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

moomin_white

Toothsmith wrote: »

And it shows that 20 odd years ago you could get some very decent dentistry done on the NHS!

like my Mum who has gold crowns which were done at Birmingham Dental Hospital 50 YEARS AGO! and they're still going fine
it's depressing the state th Government have let NHS dentistry get into. I would like to work as an NHS hygienist but a)hardly any NHS dentist employ hygienists and b) if they do the appointments are 15 mins long! what can a hygienist do in 15mins? it does more harm than good giving patients false peace of mind

Toothsmith

moomin_white wrote: »

a)hardly any NHS dentist employ hygienists and b) if they do the appointments are 15 mins long! what can a hygienist do in 15mins?

There are dentists out there doing crown preps in 15 min!!!! Now that's scary! Especially when their patients think they are 'so lucky' to have an NHS dentist!

Toothsmith

moomin_white wrote: »

like my Mum who has gold crowns which were done at Birmingham Dental Hospital 50 YEARS AGO! and they're still going fine

A much underrated restoration, the gold crown.

In these days of '10 years younger' and wall to wall porcelain and Holywood smiles, an awful lot has been forgotton.

Porcelain chips and fractures. It is very high maintenance, and needs relacing - causing further tooth damage.

Even if it's pretty crooked, a natural un-dentisted tooth has the potential to last a lifetime.

Look after them yourself, get a good PREVENTATIVE dentist who only goes for the drill as a last resort. And who, when he does go for the drill does as little damage as possible, and uses materials that LAST.

biddypea

I injured both of my upper front teeth when I was a child and the left one has been grey for some years now. I went to a new dentist about six months ago who said that the tooth had died and that I may need root canal treatment. At the time the tooth was symptomless but I now notice that it feels more sensitive than my other teeth (which I suspect is psychological and also the result of regular prodding with my tongue!)

Anyway, I saw the endodontist who recommended root canal treatment as the root is infected. I have a pathological fear of dentists caused by some nasty orthodontic experiences so am already getting worked up about it even thought treatment is more than a month away.

Just a couple of questions:

1. The dentist said that my root didn't narrow at the top like most roots and therefore that he may have to put some concrete type stuff in the tooth to fill it. He said that if this was necessary, three one hour appointments would be needed rather than the usual two. This sounds like an awfully long time for a front tooth. Does it sound reasonable?

2. As the nerve in my tooth is dead (and has been for some time) do you think it would be possible to have the treatment without injections or will it still be too painful? I am worried that injections into the roof of my mouth will be even more excruciating than the ones I had when I had extractions for my brace. If I do need injections, how many injections do you think I will need?

3. Do you think the dentist would mind if I took an MP3 player along to try to forget where I am and what's happening to me?

4. Should I take antibiotics to reduce the infection before the treatment? The dentist said that this was not necessary but I would have thought that the less infected the area is, the better the results.

5. The dentist said that the tooth could be bleached inside and out by removing the filling and putting bleach in the hole while bleaching the outside. Is it possible to do this at the same time as the root canal treatment as I want to limit the number of injections?

6. Is there anything that I could take prior to the appointment to calm my nerves as I know I'm going to be a nervous wreck?

Sorry for all of the questions but I'm really scared (pathetic I know!)

Thanks

Toothsmith

biddypea wrote: »

I injured both of my upper front teeth when I was a child and the left one has been grey for some years now. I went to a new dentist about six months ago who said that the tooth had died and that I may need root canal treatment. At the time the tooth was symptomless but I now notice that it feels more sensitive than my other teeth (which I suspect is psychological and also the result of regular prodding with my tongue!)

Anyway, I saw the endodontist who recommended root canal treatment as the root is infected. I have a pathological fear of dentists caused by some nasty orthodontic experiences so am already getting worked up about it even thought treatment is more than a month away.

Just a couple of questions:

1. The dentist said that my root didn't narrow at the top like most roots and therefore that he may have to put some concrete type stuff in the tooth to fill it. He said that if this was necessary, three one hour appointments would be needed rather than the usual two. This sounds like an awfully long time for a front tooth. Does it sound reasonable?

