Root canal

[The_Unbeliever]

Had the option for a root canal or not. Pulled the whole tooth. Cheaper, no fuss, and quicker.

Lost two teeth this way. First one started its ouchie jigglydance (after a glass of grapefruit) when I was in Mozambique. Was lucky to hold out a few days without having any pain further. Pulled it ASAP when I returned to ZA. Tooth was rotten, beyond hope of salvage.

Second one (IIRC) started to pain on its own. Wasn't nice. Opted for having it pulled instead of a root canal as we could not afford that option.

Another tooth got chipped and I asked for a filling. Afterwards, when we compared prices, we found that it would've been cheaper to have that tooth pulled instead of filling the chip up....

 

[Hosehead]

Had the option for a root canal or not. Pulled the whole tooth. Cheaper, no fuss, and quicker.

Lost two teeth this way. First one started its ouchie jigglydance (after a glass of grapefruit) when I was in Mozambique. Was lucky to hold out a few days without having any pain further. Pulled it ASAP when I returned to ZA. Tooth was rotten, beyond hope of salvage.

Second one (IIRC) started to pain on its own. Wasn't nice. Opted for having it pulled instead of a root canal as we could not afford that option.

Another tooth got chipped and I asked for a filling. Afterwards, when we compared prices, we found that it would've been cheaper to have that tooth pulled instead of filling the chip up....

So now you're going to have each and every troublemaking tooth yanked until you become a catheter toting toothless wonder?

 

[The_Unbeliever]

So now you're going to have each and every troublemaking tooth yanked until you become a catheter toting toothless wonder?

Oops, didn't see that coming

 

[cguy]

I've done a lot of reading up on root canals and basically in laymans terms the dentist is simply emblaming your tooth when he performs a root canal. Unfortunately, as has been mentioned and I've read and heard a lot of SA dentists don't get all the pulp out as far as the root (my ex wife was one of these who had that experience twice.) and the filller material can be toxic in its own right
studies http://www.ncbi.nlm.nih.gov/pubmed/17931390 Also anerobic bacteria will thrive on left behind pulp and may cause further problems. When it comes to my time if I face a root canal I don't care if a dentist has the starship enterprise because he's missing one crucial thing that every dentist practically has in the US- Nitrous Oxide. I've yet to see a dental practice here with it - They all say its too dangerous. Yeah right. Whatever.( by the way those of you who never had the option of the experience of this awesome gas, don't knock it, It's the absolutely best part of dentistry) I had all my mercury fillings purged in the US a decade ago and if it hadn't been for Nitrous I would have never bothered.

I once had some teeth removed when I was a kid (prob. 33 years ago) in SA - I was given the gas - it was pretty awesome. It could have been because I was so young, but I just remember closing my eyes, then openning them, and it was finished. Quite brilliant. I've never had it since though.

...and then get an implant. No fuss. No bother, a different specialist for the implants. No more problems. What is the point of dressing up a dead tooth in its Sunday Best?

Are you kidding? Apart from the fact that implants are waaay more expensive: RC + filling in US at a good dentist is $1000, implants + crown is approx. $3000, I expect that the ratio is similar in SA. Not to mention that a RC is usually a once off process (most of mine are 10-20 years old), where an implant requires extraction, bone graft, implant insertion, abutment insertion, and then crown insertion, the first 4 all require anaesthetic and are waaay more traumatic than a RC, not to mention that they typically require month healing periods in between. Risks of implants include breaking your jaw, rejection, insufficient stability (they get pulled out during a pressure test, and the process has to be restarted with a wider screw - assuming there is sufficient bone mass) and perforating your sinus cavity.

Besides, I far prefer the idea of having a zombie tooth to a bionic tooth...

 

[HavocXphere]

Just to clarify a few matters in this thread:

A) When a dentist suggests a root canal then you should listen. They don't do so without cause. Essentially a RC means game over. The tooth is fcked & the best they can do is maintain the basic structure of the tooth minus the nerves & blood vessels. NB without the blood vessels the tooth can't rebuild itself & it'll go downhill from there (guaranteed - but slowly hopefully).

B) It is not a choice between implant & root canal as cguy seems to suggest. The dentist will only suggest an implant when there is really no other option. Generally they refer implants to another specialist, so its not a case of them scoring extra money. e.g. if the tooth is cracked then an implant might be the only option - no way of fixing that with a filing.

Cost wise (very broadly):
Root canal - 2k
Crown - 5k (excl root canal)
Implant - 14k
...Often root canal & crown will go together.

Pro tip...find a dentist you can trust & roll with what he/she says.

