OT: Dental Experiences–Root canal and crown?

[BumbleBeeDave]

Never had one of these before but looks like I might have to. I went in for a cleaning last week and the dentist told me I have a small gum abscess and a dead right lower molar. I’ve always had sensitivity problems with my teeth, so I hadn’t noticed any unusual pain. He showed me the x-ray, which didn’t mean a whole lot to me.

He gave me a three-week course of antibiotics to clear the infection and told me I’d need a root canal, but was pretty vague on when or how urgent it is. Since then I’ve done lots of reading and when I’m done with the antibiotics I want to go back and see him and ask the right questions.

I have no idea how long the infection’s been there, but hadn’t been back for a checkup for 8 months. The tooth has had a filling for any years, but it doesn’t hurt and appearance hasn’t changed. It’s not chipped or cracked that I know of. I’ve got normal gum recession for someone my age.

So what are your experiences in this situation?

What should I ask the dentist, or ask him to do, to give me some perspective on my particular situation?

If the tooth is dead, would the antibiotics still clear the infection inside the tooth?

Get a root canal? Leave it alone until I have trouble with it? I don't want to get the tooth pulled if I don't have to. What would make it an emergency situation?

I’m not so concerned about the pain/process of a root canal (and possibly a crown) as I am the expense, since I don’t have dental insurance. Looks like a root canal would be at least a grand and if I need a crown that might be $2k more. Ouch. I'm not exactly rolling in dough right now.

Any advice or experience appreciated!

BBD

[MattTuck]

You must be under the impression this is still the serotta forum ;)

[buddybikes]

Welcome (probably) to getting older. If you trust your doctor move forward, if you don' t then get second opinion. Not cheap, probaby 2,500+ before insurance

Procedure isn't as bad as made out to be, just time consuming.

[buldogge]

Are there any dental schools close to you?

Check into student work...

-Mark in St. Louis

[Ken Robb]

Quite a few people from USA cross into Mexico to have this kind of work done for less $$$. Heck, you could probably save enough to visit Dave Thompson. :)

[dsimon]

If it a a wisdom tooth just pull it its way cheaper especially if its dead. a root canal is painful and expensive if its a front tooth well you still need to smile.:confused: I have 2 bottom molers missing one each side for years no issues but you cant tell when i smile either.:confused:

[mtb_frk]

I just had a crown done two weeks ago. It was my first one. I put it off for a while because the tooth wasn't bothering me at all. My dentist was able to do it all right in the office, including making the crown. That was quite nice, no cap and waiting a week to see how it fits. So basically it was grind the old tooth away, take a bunch of pictures, let the machine mill the crown, fit it, and then bake it. All told it was about 3 hours. They didn't give me a price up front, and I guess I forgot to ask as I have really good insurance. So they asked if I wanted to pay the copay on it while I was there, $455 which was 50% of the cost. That may have hurt worse than actual dental work. For the first few days there was some pain, and cold sensitivity but I really don't notice it anymore. I think having it all done in one trip was really nice, and might be something you want to ask about or look for in a dentist. Good luck.

[rnhood]

A fissure on the gum is a tell tale sign of a dying, or dead tooth. Even if you have had it for 8 months its not too late. In fact your tooth may still be partially alive as there are often several roots in a molar. The infection is usually small and your body's immune system deals with it. That's why it does not often cause further problems such as a proliferation of infection. Nevertheless, it needs to be cleared up because eventually it will become worse.

A root canal usually works, but not always. My recommendation is to ask your dentist to refer you to dental surgeon. They are generally better skilled (and qualified) in performing these procedures. Often a local dentist will want to do the root canal in his office as it represents income to him. But a general dentist is not an oral surgeon, and it really doesn't cost anymore to have a surgeon do it. He will then send you back to you local dentist for the crown.

Antibiotics are the normal protocol as the infection needs to be temporarily cleared prior to the procedure to better ensure success.

There is always a chance the root canal doesn't work. In this case you lose a tooth and your dentist will grind down the adjacent teeth and install a bridge. If you have deep pockets then you can opt for an implant but I favor a bridge. This is a decision each person will make - one size doesn't fit everyone.

A properly crowned tooth with root canal should last longer than you will. Other than the tooth being slightly more brittle, its a good tooth for the long haul.

