide as everyone will charge differently. I would expect upwards of a couple of hundred though. Also I cant really give an absolute recommendation for a crown over an inlay/onlay as I cant see your tooth unfortunately. That said, if you have been told that your teeth are weak then it is something to bear in mind. I would say however you need a "cusp covered" restoration to disperse the biting forces more and protect the underlying tooth this would not be an inlay. It would be a crown or an ONlay (like an inlay but covers the biting surface. If you want it to last then getting it done properly the first time around is IMO the key.

Thanks again, Welshdent. She was very intricate when filling this tooth so I think she'll be conscientious. She didn't use a microscope but wore goggles like all dentists do.

I'll ask her about specialists but she'll probably suggest she can do a good job herself. To be clear she never said my tooth was brittle, just that a root-filled tooth becomes brittle (naturally as the root is dead, I expect).

Prepared to pay a few hundred to get this done properly with either an onlay or full crown (I think my others may be onlays as they cover nearly the entire tooth). Are onlays as good as full crowns on root filled teeth? And are they available on the NHS?

Will be seeing her in 90 minutes or so and will report back on what she recommends. Main thing to remember is the dental dam!