Does the NHS offer Root Canal on a back molar?

MoneySavingKid9976

Hi everyone,
I've recently come into a problem with my Upper Right back molar. A filling is too deep causing pain on the nerves when eating and my Dentist says a solution is to perform a root canal. He has offered it to me privately. Unfortunately, due to covid and work it's not something I can afford and would rather go through the NHS channels as I understand they perform root canals in the dentistry band 2 (I think).

After asking my dentist if I could do so he said that would be impossible as he needs 'special tools'. I then asked if they could refer me to another practise and they said they couldnt help me. While I believe he is an excellent Dentist and a root canal on a back molar is tricky and does require special tools - I can't shake the feeling that I'm being hustled into going private. I feel this way because the practise offered very little advice and help with going through the NHS, my dentist pretty much forces invisalign and teeth whitening treatments down my throat every time I sit in the chair. Tells me I need 1 hour hygienist appointments when the hygienist says I only need 30 minutes etc.

Is there a history of the NHS regulary performing root canals on back molars. If so should I seek a second opinion from another practise? Also a friend has recommended I contact citizens advice bureau about this issue. But I wanted to post here first as I've always received sound advice from MSE.

Any replies are greatly appreciated. Thank you very much.

brook2jack2

What a dentist cannot do is offer root treatment privately with themselves and not on the NHS if you are under a NHs course of treatment.

However if they feel that the root treatment is complex ,and many molar root treatments are , they can refer onto someone else privately. However root treatment on back teeth can be very complex and can need a specialist to do it who has post graduate qualifications and instruments such as an operating microscope ( cost £18,000) and materials such as mdta cement (cost at least £50 per patient) . 

In general it is virtually impossible to get an endodontic specialist on the NHS . The vast majority of areas just will not provide it and the few that do limit cases to those who have severe medical problems such as radiotherapy of the jaws, which means extraction is not a viable option. 

In other words it is virtually impossible in the vast majority of areas in the U.K. to refer someone for root treatment on the NHS . If you want complex root treatment it will have to be done privately. However a dentist doing a NHS course of treatment cannot say to you I cannot do this on the NHS but I can do this privately. However they can refer you to another dentist to do it privately , even within the same practice. 

Undervalued

MoneySavingKid9976 said:

Hi everyone,
I've recently come into a problem with my Upper Right back molar. A filling is too deep causing pain on the nerves when eating and my Dentist says a solution is to perform a root canal. He has offered it to me privately. Unfortunately, due to covid and work it's not something I can afford and would rather go through the NHS channels as I understand they perform root canals in the dentistry band 2 (I think).

After asking my dentist if I could do so he said that would be impossible as he needs 'special tools'. I then asked if they could refer me to another practise and they said they couldnt help me. While I believe he is an excellent Dentist and a root canal on a back molar is tricky and does require special tools - I can't shake the feeling that I'm being hustled into going private. I feel this way because the practise offered very little advice and help with going through the NHS, my dentist pretty much forces invisalign and teeth whitening treatments down my throat every time I sit in the chair. Tells me I need 1 hour hygienist appointments when the hygienist says I only need 30 minutes etc.

Is there a history of the NHS regulary performing root canals on back molars. If so should I seek a second opinion from another practise? Also a friend has recommended I contact citizens advice bureau about this issue. But I wanted to post here first as I've always received sound advice from MSE.

Any replies are greatly appreciated. Thank you very much.

It could be either. As I understand it root canal treatment is included within NHS band 2 and the dentist should be able to do reasonably straightforward ones. If it is beyond his capabilities and / or needs more specialised equipment then he should refuse. NHS root canal specialists are in very short supply and non-existent in some areas. So that limits your options to a private specialist or finding another general NHS dentist who is willing to give it a go.

What your chap cannot do (and I don't think he has to be fair) is suddenly be able to do it if you pay him privately. If he tries that you can land him in a whole load of trouble!

The problem is that any NHS dentist loses money on doing a straightforward RC (and some other treatments) due to the way the payment structure works. He doesn't get what you pay, that goes to the government then the dentists are paid on a complex formula. So, that always raises the suspicion that his true reason for turning it down is financial rather than clinical. The problem is unless another dentist gives an expert opinion you will never know.

brook2jack2

Molar root canals involve complex cleaning on a complex anatomy fractions of a millimetre in diameter. Add to that problems with accessing the teeth because they are so far back , teeth can be tilted , have existing crowns on or patient cannot open wide enough for long enough. Many will easily reach the definition of complex. Here is a diagram to show some of the complexity of what dentists are trying to clean out when they do root treatment on a molar tooth. https://images.app.goo.gl/jFr6fdQ7WTG3QZmK6

mda99das

This is not really well know but there is guidance at
https://www.rcseng.ac.uk/-/media/files/rcs/fds/publications/complexityassessment.pdf
This is under endodontics.
Really anything that is in tier 2 and tier 3 is deemed beyond the complexities of a normal GDP, and a referral for advanced mandatory care should be made.  There is scope to do molar RCT on a PVT basis as an alternative to the NHS route.

brook2jack2

Except that in the vast majority of areas there is no NHS specialist endodontics surgery , so in the vast majority of the U.K. private is the only option for complex root treatment. 

StoicLass

My NHS dentist attempted root canal on a similarly troublesome, filled back molar previously (pre-COVID). However, it didn’t resolve the problem and I was referred to a private endodontist, cost around £500.  It has taken around 2 years for my tooth to settle and periodic sensitivity to stop, so I’ve just had the final tooth repair, a porcelain overlay, which cost £375. It’s been a bit of a saga so I hope your problem is resolved quickly and at less expense. 

TallDaisy

My dad had the same problem and couldn't afford it, he ended up having the tooth taken out as we wasn't too bothered about it and cost much less.