 

[cguy]

B) It is not a choice between implant & root canal as cguy seems to suggest. The dentist will only suggest an implant when there is really no other option. Generally they refer implants to another specialist, so its not a case of them scoring extra money. e.g. if the tooth is cracked then an implant might be the only option - no way of fixing that with a filing.

I'm not sure if you're saying that I was suggesting it's a choice, or suggesting that it's not a choice (a comma changes the sense of that sentence). I'm not reallying saying either though, since dentists will generally allow patients to make at least some less than optimal decisions based on cost constraints. To summarize what are choices and what is just common sense:

If the dentist suggests a root canal, get it. If you really can't afford it you can choose to get an extraction (although I would beg, borrow and steal before I chose this over a root canal).

If the dentist suggests a root canal, and you choose an extraction with the intent that you can get an implant instead, you should get your head fixed. A good dentist will likely fight you on this, but you could technically claim poverty, get the extraction and then get an implant for way higher cost than the root canal - there are no limits to willful stupidty.

If the dentist suggests an extraction, you likely need it. They will usually do this if there isn't enough tooth left to support a crown, or of the tooth is cracked and split. In the former case they may be willing to do another root canal (retreat - assuming that the issue is re-infection) and try do a build up, but the understanding will be that if it is reinfected, or the crown falls out, it's not his/her problem. In the latter case, it's not really a suggestion - you really need the extraction for continued health.

Implants will generally be recommended in tandem with an extraction - given that there is enough bone mass, this is usually the patient's judgement call, weighing up visibility of the tooth, functional importance of the tooth, pain and cost.

 

[Hosehead]

Just to clarify a few matters in this thread:

A) When a dentist suggests a root canal then you should listen. They don't do so without cause. Essentially a RC means game over. The tooth is fcked & the best they can do is maintain the basic structure of the tooth minus the nerves & blood vessels. NB without the blood vessels the tooth can't rebuild itself & it'll go downhill from there (guaranteed - but slowly hopefully)

Yep. He's the undertaker and he's Offering his condolences on the death of your tootsie and he's giving you a menu card with his prices . RC is embalming and his pricest option. You do want dear tootsie to stay in your gums, stone dead but upright.
Now he'll explain that after embalming your dear tootsie (which included disinfection by the way) you need to pick out a Coffin & Colour (a Crown and a shade for the crown he's gonna cement over your tooth) because in a matter of weeks dear tootsie is going to turn Blacker than the Blackest shoe Polish on the market and you don't want to be walking around with people gawking at you.

.

B) It is not a choice between implant & root canal as cguy seems to suggest. The dentist will only suggest an implant when there is really no other option. Generally they refer implants to another specialist, so its not a case of them scoring extra money. e.g. if the tooth is cracked then an implant might be the only option - no way of fixing that with a filing.

It's actually your choice on three outcomes. Nobody likes to see money walking out the door to another specialist. He can embalm and casket your dead tootsie and it'll still be stuck in your gum like a crooked tombstone, or he will offer extraction. You'll have to look real hard for that cheap option. Funeral directors keep pauper caskets out of sight. Same with extraction they prefer the RC and you don't want to go walking around with holes in your mouth do you? It's unlikely he will offer you an implant because these are done by specialists and he's not qualified,but if you insist know that there's immediate loading implants available so if your tootsie is having death rattles a bit of planning will have the oral surgeon extract and load the implant in the same visit if you meet certain criteria. Otherwise a 8-10 week wait is needed.
If you have a decent medical aid, the dental benefits are quite generous.
Personally I don't trust a single dentist in this town as they are all motivated by money IMHO

 

[The_Unbeliever]

Now he'll explain that after embalming your dear tootsie (which included disinfection by the way) you need to pick out a Coffin & Colour (a Crown and a shade for the crown he's gonna cement over your tooth) because in a matter of weeks dear tootsie is going to turn Blacker than the Blackest shoe Polish on the market and you don't want to be walking around with people gawking at you.

Cape Bergie?

 

[Swa]

I've done a lot of reading up on root canals and basically in laymans terms the dentist is simply emblaming your tooth when he performs a root canal. Unfortunately, as has been mentioned and I've read and heard a lot of SA dentists don't get all the pulp out as far as the root (my ex wife was one of these who had that experience twice.) and the filller material can be toxic in its own right
studies http://www.ncbi.nlm.nih.gov/pubmed/17931390 Also anerobic bacteria will thrive on left behind pulp and may cause further problems. When it comes to my time if I face a root canal I don't care if a dentist has the starship enterprise because he's missing one crucial thing that every dentist practically has in the US- Nitrous Oxide. I've yet to see a dental practice here with it - They all say its too dangerous. Yeah right. Whatever.( by the way those of you who never had the option of the experience of this awesome gas, don't knock it, It's the absolutely best part of dentistry) I had all my mercury fillings purged in the US a decade ago and if it hadn't been for Nitrous I would have never bothered. If I get told I need a root canal then I will politely ask for the tooth to be pulled and the abcess (if any) treated with antibiotics and then get an implant. No fuss. No bother, a different specialist for the implants. No more problems.
What is the point of dressing up a dead tooth in its Sunday Best?