[eddief]

I have had one root canal in my days. They canaled it and then filled it. As I recall, it did not need a crown at that point. And then a couple of years later that same tooth cracked. That was pulled and then I got an implant. When I got the implant I checked dental schools for pricing and they would have done it way cheaper than my dentist. When I mentioned it to my dentist, he came close to meeting the price of the dental school. I like him and he did a good job.

[Mikej]

Does it hurt? I had one in a moler and it took a year for the nerve to calm down. It hurt like a mfer - i had pain that I thought was neck muscle for quite a while, but it was a cracked tooth from my "usmc" dreams...teeth clenching while I sleep. Do you have health fsa accounts at work? And dentists are generally easy to bargain with _ they have Serotta payments to make!

[eddief]

if it's infected at least make sure you get that taken care of. tooth things are easier than cranial replacements.

[Ralph]

If.....I were having a root canal, I would have it done by a Endodonist. Actually many regular dentists won't do a root canal on a molar. It takes specialized equipment to get into all the roots and microscopes to see what's being done.

A couple years ago, a new dentist I was seeing talked me into a crown. Shortly after that developed pain. Took antibiotics a while to clear it up. He said it needed a root canal, and he could just go thru the crown to get to the roots....then patch the crown. I should have known better.

Pain returned, and I went to a specialist, an Endodontist. He had a lot more equipment than my dentist. He pulled off the crown (said he couldn't properly do a root canal thru a crown), tossed it in trash, fixed the tooth, then sent me back to my dentist for another crown. I found another dentist for the crown.

Expensive lesson. Now....if I needed a root canal.....would just go straight to Endodontist.

[rkhatibi]

I'll second Ralph. Have a specialist do the root canal.

In regards to dental schools I've used them, but only for pulling teeth and minor fillings.

[Peter B]

A fissure on the gum is a tell tale sign of a dying, or dead tooth. Even if you have had it for 8 months its not too late. In fact your tooth may still be partially alive as there are often several roots in a molar. The infection is usually small and your body's immune system deals with it. That's why it does not often cause further problems such as a proliferation of infection. Nevertheless, it needs to be cleared up because eventually it will become worse.

A root canal usually works, but not always. My recommendation is to ask your dentist to refer you to dental surgeon. They are generally better skilled (and qualified) in performing these procedures. Often a local dentist will want to do the root canal in his office as it represents income to him. But a general dentist is not an oral surgeon, and it really doesn't cost anymore to have a surgeon do it. He will then send you back to you local dentist for the crown.

Antibiotics are the normal protocol as the infection needs to be temporarily cleared prior to the procedure to better ensure success.

There is always a chance the root canal doesn't work. In this case you lose a tooth and your dentist will grind down the adjacent teeth and install a bridge. If you have deep pockets then you can opt for an implant but I favor a bridge. This is a decision each person will make - one size doesn't fit everyone.

A properly crowned tooth with root canal should last longer than you will. Other than the tooth being slightly more brittle, its a good tooth for the long haul.


+1. And see an Endodontist for the procedure. An infected root will likely lead to bone loss in your jaw--not good. I've had two root canals/crowns, both on molars. The last time was done thru a crown installed years ago to repair a cracked molar. The surgeon was able to do the root canal thru the crown and my dentist did the final fill and polish.

Rarely is it advised to postpone dental work.
Best of luck with this--it's not so bad.

[bikerboy337]

If you have insurance,get the root canal now, crown next year (January)! It'll be a lot
Cheaper if you can split it as they usually have like a $1000 or $1500 annual max, but its calendar year ... With my insurance ill only be out a few hundred on the canal and crown. Be glad you're not in pain,i had an abscess last month and was on Percocet for 3 days it hurt so bad and took 2 weeks to clear the infections ... I trust my dentist (my neighbor) and in my case he said to get the canal asap.


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[bikerboy337]

Also, plus one on a specialist for the root canal, my dentist sent me to one for that, and my dentist is doing the crown... He said that most dentists wont do a canal on a molar for the reasons mentioned above.

And the pain only lasts for about 2 seconds with a root canal, then its gone (cause the remove the nerve!)


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[djg]

Been there. I'd go to an Endodontist (which is where my dentist sent me) for the root canal procedure itself. Yes, it's expensive, but if you actually need it, but leave the tooth untreated, the consequences could be serious -- it's not just about the tooth. Do you trust the dentist? If so, I wouldn't mess around (and if not, I wouldn't mess around either -- I'd look for one to trust).

