NHS Root Canal Rework Advice

bmouthboyo

Morning All,

so about 12 years ago I had root canal work on my right upper second bicuspid. About 2 years ago I noticed the surface felt a little different and 9 months ago it developed an infection which I went to a new dentist to have seen to. There she said that due to lack of tooth remaining root canal work on it was not possible and it would need to be removed and I could have an implant if I wanted. At 2 thousand pounds and prospect of screwing into my bone I decided to take some time to consider option and probably have it extracted. Antibiotics cleared it up and away I went.

A month ago I felt a little pain so went back to the dentist and was this time seen by another. I explained what the first said about not being possible to save the tooth and he disagreed and said there is plenty of tooth. He then gave me the details of a local endodontic specialist.

I contacted the specialist and have an appointment next week.

If the endodontic specialist says he / she can save the tooth, am I not entitled to this to be covered by NHS? Seeing as it is a case that the local dentist isn't skilled enough to perform the work?

The endodontic practice states on it's website:

We are pleased to be working with NHS England to provide funded specialist endodontic services to NHS patients. Specialist treatments must satisfy NHS guideline criteria and any funding request made by the general dental practitioner. Guidelines and funding request forms (IFR) can be downloaded in Links page.

I cannot find any info regarding if I would meet the criteria for NHS funding? I work full time and so pay the full NHS charges.

With the cost looking to be £900 for the root canal and found out the other day I still then need to pay for a crown, all in would be £1400! Any advice much appreciated.

Toothsmith

Of course you are entitled to have this done on the NHS.

However - your (2nd) dentist has quite rightly identified that if it is going to have any chance of being successful, you will need he extra expertise of a specialist endodontist. So you need to be referred to a specialist endodontist with an NHS contract.

Here is where everything falls down, as specialist endodontic services available within the NHS are exceptionally rare to the point of virtually non-existent.

It might be worth asking your dentist if there are any NHS specialist services near you - but chances are he'll fall off his chair laughing, and suggest you have more chance of winning the £900 on the lottery.

It might be worth a letter/email to your local NHS team to see if there is such provision in your area - but again, the chances are vanishingly small.

You could write to your MP to highlight the problem - but the problem has been known for years, and there is no will to do anything about it, as not enough voters write to them about it.

So - the bottom line, in the real world, is that if you want to save this tooth, the chances are you will need to see a private endo specialist about it, and pay the appropriate fee.

One bit of good news though - once root filled there is nothing to stop your own dentist putting an NHS crown on top of it for the Band 3 NHS charge, which will save you a couple of hundred on that £1400 figure.

bmouthboyo

Thank you for the reply and detail, really helpful.

With regard to asking my dentist if any NHS specialist services in the area I am not sure which to ask. The dentist I originally saw who took xrays and said it is not practical to save the tooth, or the second one who I was assigned from the same practice when I assume my first one was away that day?

The second did not really say he was 'referring' me to the specialist but gave me the specialists name, saying it usually cost around £750.

What would my dentist be likely to say if I returned and said I want to be referred? Also my appointment with the specialist is next Friday 14th Feb, do I need to do this before my initial consultation with them which they will charge private consultation fees etc?

As mentioned the Endodontist's website states: "
We are pleased to be working with NHS England to provide funded specialist endodontic services to NHS patients. Specialist treatments must satisfy NHS guideline criteria and any funding request made by the general dental practitioner. Guidelines and funding request forms (IFR) can be downloaded in Links page."

Does this mean I could get my NHS dentist to refer me for NHS funded treatment? And if so why didn't they do that when I was recommended the specialist? All rather confusing.

Toothsmith

Wow - well you may well have some of the highly rare services in your area!

I would get back in touch with the second dentist you saw, let them know what you have found, and ask if you can be referred as an NHS patient to this specialist.

I'm not sure what the NHS criteria are (Brook2Jack might see this and have more knowledge in this area) But I would imagine they are quite stringent.

Good luck with it.

bmouthboyo

Thank you again.

I have called my dentist and explained to the receptionist the situation (2 dentists in same practice giving different advice, and now booked with recommended endodontist). I explained to the receptionist I am seeking NHS referral and if they will not a copy of all my case files and notes.

I think I meet the NHS criterea which is listed on the endodontist's website:

I wonder if they consider the 2nd premolar as not being essential for redoing root canal? The rest of my teeth are in good shape.

brook2jack

The individual funding request (ifr) is a multi page request form that takes ages to fill out, then goes in front of a committee to approve .

NHS specialist endodontists are rarer than hens teeth. Where they do exist the priority is given to patients who have had had radiotherapy to the jaw or bisphosphonates or other medical therapy in whom it would be very dangerous to take a tooth out.

I have filled out IFRs for other treatment and never had one granted. The process is lengthy and onerous .

You are best asking your dentist but my experience is unless you have a serious medical condition you will not get your endodontics on the NHS. At a time when funds are very restricted it is very difficult for the NHS to justify spending £700 or more on saving one tooth.

bmouthboyo

Thank you for your reply brook2jack.

I called my dental practice and explained I would like to proceed via NHS referral and that I am confused as to why I was given endodontic specialist details yet not referred. Receptionist called me back an hour later and they are putting in a NHS request now but apparently it takes up to 6 months! They advised me to cancel my appointment with the specialist for next Friday.

After reading your reply it looks like my chances are bleak so wondering if I should go for the initial consultation myself and foot the £75 + Scans and at least see if they think it is viable. Would this scupper any small chance of a NHS referral?

Seems crazy that in some parts of the country people get this on NHS and others not. Do the NHS literally reply to the request and say there is no funding and that I should pay well over a thousand pounds myself or have it ripped out? I read the IFR and can't see what grounds on that form I would be denied. Appreciate the advice from everyone here, glad I thought to post here.

brook2jack

In my part of the country there is no referral system for root treatment at all , and that is the case for the vast majority of the country.
In the very few areas where it is offered it is purely on the basis of severe medical need eg people who have had jaw radiotherapy etc.

Where the NHS spends £32 ish per person treated per year including patient fees it is difficult to see how £700 plus to save one tooth can be routinely justified in a cash strapped service.

If you have a private consultation it will not affect your chances of NHS treatment .

This is the typical criteria for referral https://www.kch.nhs.uk/Doc/rf%20-%20049.3%20-%20restorative%20dentistry%20referrals%20acceptance%20criteria.pdf

Toothsmith

Brook's reply is what I expected it would be.

If you really want to save this tooth, and have the funds to cover it - then I would continue on the private route. If the endodontist happens to agree with the first dentist and feels there isn't enough viable tooth to make success unlikely, then they will tell you honestly. It's not in their interest to 'save' a tooth which will fail in a very short time.

Your NHS practice can then crown it for you later on the NHS.

The delays waiting for the NHS to ultimately reject you will not improve the tooth's chances.

bmouthboyo

Thanks Toothsmith and Brook, really appreciate you taking the time to reply. It is what I really like about forums over social media groups.

I will go to the appointment next Friday and see what they say. If it's save able I will go the private route and take the financial hit.

Out of interest what would I be looking at for a white crown opposed to the silver ones? Seems a shame if the specialist fills with white material to then put a silver crown back on.

Toothsmith

I would imagine that would be back to the £1400 'all in' price you originally posted.