2. As the nerve in my tooth is dead (and has been for some time) do you think it would be possible to have the treatment without injections or will it still be too painful? I am worried that injections into the roof of my mouth will be even more excruciating than the ones I had when I had extractions for my brace. If I do need injections, how many injections do you think I will need?

3. Do you think the dentist would mind if I took an MP3 player along to try to forget where I am and what's happening to me?

4. Should I take antibiotics to reduce the infection before the treatment? The dentist said that this was not necessary but I would have thought that the less infected the area is, the better the results.

5. The dentist said that the tooth could be bleached inside and out by removing the filling and putting bleach in the hole while bleaching the outside. Is it possible to do this at the same time as the root canal treatment as I want to limit the number of injections?

6. Is there anything that I could take prior to the appointment to calm my nerves as I know I'm going to be a nervous wreck?

Sorry for all of the questions but I'm really scared (pathetic I know!)

Thanks

This sounds to me like you have been put in touch with someone who knows exactly what he is talking about, and you should rest assured that you are in good hands.

I know that you may not understand everything you have been told, but the fact that you have written it down so well here means that it must have been explained pretty well to you and what you've described is the way that current thinking says such teeth should be treated.

I'm sure the treatment will be absolutly fine.

I think you should have anaesthetic to numb the tooth before all this - but I am also sure that this dentist will take his time and make sure your comfort is his top priority.

I can't see anything wrong at all with having an MP3 player to hand, and I'm positive he won't mind at all.

I would ring him up about some sedation. Normally a valium tablet the night before and one an hour or two before the proceedure is fine for very nervous patients - but if you do go down this route then you will need someone to bring you and take you home.

The whitening bit will be done after the root filling, as the root needs to be sealed before the whitening goes ahead.

That is really pretty easy though, and does't need any anaesthetic. I would talk to him a bit more about that at your root filling appointments though.

Incidentally, does he actually KNOW you are so nervous? If you haven't told him you're petrified, and put on a good bravery act, then he might not pick up on it. If he knows, then he can act accordingly. And as everything else about him sounds so good, I'm sure he'll impress you with how good he can be there too!!

Good luck.

biddypea

Toothsmith wrote: »

This sounds to me like you have been put in touch with someone who knows exactly what he is talking about, and you should rest assured that you are in good hands.

I know that you may not understand everything you have been told, but the fact that you have written it down so well here means that it must have been explained pretty well to you and what you've described is the way that current thinking says such teeth should be treated.

I'm sure the treatment will be absolutly fine.

I think you should have anaesthetic to numb the tooth before all this - but I am also sure that this dentist will take his time and make sure your comfort is his top priority.

I can't see anything wrong at all with having an MP3 player to hand, and I'm positive he won't mind at all.

I would ring him up about some sedation. Normally a valium tablet the night before and one an hour or two before the proceedure is fine for very nervous patients - but if you do go down this route then you will need someone to bring you and take you home.

The whitening bit will be done after the root filling, as the root needs to be sealed before the whitening goes ahead.

That is really pretty easy though, and does't need any anaesthetic. I would talk to him a bit more about that at your root filling appointments though.

Incidentally, does he actually KNOW you are so nervous? If you haven't told him you're petrified, and put on a good bravery act, then he might not pick up on it. If he knows, then he can act accordingly. And as everything else about him sounds so good, I'm sure he'll impress you with how good he can be there too!!

Good luck.

Thanks very much - that was just the reassurance I needed.

moomin_white

Toothsmith wrote: »

There are dentists out there doing crown preps in 15 min!!!! Now that's scary! Especially when their patients think they are 'so lucky' to have an NHS dentist!

when i was a dental nurse i did some agency work and was sent to this one dental practice in North London. The dentist i worked with was doing crown preps in 15mins and i was horrified! i called up my agency and said never to send me to a practice like that ever again!

also, i completely agree with what you say about gold crowns - if i ever needed a crown on my molars i would always go for gold!

*Blondie*

I have been desperately searching the web to find a thread like this about problematic teeth etc. I am so happy to have found it! Toothsmith (and others!), you have given some fantastic answers, I was wondering perhaps if I could tell you my dilema, perhaps you would offer some advice if you have a moment.

