Dentists differences dilemma

elsien

I'm not after a diagnosis, obviously, more a "where do I go from here", but I'm giving lots of detail as it might help give some idea of why I'm confused.

I have an NHS dentist, the practice is a large national company where dentists tend to stay for a few years then move on. I've been seeing my current chap for 2 or 3 years and have not had any cause for concern.
I have a close relative who is a dentist, previously NHS now private, his practice has won awards but he lives the other end of the country and it's not practical to go to him for treatment.
My NHS dentist has been fine with me sending xrays to my relative for a second opinion - he says his relatives do it to him all the time.

Recently I had toothache, and problems with LR7 where the wisdom tooth LR8 is at an angle and has damaged LR7. NHS man has proposed extraction of LR8 in hospital, then trying to salvage LR7 - apart from it needing properly filling, it has root caries and NHS man says it would be a waste of my money to try to crown it, although he did initially mention root canal treatment.

My relative thinks (from the xrays) that LR7 is pretty unsalveageable and that I'd be better off keeping LR8 and having LR7 removed. He wrote to NHS man suggesting this, and NHS man replied saying that he considered this but believes that the impaction of LR8 would then worsen and it would not move into the space left by LR7 without orthodontic intervention. This would then leave a large stagnation area which I would find very hard to clean and I would probably then lose LR8 to root caries and lose it anyway.

So it seems to be I'm a bit between a rock and a hard place - LR7 doesn't have much of a long term prognosis from either of then and if I go with NHS man's opinion, neither does LR8. What has worried me slightly however is my relative thinks that the root caries in LR7 should have been picked up sooner if NHS man had been more thorough with regular xrays (I'm not sure when the last lot were, or if they were within the 2 years, one of the things I need to check) which has made me doubt NHS man's judgement slightly. Except he's the one who's there and has actually seen it.
NHS man is willing to discuss the options with me again if I wish.

So my short question after a long preamble is how do I decide which is the best treatment option for me - can/should I get another opinion and if so who from? Will I be able to talk it through at the hospital when the referral comes through, or will they just be looking at extracting LR8 as that is what NHS man has referred me for?
Any advice would be appreciated - I just want to lose as few teeth as possible.

brook2jack

Number one can't see the X-rays or your mouth. However give two dentists a patient and you'll get three different treatment plans.
Since nice recommendations on wisdom tooth removal we see alot of problems with decay in the molar next to the wisdom tooth and they can be a swine to deal with as decay low down on a root is difficult to deal with but wisdom teeth cannot be relied on to erupt in the right direction.

In the end there is no probable "right" solution and you need to decide whose clinical vision to go with. Ask yet another dentist and you'll probably get a third opinion. However what you can't do is ask another dentist to do a treatment plan devised by someone else especially if they don't agree with it.
You will have to find someone else to agree with your relatives plan and carry it out if you decide to go this way.

elsien

But I have no idea - that's the problem!
What about the hospital - are they likely to offer an opinion, or just get on and hoik out the wisdom tooth that I'm being referred for?

brook2jack

The hospital is staffed by people training in oral surgery. They will have very little experience in restorative dentistry ( ie can the molar be saved) and little experience in whether the wisdom tooth will come through upright.

If the molar is obviously very badly decayed they may suggest taking it out instead of the wisdom tooth but if the decay is low down on the root it's not that obvious and they will not have the expertise to tell if it's salvageable.

elsien

Thanks - just out of interest would you be miffed if you were my dentist and I was waving my xrays around at other people?
My relative said he wouldn't mind if it were him, but I wasn't sure on whether people generally might consider their judgement was being questioned and take it amiss.

brook2jack

I often ask colleagues opinions on a patients treatment. However we are all too aware you cannot treatment plan on x rays alone. They are only a two dimensional representation of a little bit of someones mouth. In the end a dentist will only carry out treatment they feel is right.

In dentistry there is rarely a cut and dried right way of treating people. Two dentists will hardly ever agree on exactly the same treatment plan which is not to say one is right , both may be equally valid .

However fundamentally the dentist patient relationship is one of trust and one which develops over a period of time as the dentist gets to know you and your mouth. I would question whether that was a functional relationship if you felt you had to have a second opinion on every occasion .