Root canal - prosthodontist or endodontist?

DavidAdam

Hi - I have been to a dentist with mild-to-medium toothache in one of my very front teeth - central incisor. I had a trauma about 15 years ago. The dentist tried a root canal treatment, but pain came back approximately 6 months later. He told me that it would probably need further root canal treatment.

He has recommended me to see a prosthodontist to receive the root canal treatment who has told me that the success rate would be approximately 70%., due to infection.
This would take about 2 hours.

If that did not work , then he would try an apicectomy which he thinks may not be successful, due to recurrence of infection, and may eventually need an extraction.

The prosthodontist says that he does have better magnification than my dentist but does not appear to have microscopes and I am wondering if i should see a endodontist instead?

The cost for the next root canal treatment is approximately £500.

If I should see an endodontist do I have to get my current dentist to refer me or where would I find one on my own? Reluctant to cause bad feeling with my current dentist!

thanks

DavidAdam

Toothsmith

It's really more a question of qualifications than what they actually call themselves.

'Prosthodontist' is more a 'restorative' specialist, so it's likely they'll have done extra qualifications in all sorts of areas. It could well be that endodontics is one of them - particularly if your dentist is referring you there for a root filling!

It's no big issue just to ask your dentist if this is the case, and to ask your original questions above to your own dentist. It is important that the patient is fully aware of the treatments they are having, and the qualifications of the people doing them. You will not cause 'bad feeling' by asking your dentist this.

DavidAdam

thanks Toothsmith for your reply.

Looking at the prosthodontist's qualifications on his business card, they all seem to mention surgery - but I do understand that a short qualification title may not describe all the subjects that he has studied and practiiced.

I think my main concern is that I would like to get the best treatment available the first time. I would imagine failed attempts at root canal treatment would make things more costly in the long run.

I should point out as well that the prosthodontist is a member of the same clinical practice as the dentist who carried out the original RCT.
thanks
DA

Toothsmith

Those are valid concerns.

But I think you need to ask the dentist the questions you ask here. You are right that the less times this tooth is treated the better - success rates decrease the more goes you need - so don't be afraid to ask how this chap would compare to a specialist endodontist.

Ask him who he would recommend if his wife/son/daughter needed a similar procedure and success was the top priority.

DavidAdam

Hi Toothsmith,
well went back to the dentist and we agreed that a endodontist would be better.

He has written me an open referral with xrays etc.. but he would not recommend one !
Says that I should check out reviews on websites.

Not sure what to make of that!

Is there a specific website that does reviews for endodontists?

bw

DA

Toothsmith

Not really.

I would have hoped the dentist would have been a bit more helpful than that! Although the referral letter & x-rays are good.

In all honesty - just googling and looking at websites of those in your area isn't a bad start - but if you narrow it down to a couple of possibilities, then just going and visiting the practice and enquiring in person would give you a good 'feel' for a place.

Where are you? (Just in case you're somewhere where I might know someone)

DavidAdam

Yes - I was a bit taken back by him not having a recommendation for a specialist.
I can only speculate why he did not do that.

His assistant did recommend one though and I am just checking him out.
(Hope there are not serious arguments now between my dentist and his assistant!).

Anyways, I am based in SE London but would travel within reason.

Even considering flying to Belfast where there is a highly qualified one - Justin Barnes (editor of the book: Principles of Endodontics).

Not sure how many flying visits I would have to make though, so maybe that is just an outside possibility.

bw

DA

Toothsmith

You should have a good enough choice of endodontists around you there.

If the assistant has recommended one, then I would begin there.

Going further afield is all very well, but even the best of dentists have unforseen things happen every now and again, and you wouldn't want to be arranging a flight in a hurry if your tooth unexpectedly started hurting.

DavidAdam

Ok - will check out the one the assistant recommended.

Thanks for your help.

BW

DA

London_Girl

There are specialist dental hospitals in London...King's College hospital...Eastman Dental and Royal London. Try asking your own GDP to refer you to the Endodontic Department.

brook2jack

As far as I am aware none of these hospitals will take referrals for endodontics except in exceptional circumstances and even then waiting lists will be long. Eg kings https://www.kch.nhs.uk/Doc/rf%20-%20049.3%20-%20restorative%20dentistry%20referrals%20acceptance%20criteria.pdf

You would not meet the criteria for the Eastman at all https://www.uclh.nhs.uk/OurServices/ServiceA-Z/EDH/RESDEN/ENDOD/Pages/refer.aspx

Barts is very unlikely to accept you for treatment
http://www.bartshealth.nhs.uk/media/127488/Restorative%20dentistry_acceptance%20criteria.pdf

Realistically it would have to be private treatment.