We are really lacking in the surgery department. US does it in a separate room in the office. We are sent to the hospital for anything that doesn't require just local anaesthetic. Nitrous Oxide isn't a very good anaesthetic though and is mostly used together with other agents. Propofol is the new way to go but as it may inhibit breathing assistance is necessary which our doctors simply don't stock up on.

 

[Zenbaas]

We are really lacking in the surgery department. US does it in a separate room in the office. We are sent to the hospital for anything that doesn't require just local anaesthetic. Nitrous Oxide isn't a very good anaesthetic though and is mostly used together with other agents. Propofol is the new way to go but as it may inhibit breathing assistance is necessary which our doctors simply don't stock up on.

Care to translate that one for us Swa...?

 

[rubytox]

If the tooth is drilled open, the abscess treated and after a course of antibiotics, then why have a RC? The remaining pulp may be susceptible to further infection. Under what conditions may further infection occur? When one gets an infection or abscess in your foot, the doctor don't simply remove your foot, right?

My toothache started a week ago and although I still can't bite on the tooth, I don't have that constant throbbing pain and at least I can enjoy a cup of coffee. I'm not really keen on a RC, not after reading all of this. I'm also not keen on extraction - even though it's a molar in the back of my mouth and not really visible, I don't think that I would be able to chew biltong without it. It's like parting with a limb or having to wear a prostheses to get around, at least that's how I feel about it.

 

[Hosehead]

Except an immediate loading implant is just as strong as the original tooth if you ever have that molar yanked.
Usually the pain from an abcess will manifest first (you'll know it - you'll be bouncing off the walls) and this they treat with anti biotics -but it may not clear the abcess and the infection will return. You might be lucky and antibiotics may settle things down or it may be a cavity causing the discomfort and once cleaned and filled thats it. See your friendly neighbourhood dentist and go for second opinion if he recommends RC.

 

[Hosehead]

Care to translate that one for us Swa...?

The OP saying that in his opinion Nitros oxide is not a very good anasthetic despite every dentist in the US having it next to the chair for general dentstry. OP errs in assuming Nitrous oxide is USED as an anaesthetic- it is not , it just whacks the patient into lalal land while patient is wide awake and fully conscious and able to talk if required- it distracts the patient from the work going on and it;s a fun fun gas.It's used in such an oxygen/gas mixture to relieve anxiety. It' not unknown for dentists to actually get themselves addicted to the stuff. To discover the effect try inhaling a lungful of whipped cream which uses nitrous gas without letting the cream in your mouth. For anasethesia US dentists offer "twilight sleep" on the chair that's what we call conscious sedation and they bring you under with an IV drug usually liquid dormicum and a pain killer like pethidine or morphine to just above unconsciousness and local anasethetic is inlected into the gums at the surgery site. Nowadays they use Propofol. However that is the US and Oral surgeons are qualified (mostly) to administer anaesthesia in the office. In South Africa, the general dentists dont have nitrous oxide machines which are not anaesthesia inducing- they are anti anxiety and if you want light sedation./conscious sedation they call in an anaesthetist to inject the drugs and monitor vitals. It's an expensive option. The other option is to do the procedure in hospital with full anaesthesia which Propofol is used as drug of choice to KO you and then the Gas to keep you under -one of the Halogenated Ethers – Forane (isoflurane), Ethrane (Enflurane), Desflurane, Halothane, Sevorane. is piped through a face mask and you are intubated.

 

[Swa]

Care to translate that one for us Swa...?

I thought it was pretty straight forward. It's more difficult to breath so additional equipment is needed. This can be a non-invasive positive pressure ventilator instead of intubation but patients do still run the risk of stopping to breath so personnel must be trained to properly handle such cases. It's suspected this is what happened with Michael Jackson.

If the tooth is drilled open, the abscess treated and after a course of antibiotics, then why have a RC? The remaining pulp may be susceptible to further infection. Under what conditions may further infection occur? When one gets an infection or abscess in your foot, the doctor don't simply remove your foot, right?

My toothache started a week ago and although I still can't bite on the tooth, I don't have that constant throbbing pain and at least I can enjoy a cup of coffee. I'm not really keen on a RC, not after reading all of this. I'm also not keen on extraction - even though it's a molar in the back of my mouth and not really visible, I don't think that I would be able to chew biltong without it. It's like parting with a limb or having to wear a prostheses to get around, at least that's how I feel about it.

