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

Toothsmith

hethmar wrote: »

I need not despair as there are other ways of saving the tooth and he can perform an episcotomy?

Apicectomy

Tinderstick

HELP!

I read with interest the posts regarding root canal treatment and wondered if anybody has experienced similar situation to mine.

I have a pus discharge from a rear upper molar that already has a PORCELAIN crown fitted (about 5 years old). I have sought the advice of a three dentists (my own and two NHS referrals) and have two similar and one very different opinion on the treatment required, although all agree that RCT is necessary.

1) RCT is required and will be performed by drilling through the crown and then filled. There is a good chance (60-70%) the crown will survive undamaged.

2) Same as above but there is only 50% chance that crown will survive. However, can refer to a specialist - then the chances of keeping the crown are greatly increased.

3) The crown MUST BE REMOVED before work can be carried out. The crown will definitely be broken if the RCT is performed through it. Once the crown is removed the RCT can be done, tooth prepared, and new crown fitted.

Another thing is, I have taken antibiotics for a week now and the inflammation has subsided quite dramatically. None of the dentists can find anything 'conclusive' from the x-rays that have been taken that actually show a root canal problem - their diagnosis are based on the pus discharge and gum inflammation. I guess I can assume the inflammation will reoccur once I come off the tablets?

I expect I might get different opinions if my car breaks down but I am surprised that a number of medical practitioners would offer quite different views.

Anybody help at all???

Toothsmith

Doesn't surprise me!

Ask 5 different dentists you would probably get 7 different options, if not more!

No two patients are identical, and no two dentists are identical.

Diferent dentists have been to different dental schools, where they will have been taught by different lecturers with their own views on what works and what doesn't.

They then qualify, and gain experience. There are many different materials and techniques out there for doing the same job. They will find ones that they are happy working with, and the ones that work best for them. There are also different courses that dentist go on after qualifying, which again, colour the way they approach their treament plans.

So who's right?

Who knows until the job is done? What does a 50% chance of the tooth breaking really mean? With dentist 1 and dentist 2, if the crown breaks, it breaks, if it survives it survives. If your crown breaks, it's of little comfort that someone elses made it. And if it survives, it's all a bit pointless if some hidden decay underneath it means that everything fails anyway.

So from that point of view the guy who would take the crown off anyway is the one who's doing the right thing.

If that guy took it off, but found no decay, then you'd probably have been better off with one of the ones who wouldn't have looked in the first place!

No one dentist is right here, and none are wrong. They are just options, and you must decide which one you want to go for.

Tinderstick

Toothsmith, very many thanks for your reply and wisdom.

I take your points about different opinions among practitioners and how this may occur. However, when it comes to patient choices what real choices is it reasonable to expect the patient to make. I certainly don't have the training and knowledge of dentistry required to make a reasoned choice between, let's say in this case, two fairly different opinions. In medical circumstances, I tend to expect choices to be made for me regarding what treatment is necessary - what else can I expect? If I'm lucky I get to possibly choose who to be treated by based on how comfortable I am with this or that person, but can I really make a decision about what treatment I should receive if I hope to get better?

From what you say it does seem sensible to me to take the crown off. If there is a real risk of decay underneath the crown then surely that option must be investigated by removing it - that would not be the case if the crown remained on.

I'm happy with the two opinions 'it must come off' and 'it need not' for me to do the work, but what I find more confusing is the difference between it definitely will break and it probably will not.

It is difficult as a layman to weigh these options and make the right decision

Toothsmith

True enough.

In all honesty, no-one can say whether something will break, or won't break when you take a drill reving at 250,000 rpm to a bit of porcelain and metal of uncertain age and unknown history.

The dentist saying 'It definitely will break' is probably lowering expectations, so that it seems like a bonus if it survives.

If someone gives you hope that it might survive, then you can only be disappointed if it breaks!

But even if it does survive, who knows if all the vibration has damaged the cement seal or not? There's no way of telling without destructively testing the tooth!

The layman cannot be expected to make a decision based on so many options and viewpoints. One problem of 'the information age' is that there are so many different opinions easily available to everybody. Is amalgam filling safe or not? Are white fillings any better? Should fluoride be in the water? Should teeth with abscesses be root filled or extracted? Should a tooth be crowned straight after a root filling? These are just some of the questions to do with dentistry which have no right or wrong answer - just opinions.

