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Medical Forum / General / Dentistry / March 2005Root Canal for Dead Nerve?
I recently chipped about 1/4-1/3 of one of my top front teeth. (It had a small filling that must have cracked off, taking a bunch of tooth with it). Didn't hurt a bit. My dentist put in a filling, which lasted almost 24 hours ($13 an hour). While drilling out the tooth for the filling, it still didn't hurt a bit, so she suspects that the nerve is dead, although she says she'll need an X-ray and a "vitality test" to know for sure. I assume that since the first filling was kaput in less than a day, I should go for the crown. She's also recommending that, if the nerve is dead, I get a root canal before the crown so that the remnants of the root don't become infected. Two questions, before I tack another $1200 for root canal and post onto the $1300 for a crown. 1. This tooth has never given me a bit of pain in the 40 years that it's been a resident of my mouth. Is it common for a root to die without any pain? 2. On a scale of 1-5, how demonstrably useful would it be to do a root canal on a dead nerve that has not caused pain, gums are healthy, etc. 1=Don't bother, no evidence that it's useful 5=There's studies that show this is important, go do it Thanks in Advance! Richard >I recently chipped about 1/4-1/3 of one of my top front teeth. (It had a >small filling that must have cracked off, taking a bunch of tooth with it). [quoted text clipped - 13 lines] > Two questions, before I tack another $1200 for root canal and post onto > the $1300 for a crown. WOW! $1300 for a crown! WOW! > 1. This tooth has never given me a bit of pain in the 40 years that it's > been a resident of my mouth. Is it common for a root to die without any > pain? Yes. > 2. On a scale of 1-5, how demonstrably useful would it be to do a root > canal on a dead nerve that has not caused pain, gums are healthy, etc. > 1=Don't bother, no evidence that it's useful > 5=There's studies that show this is important, go do it 5 >>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had a >>small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 16 lines] > > WOW! $1300 for a crown! WOW! That might include the core, a radiograph, a pulp test, etc. >>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had a >>>small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 18 lines] > >That might include the core, a radiograph, a pulp test, etc. ...and a trip to Jamaica for the doc ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>>>a [quoted text clipped - 24 lines] >> > ...and a trip to Jamaica for the doc ? With the assistant? >>>>> Two questions, before I tack another $1200 for root canal and post onto >>>>> the $1300 for a crown. [quoted text clipped - 6 lines] > >With the assistant? Whatever rocks your boat. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>>> Two questions, before I tack another $1200 for root canal and post >>>>>> onto [quoted text clipped - 9 lines] > > Whatever rocks your boat. :-) >>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had a >>>small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 18 lines] > > That might include the core, a radiograph, a pulp test, etc. Maybe. But he said the $1200 for the root canal included the post. >>>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>>>a small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 20 lines] > > Maybe. But he said the $1200 for the root canal included the post. My point being that we really don't know what the actual itemization of the bill is, nor do we know what area the office is in (or did I miss that?). The patient may be lumping more than one procedure together in his/her mind (unintentionally). >>>>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>>>>a small filling that must have cracked off, taking a bunch of tooth [quoted text clipped - 25 lines] > that?). The patient may be lumping more than one procedure together in > his/her mind (unintentionally). Richard, What are the dental codes for the procedures you've been told you need? I don't have the codes, but I do have an itemized cost estimate. $1300 for just the crown - the other items mentioned are all extra - the entire thing is more than $2500. Big, big bucks. I called a few other dentists in the area, and they wanted $1000-$1200. I'm a little west of Boston, where everything's too expensive - which is possibly why, last year, Massachusetts was the only state to see a decline in population. Any recommendations for another dentist whose fees are reasonable and whose bonding skills are superior would be welcomed. Richard >>>>>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>>>>>a small filling that must have cracked off, taking a bunch of tooth [quoted text clipped - 28 lines] > Richard, > What are the dental codes for the procedures you've been told you need? >I don't have the codes, but I do have an itemized cost estimate. $1300 > for just the crown - the other items mentioned are all extra - the [quoted text clipped - 4 lines] > is possibly why, last year, Massachusetts was the only state to see a > decline in population. I see a lot of patients from MA, and they don't even blink when I tell them that a crown is $825, and a buildup is an additional $155. Now I know why. I just did a 7-unit bridge for a guy from Massachusetts. He would fly down for each visit, so I figured that he must really like my work. I guess the truth is that he was actually just trying to save some money. ;-) Some folks go south of the border for discounted dentistry. Folks from Massachusetts go south of the Mason-Dixon line. Richard, Take the ADA procedure codes you were given in your cost estimate and call a half dozen local offices and ask what their fees are for the same procedure code. Tell them you are not asking for a quote on your work, but that you need to verify fees. You should fine a few offices friendly enough to cooperate. At least you will know if the fees are average for your area. I can only speak for average fees in this area North of Detroit. Make sure you ask by ADA CDT-2005 procedure code so you are actually comparing the same procedure.  Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >I don't have the codes, but I do have an itemized cost estimate. $1300 > for just the crown - the other items mentioned are all extra - the [quoted text clipped - 42 lines] >> Richard, >> What are the dental codes for the procedures you've been told you need? > I don't have the codes, but I do have an itemized cost estimate. $1300 > for just the crown - the other items mentioned are all extra - the > entire thing is more than $2500. Big, big bucks. I would be inclined to consider an implant instead of a root canal. >I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >a small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 6 lines] >bit, so she suspects that the nerve is dead, although she says she'll >need an X-ray and a "vitality test" to know for sure. Well that's another dentist who is not conversant with bonding techniques! Joel >I assume that since the first filling was kaput in less than a day, I >should go for the crown. She's also recommending that, if the nerve is [quoted text clipped - 16 lines] > >Richard >>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>a small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 9 lines] > Well that's another dentist who is not conversant with bonding > techniques! Why are so many dentists having trouble with bonding? Poor technique? Poor choice in bonding agents? Based on your comments about bonding, am I to infer that, if done properly, I could reasonably expect a filling to hold in this tooth? Thanks again, Richard >>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>>a small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 12 lines] > Why are so many dentists having trouble with bonding? Poor technique? Poor > choice in bonding agents? > Based on your comments about bonding, am I to infer that, if done > properly, I could reasonably expect a filling to hold in this tooth? > > Thanks again, Usually. Depends on your bite. Are your lower teeth very crooked? Do you have an overbite? Underbite? In other words, we can't tell on the computer. >Based on your comments about bonding, am I to infer that, if done >properly, I could reasonably expect a filling to hold in this tooth? > >Thanks again, > >Richard ABSOLUTELY! The sliver fill-ins are the tough ones. If there is room for a nice bevel, it can work. The bevel exposes more ENAMEL. The bonding adhere to enamel and adheres to dentin much less effectively. The bevel INCREASES surface area for adhesion. >>>>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>>>a small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 12 lines] >> Why are so many dentists having trouble with bonding? Poor technique? Poor >> choice in bonding agents? >Based on your comments about bonding, am I to infer that, if done >properly, I could reasonably expect a filling to hold in this tooth? > >Thanks again, Etch first ....... A little scrubbing action with Gluma w/Hema ....... a couple of little tips and tricks ....... here and there. Isolation? Rubber dam is best ...... la-di-dah ....... it goes on and on. You know, dentists need to watch one another do this. Just reading about it does not help. >Richard > [quoted text clipped - 14 lines] >> Why are so many dentists having trouble with bonding? Poor technique? Poor >> choice in bonding agents? >>Based on your comments about bonding, am I to infer that, if done >>properly, I could reasonably expect a filling to hold in this tooth? [quoted text clipped - 4 lines] > > A little scrubbing action with Gluma w/Hema Gluma isn't necessary with the self-etching primer/bonding agents. In fact, I never had sensitivity with any of the ethanol based agents. The acetone-based ones (Prime and Bond NT, etc) are a whole 'nuther story. Very technique sensitive! (ie--How wet is "wet" in the wet-bonding technique?) >>>Based on your comments about bonding, am I to infer that, if done >>>properly, I could reasonably expect a filling to hold in this tooth? [quoted text clipped - 9 lines] >acetone-based ones (Prime and Bond NT, etc) are a whole 'nuther story. Very >technique sensitive! (ie--How wet is "wet" in the wet-bonding technique?) In a class, I handed out a chart listing about 50 adhesives, and the relative MPas for each of them. The scrubbing action helps remove the demineralized material within the tubules ....... Basically, in many offices the dental assistant does the ordering, and she orders the system that includes the four free movie tickets (which she absconds with anyhoo). No wonder there are problems! Joel Without a picture or x-ray, we would just be guessing. >Based on your comments about bonding, am I to infer that, if done >properly, I could reasonably expect a filling to hold in this tooth? [quoted text clipped - 19 lines] >> Why are so many dentists having trouble with bonding? Poor technique? Poor >> choice in bonding agents? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Without a picture or x-ray, we would just be guessing. REPLY Even WITH, we are often guessing! Joel >>Based on your comments about bonding, am I to infer that, if done >>properly, I could reasonably expect a filling to hold in this tooth? [quoted text clipped - 19 lines] >>> Why are so many dentists having trouble with bonding? Poor technique? Poor >>> choice in bonding agents? > Based on your comments about bonding, am I to infer that, if done > properly, I could reasonably expect a filling to hold in this tooth? > > Thanks again, > > Richard STOP ! ! ! ! S - T - O - P !!!!!!!!!!!!! There is no way to tell from here if it was done right or not. We have no specifics at all. >> Well that's another dentist who is not conversant with bonding >> techniques! > >Why are so many dentists having trouble with bonding? Poor technique? Poor >choice in bonding agents? BOTH! >>I recently chipped about 1/4-1/3 of one of my top front teeth. (It had >>a small filling that must have cracked off, taking a bunch of tooth with [quoted text clipped - 11 lines] > > Joel It sounds to me like a cusp broke off and they tried to bond some plastic to the busted pieces and the old amalgam. >2. On a scale of 1-5, how demonstrably useful would it be to do a root >canal on a dead nerve that has not caused pain, gums are healthy, etc. > 1=Don't bother, no evidence that it's useful > 5=There's studies that show this is important, go do it > >Thanks in Advance! 5. Without the root canal therapy, it can suddenly swell or begi nto hurt big time! Joel |
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