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Medical Forum / General / Dentistry / July 2005Dental Advice
I just found out from my Oral Surgeon (needed to get my wisdom teeth out - whole other story) that I probably need a couple of root canals done. My question is he mentioned seeing an endodontist. I understand they are "specialists" in root canals, but I thought "regular" (not to downplay the professional achievents of DMD/DDS's) dentists did root canals all the time. As a matter of fact, my only other root canal was done by a general dentist and it went wonderfully - no pain, good job. Is there a reason to see an endodontist over a general dentist? Is a specialist for a root canal really recommended? Thanks. >I just found out from my Oral Surgeon (needed to get my wisdom teeth >out - whole other story) that I probably need a couple of root canals [quoted text clipped - 7 lines] > >Is there a reason to see an endodontist over a general dentist? Depends on the difficulty of the case and the ability of the general. >Is a >specialist for a root canal really recommended? Sometimes yes, sometimes no. >Thanks. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I agree with George and would say that you should run it past your GP first. Especially to make sure the tooth is strategic and solid enough to warrant spending the time on RCT.  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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 just found out from my Oral Surgeon (needed to get my wisdom teeth [quoted text clipped - 23 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com I kind of wish I'd never heard of an endodontist now :) My fear is that my dentist will just tell me what he wants to keep the fee in his office. Perhaps that's unfair, but I've become quite jaded from nearly every other profession. Mechanics, AC repairman, lawyers, etc. I was hoping to get more information so I could question my dentist one way or the other. I guess I'd better hope for an honest dentist (just moved so I haven't picked one out yet). Thanks. >I kind of wish I'd never heard of an endodontist now :) > [quoted text clipped - 8 lines] > >Thanks. Then just go to an endodontist and be done with it. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com < snip > > Then just go to an endodontist and be done with it. > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Not exactly the solution I'm looking for. My original problem was I'm not sure why one would use an endodontist over a general dentist. Just telling me to see a specialist is all fine and dandy, but is no help at all (which is about as helpful as your first reply - seriously was that meant to help?). My point is, what is the justification for such? Why one over the other. I was looking for unbiased, EDUCATED, and justifiable reasons. > < snip > >> [quoted text clipped - 10 lines] > all (which is about as helpful as your first reply - seriously was that > meant to help?). I think it was meant to inform. There is a reason that endodontics is one of the recognized specialties in dentistry. The level of skill that a general practitioner has with respect to specialty procedures varies immensely. That said WB gave you good information. It's impossible to tell you to pick Door #3 from here, we can't see your mouth. carabelli I know it sounds like I'm complaining about someone who is trying to help but I got the impression that he/she was just trying to be a pain in the @rse. I basically asked for some reasons to buy a chevy or a honda. He told me to buy a chevy or honda. I reiterated my concerns and he told me to just buy a honda. I apologize if he really was trying to help, but it sure didn't sound like it. BTW, I'm not asking what I <b>should</b> do... I'm asking why one sees an endodontist over a gp when the gp is cheaper and does root canals as well. Do endo's have a higher success rate? Should it scare me to have a gp do a root canal? Less complications with endo's? It's not like MD's... where you can't have a gp do orthoscopic surgery, etc. >I know it sounds like I'm complaining about someone who is trying to >help but I got the impression that he/she was just trying to be a pain [quoted text clipped - 12 lines] >It's not like MD's... where you can't have a gp do orthoscopic surgery, >etc. That is a poor analogy. Consider that your 30 year old car has a flat tire, so you went to the tire shop. while you were there, the tire balancer tells you your car is burning oil and needs a valve job. Now do you go straight to the machine shop and have them skim the head, replace the valve seats, line bore the can bearing surface, grind in new vales, etc. Or, do you take the car to a general mechanic first to check engine compression, oil pressure, transmission wear, etc. The drive train may not be with investing