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

blured

Thanks For the reply toothsmith - i appreciate you taking the time.

I spoke to NHS Direct this morning and they suggested that i request that my dentist refer me to my local dental hospital - as a means of saving money / second opinion.

I spoke to my dentist and he agreed to do this - and has referred me to Kings College - He did say though that based on his experience they might not take the referral due to the complication of the work required.

You are correct i believe in your assumption regarding my dentist i always get the impression that he is honest and looking after me the best he can.

I guess one thing i may have to consider - being as all the treatments available are only going to work for 10 - 20 years is do i just go for the extraction???


Thanks again,

Dave

Toothsmith

Extraction is a valid option. But check on what your dentist thinks is the likely survival times.

The thing that patients - and to quite a large extent dentists - really should get into their heads is that ALL treatment is temporary.

The ONLY thing that has a chance of lasting you your entire life is a tooth untouched by decay or dental drill!

As soon as anything is done to a tooth, then that thing will have a lifespan (It may be 30+ years, in the case of a very small filling) but unless you're VERY lucky, one day it will fail.

The thing you have done to replace the first thing will always be a little more destructive, and so that will last just that little bit shorter.

Now - with most ordinary small to medium fillings, that will cause very little problem over your life, but as things get bigger and more complicated, you will be struggling to keep things going as you get on a bit.

This is why it's vital to get things done as well as you can, by a dentist who tries to preserve as much tooth as he/she can be it a crown or a tiny filling.

This is where my big problem is with a lot of 'cosmetic' dentistry.

Whitening is brilliant, as it doesn't damage any tooh structure at all (When done professionally by a dentist).

Closing gaps and making smiles more even by adding little bits of white filling can be a very good way of improving things as well - and doesn'tinvolve much if any tooth structure loss at all.

Most vital is to get your kids seen by such a dentist. If their fillings are done as small as possible, and filled well with white filling, then it will set them up for a much better life dentally speaking than if big holes are made in their teeth and amalgam put in.

Better still though, is to have very good sugar control, good oral hygine, paying for fissure sealants and the like, and bringing them up with no fillings at all!

I've wandered a bit off topic here though haven't I??

blured

A touch off topic maybe but it is interesting none the less.

I have been reading up on root canal treatment on the internet - a dangerous pastime i know - and the more i read the more i am leaning towards an extraction.

There is one thing my dentist said that has stuck in my mind - that the orignal infection was caused by the filling making contact with the pulp / blood stream and the body reacting to that as if it were a foreign body, thus creating the infection. So does it really make sense to put more foreign body in as a way of fixing it?? - - seems a bit catch 22 to me.

I guess i am now paying the price for my misspent youth. I Have a lot of old amalgam fillings in my molars - all now over 20 years old. And one more recent filling - circa 5 years ago. Now it would seem that at some point these fillings are all going to fail - so i think now maybe the time to get dental insurance - hahah

I have also been reading as bit about biological dentistry - but they don't seem to offer a root canal treatment at all - is their approach, its a dead tooth so take it out?

On the plus side the antibitoics seem to be working and the pain has almost diminished to nothing.

Thanks again,

Dave

donteatthat

The problem is bugs and leakage of bugs aroung the fillings we place. Bugs cause infection, the body creates inflammation to deal with it. Its not really the filling that caused the problem but the bugs that got into the tooth before the filling was placed, or then got around the filling after it was placed.

The bloody supply and nerve to a tooth is hidden away in the centre of it and its quite a delicate thing. Its a nice organic thing for bugs to feed off, and even better when they kill it as there is no blood supply running into the tooth to flush the gunk out to help protect the tooth. The bugs make lots of toxins which spread out the root of the tooth into the bone and can cause an abcsess. Whilst this goes on the bone around the tooth dissolves away.

Antibiotics will get rid of pain by killing off acute episodes of pain - but they won't cure the problem as they can't kill off the bugs that are hiding in the tooth. These wil just pickup where they left off oozing more rubbish out of the tooth, eroding the bone even more and another abcsess will occur. Sometimes the subsequent abcsess aren't as easily treated with the antiobiotics, which is why treatment to solve the cause of the problem must be carried out promptly. This is a big mistake I find many people make by assuming no pain = no problem and antibiotics have solved the problem. They haven't!