[miksibis]

as a 23 year practicing dentist i recommend not waiting for the root canal. i second the recommendation for an endodontist or root canal specialist. my root canal were pretty good but my current endodontist is so good with his microscope assisted work that i won't do any more in my practice lifetime. amazing improvements in that field. also once endodontically treated don't neglect getting the crown to properly restore the tooth. an endodontically treated tooth becomes brittle with time and the crown will prevent future irreparable fracture of the tooth. i do agree that to maximize insurance benefits you could do the RCT this year and the crown after Jan. 1st. mike

[1X10]

Root canals, crowns, cracked teeth, bridges, etc, etc....I have unfortunately had them all and then some...Zero enjoyment on mouth and the pocket book$:eek:

I am lucky to have had an uncle who is top notch dentist and specializes also!!

My advice is in the same suggestions of everyone else, and get treated...if it abscesses and the nerve flares up it can bring a whole new level of discomfort:no::no: As much as the $$cost can be a discomfort its nothing like the feeling of this!!!

Good luck...

[Hawker]

you must be under the impression this is still the serotta forum ;)

lol. :)

[endosch2]

Do not ignore it, go to an endodontist for the root canal. They are specialists who do them all day long and have a high success rate. Keep your teeth, as you get older you may potentially lose others which can lead to changes in nutrition. Root canals done by specialists have a very good success rate. The root canal and crown are expensive but your health is worth it. You have an active infection until this is treated.

[OtayBW]

Just FWIW - root canal and crown...piece of cake. Have it done right and no worries, no problem.

[rounder]

The first root canal I had was while in college. The dentist did the root canal and then installed a crown with gold. A few months later, I was in pain and went back to the dentist. He said that the tooth had to be removed and removed it. Plus he kept the gold. That was a bad experience.

A couple of years ago, I had another tooth that needed a root canal. The local dentist did a root canal and installed a crown. It was not cheap but has been fine since,

[93legendti]

+1. And see an Endodontist for the procedure. An infected root will likely lead to bone loss in your jaw--not good. I've had two root canals/crowns, both on molars. The last time was done thru a crown installed years ago to repair a cracked molar. The surgeon was able to do the root canal thru the crown and my dentist did the final fill and polish.

Rarely is it advised to postpone dental work.
Best of luck with this--it's not so bad.

My uncle let his bone loss go for years and then lost all his teeth-he didn't eat solid food for a year after that.

I've had a few root canals and endodontists are excellent doctors. No pain. Relatively quick procedure and they always call personally to see how you're doing.

[kramnnim]

It's too bad they can't kill the nerve with lasers instead of doing the root canal.

[jlwdm]

Take care of your teeth. And get a new dentist as you don't trust the advice from your current dentist. You should trust your dentist 1,000,000 times more than members of a bike forum.

I had a root canal in June and the Endodonist made it painless.

Jeff

[cmg]

had root canal/crown done about 3 months ago. cost $1800+ no insurance, get insurance. It is worth it. Didn't want to have gaps, at least not yet. Don't worry about the pain, that is minor.

[kramnnim]

Is insurance that only covers ~$1k per calendar year fairly standard/normal? (for the US)

[merlinmurph]

As a guy that has had a number of root canals and crowns, believe me, it's painless. Maybe there's the occasional bad experience, but I never understood all the jokes about root canals. Just not a big deal.

Get it done. It's expensive, even when paying 50%, but you really don't have any cheap options. Doing nothing is not an option.

[mosca]

A few years ago I had some tooth pain that I erroneously attributed to grinding my teeth at night. Eventually I got a nasty infection in my gum and found out I had an infection in a tooth that had caused the problem. They told me the infection could eventually get into the brain tissue, which is probably pretty rare but still not a pleasant thought.

So get the root canal done right and soon. As others have said, expensive but basically painless.

[Duende]

Take the anti-biotics. Then go see a good dentist to find out if your tooth is really dead or not. The infection can screw with the nerve sensitivity and make it seem like it's dead. But it might not be. Don't trust X-rays alone!

Trust me. I just went through this exact same situation. Some ethical dentists will double check. Others will send you staight to get a root canal.

[BumbleBeeDave]

I'll get this taken care of way sooner than later. Just not something I was looking forward to having done over the holidays!

Seems like the best first step is going to be to finish the antibiotics and head back to my dentist to assess the options. To be fair to him, when I said he was"vague" I don't mean he blew me off. He just said we need to get rid of this infection to buy some time to decide. My insurance would pay to extract the tooth, but not for a RC or crown. Yes, I know, crappy insurance, but right now it's all I have.