the money in. .. Stephen Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Actually, your's too is a poor analogy. The tire balancer would have to also be trained in general automotive mechanics. Also, your analogy is questioning what WORK should be done to bring about a desired solution. That's not the question. I know what WORK has to be done, just not WHO should do the work. More accurately, the tire balancer would've said something like "hey, your break pads are shot. I can clearly see this. You need new break pads." Now the problem is, do I take it to the corner garage that does ALL types of automotive repairs on ALL makes and models, or do I take it to a place that advertises a specialty in doing break pads on Honda Accords? Why? If I can pay 30% less at the do-it-all shop, why not do that? Do break pads fail more often after being repaired there then the specialty shop? I'm guessing that I'm starting to piss people off here, but I'm not sure why that is happening. I asked a simple question, and the reply I got was terse and basically said nothing. Now it is difficult to determine intent from a newsgroup posting - so I can be wrong and maybe just misunderstood what was being stated. For now, I stick with my original assessment that I asked why you'd do one thing over another - and the response was sometimes you do it this way, sometimes another way. Hmm. You are missing my point entirely. You can have the RCT done anywhere with equal risk of getting good or poor treatment. Some offices choose not to do RCT at all, so we need lots of specialists to handle their cases. Some RCT is especially difficult and we need specialist help there, too. However, you need to know that the teeth are worth saving and are of strategic value prior to getting the RCT done. Your OMFS probably noted some dark areas under the root tips of teeth and did the right thing by steering you into getting care. You seem to be focusing (I could be wrong since NG postings are a terrible way to communicate with strangers), on cost rather than should you do it at all. You will need a GP to restore the teeth after the RCT. Go see the GP first, determine if doing the RCT is in your best interest, THEN decide who will be doing the treatment. An Ednodontist (RCT specialist) is NOT going to restore the tooth when he is done. He is going to seal the tooth with temporary cement and send you back to your GP. The tire balancer sees smoke coming out of the exhaust and tells you to get a valve job. But, he has only done one actual valve job in his life helping his uncle in the back yard ten years ago. The OMFS sees dark areas under the root tips of adjacent teeth, so sends you off to get RCT, but he has only done 5-6 RCT in his life, all in dental school, and hated every one. No one is angry with you. Just trying to steer you into the best possible care. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > Actually, your's too is a poor analogy. > [quoted text clipped - 19 lines] > and the response was sometimes you do it this way, sometimes another > way. Hmm. Now that is all excellent information - thank you. But for clarification, I KNOW I have to get the RCT (I assume that stands for root canal therapy) done. I am focusing on WHERE to get it done. The information you gave is greatly appreciated. <snip> > I'm guessing that I'm starting to piss people off here, but I'm not > sure why that is happening. I asked a simple question, and the reply I [quoted text clipped - 4 lines] > and the response was sometimes you do it this way, sometimes another > way. Hmm. I read this thread for my own amusement. Pretty typical. This group does make one question the intelligence of the modern dentist doesn't it? -- Cliff > <snip> > > [quoted text clipped - 13 lines] > -- > Cliff Then why didn't you add something productive? T > > <snip> > > > [quoted text clipped - 17 lines] > > T Take a look at some of his postings in other groups and you'll have your answer http://tinyurl.com/b5sww carabelli > > Then why didn't you add something productive? > > [quoted text clipped - 5 lines] > > carabelli Yikes! Kind of makes you wonder what kind of hollow person has so little to do that they resort to such crap. T Another Cliff fan wrote: > Take a look at some of his postings in other groups and you'll have your > answer > http://tinyurl.com/b5sww Which is? I stand behind everything I write here. I speak my mind, and when I see things wrong, I spout about it. It would be nice if others has as much spine. -- Cliff <clifffreeling@yahoo.com> wrote ........... It would be nice if others has as much spine. > -- > Cliff We do, the difference is we have a brain attached to it. carabelli >Another Cliff fan wrote: >> Take a look at some of his postings in other groups and you'll have your [quoted text clipped - 4 lines] >I speak my mind, and when I see things wrong, I spout >about it. It would be nice if others has as much spine. Cliff, you have about as much spine as a jelly fish. