dental dilemma advice

FBaby

I would very grateful for some advice from our friendly experts on what I should do at this stage of treatment. Will try to sum up.

2 years ago or so, I start to experience a bit of pain on one molar. Went to my dentist who did looked at it in record time, no x-rays and concluded that it was just a bit of chipped enamel and nothing to worry about (and come back if more pain). The pain went shortly after and I forgot about it.

1 year later, I had orthodontic treatment and x-rays were taken for that purpose. This highlighted an area of concern relating to that tooth and was advised to go back to dentist. Did so, saw a different dentist to previous one who did own x-rays (supposedly more reliable than orthodontist's) and concluded that it pointed to there was a problem and that I required root canal treatment. I was of course annoyed that this had not been picked up at first appointment 12 months earlier, was going to complain but in the end didn't. I was booked for an appointment for the root canal, but cancelled as I didn't feel comfortable with the whole issue, had no idea who was going to do the treatment, was given no information and started to feel anxious about the whole thing.

Wrongly so, I buried by head and ignored the issue until last week when I had a regular appointment schedule and decided it was time to revisit the requirement to treat the tooth. The appointment was with the original dentist who saw 2 years ago. To my surprise, she looked at the practice x-rays, but concluded, unlike her colleague- that she believe the shadow appearing on the x-ray was an old filling and that in account of the fact that I'd had no pain at all for 2 years and that there was no evidence of infection, she didn't think the tooth needed treatment.

My first reaction was one of huge relief, but now that I had time to reflect, I am left confused and annoyed as to the fact I have been given conflicting advice about treatment. If indeed she is correct, I could have ended up going through expensive and painful treatment for nothing. However, what if she is wrong... The other dentist had told me that I experience no pain because the tooth was now dead.

So what do I do? Accept what I was told this week and forget about it, or?? Seek a third opinion? From an NHS dentist or private? Or something else?

justme111

Seek third opinion from a private dentist. Or a xouple of them better.
Indeed xrays are just shadows so there can be diffetent interpretations to it.
Now , so that you have some idea about what is happening in NHS dentistry - the fee that the dentist will earn for doing that root treatment will likely not cover even materials not to mention surgery time which costs a lot due to considerable outlay in running the surgery or dentist's wages. So basically he will work for free for a couple of hours needed to do root treatment on molars and in addition have surgery expenses , ie defacto he will pay for the privilege of doing your root treatment.

heuchera

Trust your instinct. It's never let me down so far, and I've had one or two, shall we say, iffy dentists in the past. You know when someone's trustworthy and when someone's after doing the work to earn a bit of cash.

brook2jack

Give the X Ray to the dentists on this board and you will probably get five different opinions. Dentistry , like all medicine, is not cut and dried.

This is why it is important to find a dentist who you trust and stick with them , as you will get the best treatment with continuity.

I cannot say what is the correct treatment for you , sometimes it is very difficult to correctly diagnose even with X Ray's etc and sometimes time is the best diagnostic tool. In general if there is a problem time will show .

FBaby

Give the X Ray to the dentists on this board and you will probably get five different opinions. Dentistry , like all medicine, is not cut and dried.

That is quite worrying I have to say. I understand that medicine is not cut and dried, but saying that an x-ray result could lead to such different opinions is certainly not reassuring. What am I suppose to do then?

I don't see how trust got anything to do with picking the right dentist, what am I suppose to rely on to trust one over another? I haven't received any significant treatment from either, so could only go by bedside manners and I know that this is not an indication of expertise.

I am quite astonished I have to say that it is left to me to decide whether to just wait and do nothing, potentially risking losing a tooth, or take the risk of going for painful and expensive treatment potentially for nothing. I am not medically trained, so how am I supposed to make the right decision?

ravilious_fan

I must admit I am inclined to agree with FBaby, - either there is significant decay in that tooth or there isn't.

justme111

Decay does not equal need for root canal treatment and need for root canal treatment does not equal decay.
If I were you I would ask these questions :"my symptoms were x,y,z . What could be the reason for these symptoms? What makes you think these conditions could be the reason for these symptoms ? How can these conditions be dealt with? What makes you think I need root canal treatment? Let's say that one of the dentists tells you the shadow on the tips of the roots plus the fact tooth is not responsive to thermal stimuli means that likely there is bone resorption next to the root tips and that the " nerve in the tooth has died". So root treatment is meant to stop that inflammation. You are not convinced so you go and have a chat with another dentist and if another dentist says he does not think you need root canal treatment you can ask "what about the shadow on the tips of the roots" and listen to what they have to say. They might not have taken xrays at all which would been an indication of their thoroughness (not) for you. Or they might not have checked the tooth for responsiveness to cold. Ask why. They may give you satisfactory answer - for example , tooth is crowned so checks impossible/unreliable. Or they may errmm and uhhmm.