Anyway, after a week on the antibiotics the abscess is gone and I'll finish out the course and go back to ask the right questions. First confirm the tooth is really dead, then get his referral to an endodontist. There's one less than a half mile from my house who has all the microscopic equipment for the RC and another dentist I've seen before in the past (and liked) who has the 4D crown molding equipment.

Guess I'll have to pull some $$ from savings, but this is not the kind of thing I want to look for a "deal" on. Find the best dentist and pay the freight.

Thanks again for all the great advice!

BBD

[BumbleBeeDave]

. . . and it was not a bad experience. The tooth was dead anyway, and once he numbed up my jaw there was no pain or discomfort. Really underwhelming considering how worried I was about it. The endodontist I checked out has the microscope equipment, but charges $2100(!!!) for just the RC. His practice is limited only to root canal's and yes, I'm obviously in the wrong business. My regular dentist is a vet and confirmed he's done at least several thousand of these in his career, so I figured he's probably going to know what he's doing. Plus he only charges $950 for the RC. :rolleyes:

My dentist said the tooth had a crack on top, which was obviously how the infection got in. But it didn't extend to the base of the tooth, so he can still do the RC and save the tooth. He prepped and disinfected today, but then said that given the size of the gum abscess I had he packed it with antibiotic stuff, put on a temp filling, and I'm going back next week to get it finished and a better filling put in. Then he lets it calm down for a month before doing the post and crown.

Thanks again to all for your advice and perspectives!

BBD

[Ken Robb]

I think your dentist sounds like a really good professional.

[R3awak3n]

I have 2 root canals coming up... This month has really sucked, broken ankle, 2 root canals and 2 cavity fillings coming up. I will be broke for a while.

Glad the pain was manageable. Everyone says root canals are like the worst thing ever but recently been talking to some people that said its not that bad. I feel like breaking my ankle, any dental thing is a piece of cake so I am not so worried.

[ispy]

Glad you got it done. Sounds like your dentist was pretty sensible. I went through this in the fall... still cost me $2000 (with crown) after insurance! However the endodontist was terrific and painless; I almost fell asleep in his chair twice.

I contacted, IIRC, 7+ endodontists to research cost since my insurance coverage was very little: I was surprised that costs ranged widely from $1000 to $2300 (SoCal), and that's without the crown. My mother-in-law who is Asian recently had to face TWO root canals + TWO crowns, and saved a gob of money by switching to Korean dentists. I know... this sounds very un-PC shall we say... but she went to what seemed a bustling office and so far has no complaints. I want to believe that one gets what one pays for, but sometimes I wonder...

Don't wait more than 1 month to get the crown FWIW.

[malcolm]

Dental schools. Most will have a faculty practice which is the faculty private practice and it won't save you any money, it's billed as any other dentist. I go to one and have had a plethora of dental work over the years due to being a chronic jaw clencher during sleep. I've been very satisfied.

Student clinic, will save you money and given federal guidelines regarding billing and recovery from medicare carried over to major insurance companies will almost always have a faculty dentist present if not in the room checking occasionally or at least immediately available for consultation. I wouldn't hesitate to use this service if I was uninsured for general dentistry or acute problems temp fix of a fracture or abscessed tooth. I would only use them for specialty procedures if I couldn't afford to go elsewhere. If that were the case ask if the faculty dentist were present for the whole procedure, I suspect in many cases they are.

Same as for any medical procedure ask for alternatives and the pluses and minuses of them. If he or she is unwilling to explain them in a manner that allows you to make a decision move on or at least get a second opinion.
An infected/abscessed tooth in need of a root canal is generally viewed as a sooner rather than later thing but if it gets better with antibiotics you do have some time to look around. The problem is antibiotics will cool it off but it will recur it may be weeks or even months but the longer you sit on it the lower the chance the tooth will be salvageable and then you are into implants and they make the cost of a root canal seem reasonable.

Interesting story several years ago. A journalist with no dental problems went to random dentists across the country and the range of recommendations was astounding with only a handful recommending nothing which is what he needed. Dentistry like many other professions has its money makers that are cash cows for the practice.

[fiamme red]

I also had a root canal done yesterday, and it wasn't nearly as bad as I expected. I was in pain for a few hours after the anesthesia wore off, but felt fine this morning.