Root canal treatment options?

Hoot_Owl

Good afternoon,

I was hoping for some advice regarding going for NHS treatment vs going private?

After a bout of toothache and visit to my dentist I was told I would need root canal (infection in upper front molar was found, was treated with antibiotics) and crown fitted on tooth since it currently has a rather large amalgam filling. I’ve been given a number of options:

- tooth extraction - though I would want to ideally avoid this since I already have a misaligned bite, the molar affected is one of the few teeth at the back that ‘meet’ when biting down.

- NHS treatment, would be offered root canal + metal crown which would be covered by band 2 pricing (£200 thereabouts however this would be completely free to me since I’m on income related benefits) the caveat being there would only be around 60% chance of the root canal being successful.

- referral to private endodontist (sp?) who would have better expertise, tools used and overall better outcome for successful treatment. The downside being it would cost £700 for the root canal plus another £400-£500 for the crown, a lot of money to me!

I could afford the private treatment (some savings set aside though it would be a big dent! Lol), it would give me a better chance of saving the tooth (which would leave me with a gappy smile if extracted), but on the other hand the free treatment option with the NHS certainly looks appealing, but uncertainty over the chance of success..

I need to make a decision soon, but it’s difficult!

Undervalued

Hoot_Owl wrote: »

Good afternoon,

I was hoping for some advice regarding going for NHS treatment vs going private?

After a bout of toothache and visit to my dentist I was told I would need root canal (infection in upper front molar was found, was treated with antibiotics) and crown fitted on tooth since it currently has a rather large amalgam filling. I’ve been given a number of options:

- tooth extraction - though I would want to ideally avoid this since I already have a misaligned bite, the molar affected is one of the few teeth at the back that ‘meet’ when biting down.

- NHS treatment, would be offered root canal + metal crown which would be covered by band 2 pricing (£200 thereabouts however this would be completely free to me since I’m on income related benefits) the caveat being there would only be around 60% chance of the root canal being successful.

- referral to private endodontist (sp?) who would have better expertise, tools used and overall better outcome for successful treatment. The downside being it would cost £700 for the root canal plus another £400-£500 for the crown, a lot of money to me!

I could afford the private treatment (some savings set aside though it would be a big dent! Lol), it would give me a better chance of saving the tooth (which would leave me with a gappy smile if extracted), but on the other hand the free treatment option with the NHS certainly looks appealing, but uncertainty over the chance of success..

I need to make a decision soon, but it’s difficult!

As I understand it (and hopefully one of the regular dentists that posts here will confirm) it should also be possible to just have the root canal done privately (if that it what you choose) then return to the NHS for the free (in your case) metal crown.

Again in my non professional understanding what you have been told about the better chance of success, if done by a private specialist, is probably true. However, sadly the NHS dentist will also have a financial incentive to give such advice as he will make a loss out of doing the root canal on NHS terms. Now that shouldn't affect his professional judgement and it may well not be doing so but it does seem to happen quite often!

He has at least offered to do it, to his credit. A difficult decision for you to make and in some ways it being totally free to you on the NHS makes it worse. A paying NHS patient would only be looking at the difference in cost, not the whole bill.

Sadly nobody can give you a guarantee it will be successful even if done privately. The fact the NHS chap is willing to "have a go" implies it is not too challenging. Again maybe one of the dentists will comment although obviously only in general terms as they can't see you.

Toothsmith

Undervalued pretty much summed it up well above.

From the advice given by your dentist, I would be a bit less cynical in this case. He has offered to do it for you - but it's quite correct that a specialist with 2-3 years extra training, specialist equipment costing tens of thousands of pounds, and being the thing he/she is doing all day every day - there would be something very wrong if they weren't getting better results!

I'm purely private - so if I do root treatments for my patients, I'm not making a loss - but I still have to tell my patients they would get a more likely chance of long term success if they paid a bit more and saw a specialist. A fair few of them still choose this option. In all honesty, if I needed a root filling in anything other than a straight forward incisor, I would go to a specialist too.

Hoot_Owl

Thanks for your replies,

It seems quite clear cut the better outcome would be private treatment, even though instinctively it is very difficult turning down free treatment on the NHS.

It would of been great if I could of ‘gotten away’ with my dentist doing the root canal, a 90 minute appointment was made for next week but I’m leaning towards cancelling and going private. Having only the root canal done by a specialist may be a good sacrifice, cutting down on the expense, even if there are no guarantees of even the private treatment working, it’s a risk either way.

Thanks again.

elsien

I had a similar situation - my NHS dentist was willing to do the root canal but the private specialist had a better long term success rate which is what I went for.

I did then go back to my NHS dentist for the crown. There was a bit of a wait for this, which isn't ideal, but it all worked out in the end.

Whatkattydid

I also had a similar situation - upper molar - and what swung it for me was asking my dentist, if it was her tooth, would she want the specialist to do the treatment? She said yes.