What you need to do is find a dentist who suits the way you want to be treated, and trust his opinions. Getting too many opinions can just lead to confusion.

When I have a patient in the chair with a problem, my way of deciding on a treatment plan is to think what I would want done if that were my problem, and that were my mouth.

I give the patient the options, pros and cons of each, and what I would choose if I were them. If they take my recommendation, fair enough, if they want something different, then providing I don't feel it's detremental to them, then that's OK too.

The longer the relationship you have with your dentist, the better he/she will get to know you and your mouth. The better he knows that, the more successful the treatments are likely to be. So don't chop and change dentist too often.

Tinderstick

Yes, you're right about the information age, some things are useful to know, others, well they just cloud the decision-making process as in this case. A good relationship with the dentist is of course the best way forward. Unfortunately I was enjoying such a relationship until recently when an NHS/private issue arose and made that unworkable, hence the three opinions now (but thats another issue for another time perhaps).

You do show good wisdom by trying to put yourself in the patient's position and all you say makes very good sense to me. I would expect no more from a dentist in their approach than you have adopted (alas you are a good five hours drive from me).

Many thanks for taking the time to post

hethmar

Alison - you LOVE them??

alison999

hethmar wrote: »

Alison - you LOVE them??

i work at a dentist lol i dont want to describe it and put people off, but i just find it really interesting.

freaked_out

Thank you for your advice. It helped me come to terms with my worst nightmare. Just to let you know that I chose the NHS plate (£190)as 1st reserve in the short term. I was then intending to sell body parts for titanium implants and crowns. I'm thrilled that after my private root canal treatment(£300) today, my ceramic bridge is still in place. I need to go back once the antibiotic wadding clears up any intection. Fingers crossed.

Olympika

I would be so grateful for some advice...

Had a large filling on upper left 6 done 5 years ago, which had to be redone almost immediately becuase there was air trapped underneath it and if I flew anywhere I though my head was going to explode. Since it was redone I hadn't had any more problems until about 2 weeks ago when it started to throb every so often, which was getting worse over time.

I made an emergency appointment at the private dentist I go to, but my usual guy, who I really like (very gentle, tells you whats going on and also rather good-looking ) couldn't see me so saw someone else. She took an x-ray and there's infection under the tooth and she removed the filling. I then assumed she was simply replacing the filling after cleaning it out (that was what she told me was the plan) but after being in the chair about 25 mins, I was left with antiobiotics in the space where the filling was, a temp filling on top and told that there was an infection which had spread to the pulp, which was also now bleeding. She also said I should see how it setlled over the weekend and make an appointment (45mins)to see her again on monday (which have done, 9am) for likely root canal. I knew in the back of my mind root canal was a possibility, as 5 years ago it was mentioned but previous dentist (not my usual current one, nor this lady) decided to simply try a large filling but didn't like that she didn't explain what she had found during the examination / treatment.

I am 100% utterly TERRIFIED of having root canal - I was always ok at the denitst until a very bad lower wisdom tooth extraction 10 years ago where the butcher who did it misread the x-ray, saying he could easily do it under local, when in fact it was anchored in place and he announced after an hour that he didn't know what to do next as he couldn't get it out. At which point I just cried. I had my gum slit and jawbone drilled, which was bad enough but then got dry socket afterwards too. I simply wanted to die. So... I am absolutely petrified now, especially as this is a different dentist to the lovely guy I usually see. [/moan]

As it's a 9am Monday appointment I can't cancel it and ask to see my usual dentist, I'll have to go... and he is booked up all week anyway. What should I do? Go and explain how I feel? I am REALLY REALLY tempted to simply have the tooth taken out, you would be able to notice the gap right at the corner of my mouth, but should I really try to save the tooth? am 33...

I have a temp filling in there at the moment, how long do they last if I do explain that I don't want to be treated by her but want to see my usual guy? Is it even ethical to do this (in a private practice?)

Am in a helluva lot of pain and I don't think (having read on here) that she would be able to do the extraction on Monday anyway, but can the first part of RCT be done before any course of antiobiotics? I am SURE the tooth still has feeling...

Thanks so much and sorry for the long post