If you find a dentist who you can trust you will not have to do all this detective work , you would just ask : what should I do and follow their advice. And if they say it is not clear they would tell you what possible outcomes are if you do nothing or if you do x y or z. Then you ask further questions and decide what outcome you are most comfortable with.

As you rightly say you are not qualified so that is why trusting the dentist is so important. Yes it is difficult to assess who to trust - see above , questions and answers should help. Yes there is a potential of making mistakes in that choice.
Notes to consider - root treatment should not be painful.
On the NHS root treatment falls into band 2 charge and as such costs £51.50 at the moment so not clear why you say it is expensive.
If you want molar root treatment done to certain standard (which you may given that you paid for orthodontic treatment ) I would advise to look for someone with additional expertise in the area.
If you want to minimise chances of dentist having perverse incentives find a dentist who does not do NHS work.

FBaby

Thanks Justme, that's really helpful. Not easy to manage to ask all these questions during an appointment as they make you feel they are in a constant rush and anything beyond 5 minutes and you are told they can't talk any longer, but maybe I could write to the practice manager and ask for a longer appointment?

I was told treatment would be £299, that is indeed on a molar and that was to also put a crown on I believe (reading from the piece of paper that was given to me). I wasn't told who would actually carry out the procedure.

I have a long standing fear of dentists which I have only tackled in the last few years through self inflicted CBT. However, I still get very anxious and inevitably, my instinct is to hear what I want to hear and do nothing. Having done so though, I have lost 2 teeth through neglect and I really don't want to lose another one, hence my concern.

justme111

Why would you want being treated in a place where you feel rushed ?
What is the likelihood of dentist not rushing your treatment you think going to be ?

Mr_Costcutter

My neighbour is a dentist and advised me to have root canals performed by a specialist. That the equipment they use has higher magnification and as all they do all day is 'root canals', they are extremely experienced. This is particulary important if you have 'narrow' canals - which I have.
No disrespect to the dentists who post on here - your help is very much appreciated

Good Luck

Toothsmith

Mr_Costcutter wrote: »

My neighbour is a dentist and advised me to have root canals performed by a specialist. That the equipment they use has higher magnification and as all they do all day is 'root canals', they are extremely experienced. This is particulary important if you have 'narrow' canals - which I have.
No disrespect to the dentists who post on here - your help is very much appreciated

Good Luck

Non taken - I recommend exactly the same thing!

It's just people too often look at the fee charged by the specialist and then ask if I'll 'have a go' at it!

If it's straight forward, and the patient accepts the higher risk of loosing the tooth, then I'm generally happy to.

As for the OP - and others that have said 'surely it's straight forward - the x-ray will either show a problem, or it doesn't, as Brook said, It really isn't that easy!

In your first post - I too probably wouldn't have taken an X-ray with just the information and symptoms presented.

Having taken the x-ray - all you are actually looking at is a 2 dimensional shadow-picture! It's very much down to interpretation.

Now yes - if a tooth has loads of decay, or a classic black circle at the end of the root - then you have a picture just like in the text book - and diagnosis is easy. But what if you see a funny little sock shape, just slightly darker than the bone around it? Is that infection, or just the way the bone happens to look there? Sometimes you might as well toss a coin! So you also have to bring in what the patient is experiencing? If they're in lots of pain and that tooth is also tender to tap - then yes - it's an abscess. But if it just causes a bit of discomfort for a couple of days every few years, what then?

If a tooth is alive, you want to keep it alive, as a root filled tooth will need more things doing to it, and will probably end up being lost at some point in the years to come. So just diving in on poor evidence is not always the way to go. Of course, it's also possible that the dentist could go in and find the tooth is dead with a smelly infected root - until you go in you can't be 100% sure without much more evidence.

What you really don't want, though, is for the dentist to go in, and find a nice pink, bleeding healthy nerve! That would mean the treatment was completely unnecessary!