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >Another Cliff fan wrote: > >> Take a look at some of his postings in other groups and you'll have your [quoted text clipped - 7 lines] > Cliff, you have about as much spine as a jelly fish. > -- Yes, it takes a great deal of spine to mouth off when no one knows who or where you are. T Well I have to say after some confusion, and a side tangent or two - I got A LOT of great information. I think I'll find a dentist on some recommendations, and trust that he/she is a strong believer in professional ethics (which I'm sure the vast majority are). You actually brought something up that concerns me though. So an endodontist performed RCT on a tooth that should have been extracted? Good gravy, what a mess. Does that mean the tooth will probably continue to give problems even after it's crowned? > Well I have to say after some confusion, and a side tangent or two - I > got A LOT of great information. I think I'll find a dentist on some [quoted text clipped - 5 lines] > Good gravy, what a mess. Does that mean the tooth will probably > continue to give problems even after it's crowned? Well, I guess like all else, things are open to opinion...but in the cases I refer to the saving of the teeth seemed to be care that I felt was more heroic than prudent. In general, I like to save teeth when possible, but sometimes when a tooth is so badly broken down that a restoration will be short lived, it seems better to move on. I have had cases where an endodontist "saved" a tooth, but left me with a headache...a tooth that was going to be real hard to restore, and would likely require more care in short order. When the crown I was forced to make failed, and the tooth needs removal in 2 or three years, I am the one who will take the heat and have to answer why the tooth that the patient spend $1500+ on "saving" now needs to be removed. This is why I say it is good to have the quarterback involved in making the play. The dentist will ultimately restore the tooth, and should be allowed to judge whether he/she feels a good restoration can be made. An endodontist is usually more experienced at root canal therapy, but probably hasn't restored a tooth in years. T Most endodontists have not restored a single tooth since dental school. And they did not like doing it then or they would not have specialized in a field where they would never have to do another one. The endodontist knows he can save the roots with RCT. However, he seldom knows how the GP is going to ultimately restore the tooth. That is not his job. Same thing with the OMFS. They do not restore teeth either. You need a GP or a prosthodontist to plan the final treatment. Patients are not happy to spend $1200 on a molar RCT, only to be told by the GP that the tooth needs to be extracted right away. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > >> Well I have to say after some confusion, and a side tangent or two - I [quoted text clipped - 33 lines] > > T >Patients are not >happy to spend $1200 on a molar RCT, only to be told by the GP that the >tooth needs to be extracted right away. Wtf... $1200? Is that what it costs now lol?! Granted I've only had one done in my life and it was 10 years ago, but it was only like $300 for a molar (w/out insurance)! Anyway, I do appreciate the advice - I've made an appointment with a gp and will go with their suggestion. > >Patients are not > >happy to spend $1200 on a molar RCT, only to be told by the GP that the [quoted text clipped - 6 lines] > Anyway, I do appreciate the advice - I've made an appointment with a gp > and will go with their suggestion. The price varies according to location, but $1200 is not out of line! You got a bargain at $300...even 10 years ago. Glad to hear your care is proceding the way you report. Let us know what happens. T >>Patients are not >>happy to spend $1200 on a molar RCT, only to be told by the GP that the [quoted text clipped - 6 lines] >Anyway, I do appreciate the advice - I've made an appointment with a gp >and will go with their suggestion. The average fee in my area is $700 - 900. Differences in fees are largely due to geographic location. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > "W_B" <no_one@nowhere.net> wrote in message > > [quoted text clipped - 3 lines] > Yes, it takes a great deal of spine to mouth off when no one knows who or > where you are. Strong words from two who hide behind phony names. Anyone could find me with a little effort. I stand behind my words. Do you? I see supposedly practicing dentists who spend workdays posting to a newsgroup... -- Cliff > Strong words from two who hide behind phony names. Anyone could find > me with a little effort. Have fun dealing with all the stalkers, kooks, hackers, spammers and other assorted a.sholes whose idea of "fun" is to harass people offline. > I see supposedly practicing dentists who spend workdays posting > to a newsgroup... So why aren't YOU working? a) You're unemployed. b) You're technically "at work" but you're f.cking around on the 'net. c) Your job is to troll sci.med.dentistry. d) You're retired or crippled and you can't think of any better way to pass the time than by f.cking around on the 'net. e) You're just a useless housewife/househusband. Answer (default is "a"): > So why aren't YOU working? > [quoted text clipped - 4 lines] > pass the time than by f.cking around on the 'net. > e) You're just a useless housewife/househusband. Okay, I'll admit it. I'm a retired and unemployed cripple who weighs 837 lbs. (allowing 7 lbs. for clothes) before breakfast. I draw a huge disability check every month that keeps me in chips and dip, ice cream, steaks, cookies, and lots of Koolaid; and I forgot macaroni and cheese, my favorite. And I guess some would consider me a useless houseobject. On top of everything else, I think my kids are trying to bump me off secretly, while scheming to collect my checks after they poison my Koolaid with antifreeze. I think the only reason it hasn't happened yet is that they're still contemplating how to deal with body disposal. But do you use words like "f.cking" with patients you lose patience with? Is that why you're here now instead of filling teeth? -- Cliff > Okay, I'll admit it. I'm a retired and unemployed cripple who > weighs 837 lbs. (allowing 7 lbs. for clothes) before breakfast. [quoted text clipped - 7 lines] > the only reason it hasn't happened yet is that they're still > contemplating how to deal with body disposal. Share your issues with someone who cares, kook. Nobody in SMD wants to hear about them. > Share your issues with someone who cares, kook. Nobody in SMD wants to > hear about them. But you snipped my question to you...didn't answer it either. -- Cliff > > Strong words from two who hide behind phony names. Anyone could find > > me with a little effort. [quoted text clipped - 8 lines] > > a) You're unemployed.............. I think he's procrastinating his summer reading assignments until the week before Middle School is back in session. carabelli >> "W_B" <no_one@nowhere.net> wrote in message >> > [quoted text clipped - 8 lines] >I see supposedly practicing dentists who spend workdays posting >to a newsgroup... Unlike you most of us can touch-type, and can speed read. So it only takes about a minute between patients. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Unlike you most of us can touch-type, and can speed read. > So it only takes about a minute between patients. I wish I were as sharp as you W_B. -- Cliff >> Unlike you most of us can touch-type, and can speed read. >> So it only takes about a minute between patients. > >I wish I were as sharp as you W_B. Keep wishing, it'll never happen. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I'm guessing that I'm starting to piss people off here, but I'm not > sure why that is happening. I asked a simple question, and the reply I [quoted text clipped - 4 lines] > and the response was sometimes you do it this way, sometimes another > way. Hmm. Maybe it is because you got several answers already, but keep asking the same question. Medical advice from someone you have never seen is always a guessing game. Your tooth may have a root system that looks quite complex, your oral surgeon may be related to the endodontist, your oral surgeon may know your GP does poor endo, the endodontist's office may be next door and the recommendation was one of convenience. The bottom line is no one knows what the right answer is for your situation. You seem to have trust issues with your GP, fearing he may be putting $$ over sound treatment recommendations, so I think your first course of action is to find a new DDS. If you don't trust those who will actually be caring for you, then you will have doubts no matter what you do. T >Maybe it is because you got several answers already, but keep asking the >same question. LOL, actually... no I didn't. That was my complaint. My question was, WHY use one over the other. NOT SPECIFIC ADVICE FOR ME. I know that is impossible over the internet. Please point out the answers you refer to, and I'll gladly admin my wrong. I asked WHY use a specialist, and the answers I got were "sometimes you use one, sometimes another", and "I can't tell YOU what to do w/out examining you (paraphrase)", etc. Please re-read my original question, then point out where the answers are located. Thanks > >Maybe it is because you got several answers already, but keep asking the > >same question. [quoted text clipped - 12 lines] > > Thanks Perhaps because I know there is no general answer to your question, I saw the answers, but understand where you may not. Sorry. The answer varies from office to office. Some may use a specialist because they hate doing root canal treatment. Some because they are lousy at it. Others may only send difficult cases to a specialist...by difficult I mean ones where the appearance of the tooth suggests the treatment will be technically difficult. Still others may elect to send patients who whine a lot or seem to have a litigious mind set out for more complex care. Sadly, we all practice defensively these days. There is truth to your comment that some offices don't refer out because they want to keep the money in their office. If the dentist is great at endo, then no big deal...if, however, greed out votes good judgment, they deserve a swift kick in the a.s...with a steel toed boot! My personal answer is that I send a patient to a specialist when I don't have time in my schedule to treat them myself or if it is a case that may be difficult and better handled by someone who does this exclusively. As for your oral surgeon recommending you see a specialist...this is something I don't like. Assuming you have a regular dentist you like, he/she should be the quarterback. I have had several occasions over the years where I was kept out of the loop, and then had a patient return to me for the "final restoration" of a tooth where root canal was completed at significant cost, and it was a tooth that probably would have been better off extracting. As a GP I don't like to be put into that situation and would rather have the chance to look at things before care proceeds. As I said before, if you don't trust that your dentists motives are in your best interest...and it sounds like this is the case...maybe a second opinion would be prudent. T >I know it sounds like I'm complaining about someone who is trying to >help but I got the impression that he/she was just trying to be a pain >in the @rse. Nope, just short, sweet, and to the point. >I basically asked for some reasons to buy a chevy or a honda. He told >me to buy a chevy or honda. I reiterated my concerns and he told me to >just buy a honda. I apologize if he really was trying to help, but it >sure didn't sound like it. I would tell you to buy a Toyota. >BTW, I'm not asking what I <b>should</b> do... I'm asking why one sees >an endodontist over a gp when the gp is cheaper and does root canals as >well. Unfortunately you don't know that. Endodontic treatment quality varies widely among GPs. The same could be said about endodontists but the endodontist only does RCTs and is likely more skillful. >Do endo's have a higher success rate? Probably. >Should it scare me to have >a gp do a root canal? Depends on the specific GP. >Less complications with endo's? Not neccesarily. >It's not like MD's... where you can't have a gp do orthoscopic surgery, >etc. Sure you can, but would you rather go to a plastic surgeon for 'lipo' or a gp who took a weekend course ? It's your money, you get what you pay for; sometimes you get less... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >< snip > >> [quoted text clipped - 13 lines] >My point is, what is the justification for such? Why one over the >other. I was looking for unbiased, EDUCATED, and justifiable reasons. An endodontist has more training and expertise at treating root canals. IIRC you said that you didn't have a general pratitioner, you also said that the generalist "wants to keep the fee in his office" or something to that effect. If you want to be sure of the best possible outcome of RCT, go see an endodontist, it's better than shooting in the dark. All of my replies are meant to help, terse though they may be. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Not exactly the solution I'm looking for. My original problem was I'm > not sure why one would use an endodontist over a general dentist. Just > telling me to see a specialist is all fine and dandy, but is no help at > all (which is about as helpful as your first reply - seriously was that > meant to help?). One reason you might want to see and Endodontist: the OMFS suggested that you see an endodontist. If the teeth needing Endo were simple and easy to do, I think your OMFS would have suggested seeing your general dentist. Because he (she?) suggested an ENDO, I'd assume the teeth are difficult to do. However, you can always call your OMFS back and find out why s/he did suggest an Endo right away. You may even ask him/her whether the speciallist is really necessary. That said, I like DrS's idea of at least having the general dentist loook at the mouth and see if those teeth are good candidates for RCT HTH SP SignatureFinally: take out the TRASHH |
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