The remaining pulp may already be infected and antibiotics have a rather tough time getting there. If you want to keep the tooth for chewing biltong you might as well forget it. Imho neither fillings nor crowns are strong enough for main pressure points. I had four of my front teeth replaced and one bent on a lunchbar while the other one I discovered loose in my mouth.

@Hosehead: Mistook your comment for the reply by cguy. Guess it was more than N2O he had then.

 

[Ancalagon]

I need some advice on this subject.

Two weeks ago, I went to the dentist because I had a dull ache in a molar. The dentist said it was a very deep cavity, nearly reaching the pulp of the tooth, and that it was infected or something. I dont think there was an abcess or anything. She drilled the cavity out, and gave me a temporary filling with some medicine added to calm the nerve of the tooth, and put me onto two courses of antibiotics, to take care of the infection. The next week Monday, I went back to her, and she said that she can give me another temporary filling, and we wait 6 weeks, or she gives me a permanent filling and we hope for the best. She said that there is no guarantee that I wont need a root canal, which is why she would recommend the temporary filling - because I could waste the money spent on a permanent filling.

So I opted for a permanent filling, hoping that I would not need a root canal. For the next 2 or 3 days, it hurt like hell, with the palate on that side of my mouth being very sensitive to cold. Now, the palate is no longer sensitive, but the tooth still is. I dont think I feel a dull ache really, its just that I rinsed with Listerine and it was quite sensitive. Pain level maybe 2 out of 10.

Will it get better over the next few weeks, or will I still need a root canal? I really, really dont want a root canal.

 

[rubytox]

I need some advice on this subject.

Two weeks ago, I went to the dentist because I had a dull ache in a molar. The dentist said it was a very deep cavity, nearly reaching the pulp of the tooth, and that it was infected or something. I dont think there was an abcess or anything. She drilled the cavity out, and gave me a temporary filling with some medicine added to calm the nerve of the tooth, and put me onto two courses of antibiotics, to take care of the infection. The next week Monday, I went back to her, and she said that she can give me another temporary filling, and we wait 6 weeks, or she gives me a permanent filling and we hope for the best. She said that there is no guarantee that I wont need a root canal, which is why she would recommend the temporary filling - because I could waste the money spent on a permanent filling.

So I opted for a permanent filling, hoping that I would not need a root canal. For the next 2 or 3 days, it hurt like hell, with the palate on that side of my mouth being very sensitive to cold. Now, the palate is no longer sensitive, but the tooth still is. I dont think I feel a dull ache really, its just that I rinsed with Listerine and it was quite sensitive. Pain level maybe 2 out of 10.

Will it get better over the next few weeks, or will I still need a root canal? I really, really dont want a root canal.

Wish I could give offer you some positive words. If you did have an abscess, you would have smelled and tasted it when the tooth was opened up. It smells and tastes very off.

I still can't chew anything on that side of my mouth (temporary filling was done last Wednesday). I'm not going back to the dentist until there is no pain or until I'm sure that the tooth is beyond rescue.

Considering how the temporary filling hurts, I'm thinking it would be normal for the permanent filling to hurt for a while. If the pain is intolerable, it may be time to reconsider your options?

 

[Ancalagon]

Its not intolerable - in fact, most of the time, there is no pain. Its just that it is still sensitive to cold, and I didnt think it would be.

I can chew normally on that side of my mouth.

There was no pain with the temporary filling, only temporary pain with the permanent filling with lasted a few days, and now no pain unless I rinse with something cold (and that isnt even that bad).

Flip, I'm starting to think I got lucky on this one!

 

[Zenbaas]

Its not intolerable - in fact, most of the time, there is no pain. Its just that it is still sensitive to cold, and I didnt think it would be.

I can chew normally on that side of my mouth.

There was no pain with the temporary filling, only temporary pain with the permanent filling with lasted a few days, and now no pain unless I rinse with something cold (and that isnt even that bad).

Flip, I'm starting to think I got lucky on this one!

Try some desensitising toothpaste like Sensodyne rapid action or Colgate sensitive pro relief and rub it into the tooth for about a minute with your finger where you feel the sensitivity and see if it helps.

 

[rubytox]

Try some desensitising toothpaste like Sensodyne rapid action or Colgate sensitive pro relief and rub it into the tooth for about a minute with your finger where you feel the sensitivity and see if it helps.

I use Sensodyne ... it's a bit more expensive than other toothpaste but really worth the money. Colgate is good but even more expensive than Sensodyne and also works well.

 

[Ancalagon]

I've been using sensodyne repair and protect every day for the past year or so. But yeah, I might rub it directly on.

I only bought the listerine today - I'm thinking I need to take better care of my teeth.