The treatment is either to remove the bugs by removing the tooth, or removing them from inside the tooth, by cleaning it all out, and filling up the void with a dense filling - which is root canal treatment. Delaying proper treatment can have longer term problems as if you decide to remove the tooth when it gets really bad and go for an implant, the bone may have been too badly damaged for this so its a no go.

Root canal treatment is a good method of saving teeth. It is predictable in the right hands, but it is a time-consuming fiddly procedure. Its success depends on the time spent disinfecting the infected root, and as some teeth have multiple, very thin roots (some only seen with a microscope) the patience and skill of the dentist carrying out the procedure. Inadequate cleaning or filling will leave bugs behind or space for them to grow back into, and re-doing a root canal treatment has a poor success rate.
So it must be done right, first time.

I don't do any root canal treatment. It's difficult and I am not good at it. I refer it all to a specialist in this field that I work with. The dentist I work with needs 3 hours to do a root canal treatment on a back tooth properly. An NHS dentist will get paid the same amount of money to do a root filling as they do for an extraction.

HTH

DETx

alison999

donteatthat wrote: »

An NHS dentist will get paid the same amount of money to do a root filling as they do for an extraction.

which is why they hardly ever do it :rolleyes:

donteatthat

I am too polite to say that!
Well, maybe in a more diplomatic mood than normal!

hellova_guy

Approximately 4 years ago after getting an abcess on one of my molars I had a root filling done , all was fine until 3 months ago when a slither of the tooth broke off , there was no pain but the tooth felt sharp on my tongue so i went to my dentist. She said the damage was minimal and could be repaired easily. After a quick chat I decided that a white filling was the way to go and she agreed. The advantage of having the work done was no injection because the tooth had no nerves , all seemed to go well and the end result was a fantastic looking white tooth , the only thing that did sting a little was the £105 bill.
3 months after the filling I now have an abcess on the root of the tooth again , my dentist has prescribed me anti-biotics and wants to refer me to a private dentist to carry out a 2nd root canal treatment at a cost of just short of £1000 or remove the tooth herself.
My question is ................... Have I just been unlucky with this tooth or has my dentist left something in my tooth or not cleaned it properly which has caused the infection and subsequent abcess?

Many Thanks Guy

Toothsmith

A minimal repair would be very unlikely to be the cause of any problem like this.

Also, if she had done something wrong, she'd be reluctant to ship you off to a specialist (Who would certainly tell you exactly what had gone wrong and why).

Hopefully the person who did it 4 years ago did it under rubber dam, and spent a good 90mins - 2h on the job in order to give it the best chance of survival possible? Or was it an NHS 2x30min appointments stuff and pray?

Did the dentist who did the repair x-ray the tooth before repairing it? Did it look OK then?

hellova_guy

the first root filling was NHS ( still cost me £90 ) it was 2 visits approx 45 minutes each visit.

the repaired tooth wasnt x-ray'd prior to the repair , although I said it was a minor repair , the amalgum filling was drilled out and replaced with a composite filling.

1 futher question you may be able to help me with , the dentist prescribed 1 x 250mg ammoxycillin tablet 3 times a day, is this enough because the pain is killing me and my under jaw line is swollen and tender?

thanks guy

Toothsmith

The last bit is medical advice, and that is not allowed to be given.

There are different drug regimes depending on the type and severity of the infection. Go back to the dentist if it doesn't seem to be working - but abs take a good 24-48 hrs to kick in.

Also - I hope you're not holding anything warm against the area to try and sooth it? That can make things much worse.

The NHS guy sounds like he spent plenty of time on it, which is good.

The repair shouldn't have kicked things off like this - but I bet the dentist now wishes she'd taken an x-ray prior to the treatment! That way she'd have been able to show you for certain that there was an infection below the tooth before she started!!!