Late last November I went to see my dentist (a new one - haven't been registered for 7 years, couldn't find a local nhs dentist who hadn't closed their books!!) He told me I needed some fillings - 2 on the (outer) sides of my back teeth and 1 on the back of my front tooth. (My front teeth overlap by about a millimeter - apparantly some decay had occured at the back.)
I agreed to have the fillings (white nhs for the back teeth, private white for the front after some persuasion from my dentist).

While my entire mouth hurt for some time afterwards, I soon realised that my front tooth was causing most of the pain and by Christmas I was in agony! Just going from a warm room to a cooler room was painful; Drinking anything hot or cold was out of the question; the pain was excruciating.

Two weeks ago I booked an emergency appointment to see a dentist but ironically, on my way, I realised that the agonising sensitivity in my tooth had subsided somewhat. A dull ache was there instead. I was given an appointment with a different dentist who took an x-ray and told me the filling in my front tooth had touched the nerve, and an infection had set in at the root. She gave me some antibiotics but told me that although the infection might clear up, it would probably return and that my only options were to have a root canal or have it removed!!! She explained I could have it done either on the nhs or privately which would be better because 'better equipment' would be used.

Now, two weeks later, my tooth feels relatively normal after finishing my course of antibiotics, although there is some discomfort when the bottom of the tooth touches my lower teeth. The ultra sensitivity has gone; but I have a horrible feeling this is because the nerve in the tooth has 'died'. Or is it possible for the nerve to miraculously repair itself?

My main issues here are; my dentist gave me no warning that the filling might damage the nerve, doesn't he have a responsibility to explain the risks involved?
I want to go back and see the dentist who gave me the filling, but I feel it's wrong to be charged £15.90 each time to see him! Surely as my current visits are linked to previous work, I shouldn't have to pay to see him??

Is a front tooth more vulnerable to cracking after a root canal? (Being 'thinner' than, say, back teeth.) In your opinion, is it worth having a root canal on a front tooth? Would I be better off having it removed and an implant or bridge instead??
'Crowns' - what exactly are they? Would I have one for a front tooth after a root canal?
I understand that no root canal job can ever be guaranteed for life. If I spend some £600 having a root canal done by a specialitst, then have to pay another £600 or so for a crown, at the risk of the tooth cracking or the root canal needing to be done again some years later, perhaps it would make better sense to spend a little more and have the tooth removed and have a permanent implant in its place?
Any advice Toothsmith or indeed anyone else can offer would be very much appreciated!
Thanks :-)

alison999

on the nhs you pay per course of trt. after you had your fillings done your trt was finished and the course of trt would of been closed. when you back and got uyou antibiotics a new course will of been opened for you and chances are the charge was for the x-ray. you dont get charged if all you get is a perscription. when you go back again, a new course will be opened and if have root trt or the tooth extracted it'll be £43.60. i cant really comment on your trt b/c im not a dentist but i hope i explained the charging part alright.

Toothsmith

Sorry Blondie - I missed this post somehow!

Alison has explained the charging part well. This is the same course of treatment and so it will be covered by the same charge.

As for explaining the risks involved - I didn't see how big the filling was in the first place, so I can't really comment. If the filling was large, the dentist should have explained that there may be further problems, but at the end of the day - he still has to fill it anyway, so it's not as if had you known the risks you would have had any alternative.

The antibiotics will have taken down the infection on the tooth, which is why it's feeling better now, but anything from a few days to a few months after finishing the antibiotics, the pain will return. The tooth still needs dealing with.

I always find it a bit uncomfortable to have to listen to how NHS practices justify doing things privately.

If they think a particular way of doing something is crap, then they shouldn't do it that way!! Doing something badly to keep it cheap isn't doing anybody any favours in the long term, and if they think it's that bad, they should be teling people to have the teeth out rather than have it badly root filled.

I would recommend getting it root filled privately, but make sure whoever is doing it uses a rubber dam (A way of isolating the tooth so that the bug filled soup that is saliva doesn't get into the nicely cleaned root canal). A specialist will always use one. If you are paying privately for a root filling, you should expect the dentist to use on as well.

It's hard to explain concisely what a crown is. have a look on the 'gold filling thread, or even put 'crowns' into the search bit at the top of the page, and you will find other threads about them.

Root filled teeth often do need crowning, but you need to discuss that with your dentist.