I am an NHS patient in a mixed surgery, so my dentist referred me to the specialist, and after I had the treatment with him he discharged me back to her for an NHS crown. The specialist did final x-rays a month after the treatment was complete to make sure everything was okay before he signed me off.

Another option my dentist offered was for her to attempt the treatment, and if it didn’t work out, then she would refer me on. (My tooth had very curved roots, which she thought might be challenging.) I just wanted it done, without too much disruption/time off work, but maybe that is an option for you?

Hoot_Owl

Whatkattydid wrote: »

I also had a similar situation - upper molar - and what swung it for me was asking my dentist, if it was her tooth, would she want the specialist to do the treatment? She said yes.

I am an NHS patient in a mixed surgery, so my dentist referred me to the specialist, and after I had the treatment with him he discharged me back to her for an NHS crown. The specialist did final x-rays a month after the treatment was complete to make sure everything was okay before he signed me off.

Another option my dentist offered was for her to attempt the treatment, and if it didn’t work out, then she would refer me on. (My tooth had very curved roots, which she thought might be challenging.) I just wanted it done, without too much disruption/time off work, but maybe that is an option for you?

Hi, thanks for your reply.

I was thinking the same, about maybe letting my dentist try the root canal first and like you say if it goes wrong they could refer me back to the specialist. But then I’m not sure if a ‘redo’ RCT might have less of a chance of success compared to doing it correctly first time?

I think the reason why my dentist gave me the option of them doing the treatment is because the affected tooth was a first molar at the front. I looked at the X-ray and from what I could see the roots looks relatively straight (compared to what I see googling ‘curved tooth roots’).

Like I say it’s difficult turning downing free treatment and having to spend £700 when even then there are no guarantees of successful treatment..

Toothsmith

Hoot_Owl wrote: »

...... But then I’m not sure if a ‘redo’ RCT might have less of a chance of success compared to doing it correctly first time?....

This is exactly right. Redoing a failed RCT does have lower chance of success than having it done well in the first place.

It's not a bad idea to have your general dentist 'have a bash' before considering referral - but the key thing would be deciding between you how 'heroic' you want the general dentist to be.

The challenges in the preparation can be:-

Finding all the canals in the first place (There are 3 or 4 in a molar tooth typically)

Preparing all the roots right down to the ends

Filling them with a nice solid mass of root filling material right down to the full prepared length.

If your general dentist stops if at any any point he cannot find or prepare one of the canals to it's full length, and sends you off to a specialist at that point - then it won't affect the specialist's chances of success that much.

Sometimes though - even if not all canals can be found, or not all can be filled right to the tip - you can still get a 'successful' outcome. So if you decide that your dentist can go right to the finish even if it's less that 'optimal' - then ther result *might* be perfectly ok.

However - if a year or two later, you find that it has failed, or not settled down - referral to the specialist at that stage will be affected by a lesser chance of success.

You and your dentist between you need to decide what level of risk you are prepared to take.

Hoot_Owl

Toothsmith wrote: »

This is exactly right. Redoing a failed RCT does have lower chance of success than having it done well in the first place.

It's not a bad idea to have your general dentist 'have a bash' before considering referral - but the key thing would be deciding between you how 'heroic' you want the general dentist to be.

The challenges in the preparation can be:-

Finding all the canals in the first place (There are 3 or 4 in a molar tooth typically)

Preparing all the roots right down to the ends

Filling them with a nice solid mass of root filling material right down to the full prepared length.

If your general dentist stops if at any any point he cannot find or prepare one of the canals to it's full length, and sends you off to a specialist at that point - then it won't affect the specialist's chances of success that much.

Sometimes though - even if not all canals can be found, or not all can be filled right to the tip - you can still get a 'successful' outcome. So if you decide that your dentist can go right to the finish even if it's less that 'optimal' - then ther result *might* be perfectly ok.

However - if a year or two later, you find that it has failed, or not settled down - referral to the specialist at that stage will be affected by a lesser chance of success.

You and your dentist between you need to decide what level of risk you are prepared to take.

Thanks Toothsmith,

After reading your post I’m left with the impression going through the NHS dentist is just adding to the risk of complication down the road.

Now I think about it, I would be kicking myself if I find in a month or few years time having to have go through treatment all over again in an attempt to salvage the tooth! Even though there are no guarantees, if the job is done right first time around and it lasts a few decades at best, then it is money well spent.

Toothsmith

10 - 12 years is the average survival time for a successful root filled tooth

Some will last a lot longer, some will fail earlier (That's how you get an 'average' )

There are no dental treatments that any dentist could put their hand on their heart and tell you it would last for 'decades'.

The only thing that could last you for decades is a tooth that a dentist has never had to touch.

Hoot_Owl

Wishful thinking maybe? A got that timeframe from the tooth itself having a very large amalgam filling that up to now had lasted 20 years! But I can appreciate a root filling tooth is a whole different kettle of fish, but still a good amount of time if successful.