Infection under root canal - help!

huggermugger

Hi
I have a crown in my last-but-one tooth on my lower jaw which was fitted 4 years ago & hasn't caused any problems until about 5 days ago when it started to become sensitive to heat & cold. It was done by my old dentist, in whom I had great faith, who has now retired. I returned to the practice today and was seen by my new, young dentist. He took an x ray and said I had quite a large infection which is spread under my 3 back teeth. He has given me two lots of antibiotics - for aerobic & anaerobic bacteria; amoxycillin & meta something. He said he cannot be sure of the centre of the infection. He showed me the x ray and the roots of my two back teeth curve back considerably. (I have an impacted wisdom tooth there as well and know that the roots run backwards from that) He said that if the antibiotics do not relieve the pain, then it is probably the rear tooth that is the problem and that it will need treatment using a microscope and that one of his colleagues would do it at a cost of £450and the treatment would require one appointment of a minmum of one hour and would mean a lot of pain afterwards. I said I was covered by an exemption certificate and he said that this treatment would not be covered on the NHS. I said if it was going to be so difficult/ painful/not covered by NHS in the practice could I have it done under a general in hospital. He said he has tried to refer patients three times in such circumstances and each time they have refused to carry out the procedure & sent the patient back to him. I categorically told him I do not have £450 and what is the NHS alternative - he said under the NHS they would take the tooth out.

Does all this make any sense and is it correct? I have only been to him for 2 check ups and had no work done. His English isn't brilliant (he is East European I think) but he has always seemed pleasant and kind. I know I am jumping the gun at the moment but if this is all a load of tosh then I would rather get a second opinion (if that's possible).

I did actually pay £350 for the original root filling & crown as my previous dentist told me that he didn't do such work on the NHS anymore as the time allowed by the new rules was totally insufficient. He also said that the quality of the NHS crown was also not brilliant and that he highly recommended a porcelain one as it would last much longer. At the time I accepted this and paid up. Was this a load of tosh as well?
Very very confused and fed up - the only way I could pay this time would be to put it on a credit card.

Sorry this is so long, really would appreciate some help/advice.

brook2jack

The problem is that root fillings on back teeth can be difficult at the best of times and if roots are very curved etc they need specialist equipment to carry out the root filling. I do not know of any pct that funds nhs specialist root treatment.
You cannot have a ga for root treatment as it takes too long and the instruments are too fiddly. Most dental hospitals will not take referrals for root treatment. So that leaves you with extraction of the tooth which may well be worth considering if your dentist thinks it may let your wisdom tooth through. The problem is no root treatment is 100% guaranteed to work so you need to think and discuss the probable success rate with the dentist.

As to your old dentist , any tooth that is crowned has a 25% chance of dying off later on and needing a root treatment however well it's done.

huggermugger

Sorry - not made myself clear maybe. My old dentist did a root canal - the majority of the infection is undeneath that. The new dentist is talking about treating the tooth behind it, if the infection does not clear up with the antibiotics. He has made no mention of the wisdom tooth, I just mentioned that in context of the roots of my back teeth being curved/tangled.

Are you saying that he is correct that on the NHS my only option is an extraction?

huggermugger

Sorry again - getting tired & in pain and that sounds very abrupt.. Thanks for your help so far - appreciate you taking the time. Just trying to understand my options.

silvercar

Are you saying that he is correct that on the NHS my only option is an extraction?

It may be more accurate to say there is no dentist prepared to do the work on the NHS.

The problem is the NHS will only pay a set fee and if that fee doesn't equate to an amount of time that a dentist feels he would need to do the job properly, he won't agree to do the work.

So with no dentist prepared to do that work for you on the NHS, your options are to pay for the treatment to be done privately or have the only NHS treatment that is available, which would be an extraction.

One step at a time, the antibiotics may work!

silvercar

huggermugger wrote: »

Sorry again - getting tired & in pain and that sounds very abrupt.. Thanks for your help so far - appreciate you taking the time. Just trying to understand my options.

As well as the antibiotics, treat your pain.

I won't break the site rules against advising on medication, but I find taking one paracetamol and 1 nurofen tablet (instead of 2 or either P or N) works well for me. I also rub a small amount of colgate pro-sensitive tooth paste, directly on the offending teeth.

BTW, I have no medical background, just suffered root problems in the past.

mum2one

I've just had an extraction done on a tooth at the very back, from an absess and a bad infection, and the tooth next to it I need a root canal, I was due to have both done at the same time, but I had another absess and another infection, - so had the extraction and the root canal cleaned out, - got to go back and have root canal and a crown, all mine is on NHS, - exempt from paying - I can not fault my dentist.

I would suggest paracetamol or nurofen (as long as your not allergic), to help with the pain, while the antibiotics kick in the infection.

Really hope you get sorted, know myself the pain is not nice, x

brook2jack

Please don't advise on painkillers. People who are asthmatic, for instance, should NOT take ibuprofen/neurofen as it can bring on or make asthma attacks worse. There are many other contraindications to painkillers eg do you know if op has liver problems or is on other medications? Do they have any medical history? Best leave that sort of advice to someone who can see them and make informed suggestions.

brook2jack

huggermugger wrote: »

Sorry - not made myself clear maybe. My old dentist did a root canal - the majority of the infection is undeneath that. The new dentist is talking about treating the tooth behind it, if the infection does not clear up with the antibiotics. He has made no mention of the wisdom tooth, I just mentioned that in context of the roots of my back teeth being curved/tangled.

Are you saying that he is correct that on the NHS my only option is an extraction?

Yes if the roots are curved or difficult then they need specialist equipment such as a microscope etc and I don't know of any nhs root treatment referral service and indeed most dental hospitals specifically say they will not take referrals for root treatment. The thinking is in today's financial climate no pcts have the money to spend £400 to £800 plus the cost of a crown to save one tooth.

If there is a problem as well under a previously root treated tooth this can make things complicated as it can be difficult to tell where the infection is based, and before you make any decisions you should ask the dentist what the worse case scenario is, does he think two teeth are involved in which case you need to think about the possible costs of two teeth needing specialist root treatment (ie back tooth and tooth previously root filled) with no guarantee that root treatment will work.
You need to chat with your dentist again before you commit to any treatment and discuss chances of success etc but the bad news is there is no nhs service I know of that would take on this sort of case. You are looking at having the tooth out as only around 20 teeth are necessary for the strict definition of dental health.

huggermugger

Thanks for this brook2jack. Not been here as I have been a bit preoccupied... finished the antibiotics yesterday - wasn't given a followup appointment so presumably I wait to see if the pain continues/gets worse.. I would describe it as sensitive in that area but no longer painful, so perhaps I've got away with it for now.

One more question - as an added complication, I have been told with other back teeth that the roots are so tangled up with the nerves that if the tooth were to need to be taken out, there could be nerve damage resulting in loss of feeling in my mouth or part of my face. Is that likely? This was a long time ago & related to my wisdom teeth but this one is only one in front of a wisdom.

brook2jack

It is relatively common for a wisdom tooth to be closely involved with the nerve but not at all common for teeth further forward. However only the dentist who can see your x ray can tell you for certain.