What to do when endodontists disagree?

GoldenOldy

Good Afternoon

I have been experiencing tooth pain on and off in a tooth which was previously root filled and had a crown about 18 years ago. My lovely dentist referred me for a ct scan and to an endodontist, Because the endodontist only works locally 1 day a week the appointment was some time away. I panicked as 1. I do panic anyway and 2. My tooth was hurting more than usual, so I booked into another endodontist (lets call him endo 1) who has great credentials. 

Saw endo 1 who told me the tooth had an infection above it, but it could be saved. Which was all good. They said theyd do it in 1 go , in 1 hour 45 mins.Only problem was the clinic was really grotty and frightening looking, and they were quite high handed and frightened me. They were also rough when opening my mouth and poking around, and I got the feeling they didnt like me,He initially suggested cutting the root via surgery but then changed his mind.

Nonetheless booked a provisional appointment for 3 weeks.
Endo 2, the original referral man was then seen the following week. Couldnt be nicer. Very gentle, very approachable, great eye contact.Let me ask questions.

The only thing here was he cant treat me for four weeks. 

He also said to re root fill it. He said do it in 2 goes though in order to put some disinfectant in and let it soak (more or less)

He  BUT….here’s the thing…he said i dont have an infection?! He said the blobs on the ct scan were swellings produced by my own body trying to fight off bacteria in the canal.

He also said because I grind my teeth thats why it might be hurting more on some days than others.
He also said no big hurry unless its really killing me,

so ultimately i really liked chap and dont feel the need for any sedation with him (whereas i do with endo 1 just to go in there), but who can I trust? And why do they differ?

Sorry to go on,  but am frightened.

Anyone ‘in the know’ out there?

brook2jack2

Give three dentists/endodontists one patient and you will get four different treatment plans. Dentistry is not an exact science and each of those four treatment plans may be equally valid. 

Your dentist referred you to an endodontist, you prefer and trust this person better , but you have to wait a few weeks longer . It is no emergency so why not go with the person your dentist recommended and you feel comfortable with?

Undervalued

I think when buying any service from a qualified, regulated person it is almost impossible for the consumer / patient to know in advance who will do the better job. There may well be more than one perfectly valid way of arriving at the desired outcome.

So, perhaps the most relevant criteria is to go with whoever you are more comfortable dealing with? If you are more relaxed it must, to some extent, make it easier for the person providing the treatment to do an excellent job.

You haven't mentioned cost and I have no idea how significant that is to you? If there is a big difference in price then that must also be a factor for most people.

GoldenOldy

Thankyou both, it hadnt crossed my mind that both treatments are valid. I feel much more relaxed now you have bought this up. There is under 80 pounds difference in cost, so not a massive difference. 

Toothsmith

GoldenOldy said:

 BUT….here’s the thing…he said i dont have an infection?! He said the blobs on the ct scan were swellings produced by my own body trying to fight off bacteria in the canal.

He also said because I grind my teeth thats why it might be hurting more on some days than others.
He also said no big hurry unless its really killing me,

This is really just a fluffier, cuddlier way of saying "you've got an infection" !!

welshdent

Endodontist here!
So you DO have an infection. But you may not have an abscess. I always say endodontic disease is stops along a train line and sometimes you can go back a stop too! But ultimately there is bacteria inside your root canal system that needs cleaning out. We have our own patter to explain things simply. Usually the shadowing on the ends of roots in basically visible signs of inflammation caused by the infection inside your tooth. 

It doesnt sound like they have different opinions to me. They both have advised treatment. The lack of urgency is something I lean towards when a case is minimally or non symptomatic. A few weeks here and there will make little difference to the outcome in my experience. 

Treating it over 1 or 2 vists - both are correct. Whats more important is how its cleaned. If they use appropriate cleaning protocols then I am minded to go with the recommendations of the clinician who knows what they are doing, how they are doing it and how their cases usually turn out. 
There is non consensus on the "best" approach. My masters dissertation was on that very topic. Its unlikely that there will be a consensus anytime soon. Typically the factors that we consider would be pain, active infection, available time to disinfect the canal system following establishment of a pathway along the whole canal, patient tolerance. Dentist/Endodontist skill and or preference. 

My advice is to see the one you feel most at ease with. 

GoldenOldy

Thankyou welshdent, I have only just seen your reply.

welshdent

No probs! Hope you got it sorted

GoldenOldy

Actually still at it. Went with the ‘nicer’ chap. He said to deal with one at a time. Cleaned most obvious one out. Put antiseptic or whatever it is in it, with the idea then to re fill it .Got great results for 3 weeks then started flairing up again. Went back at xmas , didnt refill, but re dressed it(?) and said to leave until march. Has just started to kick up again now. Feels like its pushing down somehow. Not pain, but discomfort. But oddly sometimes after i’ve cleaned it, or ate a crisp say, the discomfort goes. Its very odd. Would welcome any thoughts you may have? Thanks