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Medical Forum / General / Dentistry / September 200510 yr old - Root Canal or Pulpotomy???
We have been told that our 10yr old daughter needs a root canal. We made an appointment with an endodontist to have this done. He gave her one shot to numb her tooth and then claimed he could not do the procedure and we should see a pediatric dentist. I called our dental savings plan and they searched for a pediatric dentist as far as 50 miles away from our home and nothing. They said I could try and find a dentist to do the procedure or another enodontist or they recommended that I look into a therapeutic pulpotomy. I have read what a pulpotomy is all about, but how do you know which treatment to use? Will a dentist do a pulpotomy or a root canal on a child? Are there other treatments to be done after/later a pulpotomy? I simply can't afford the $800 price tag to go to a pediatric dentist not in my program for a root canal. What is the cost of a pulpotomy? This will be her first visit to a dentist that wasn't a routine cleaning or check up. She has had no cavities or fillings until now and not only will she need this treatment, but she will also need two cavities filled. Can you please just try and give me some information I can work with to make the right decision? I should also tell you that the tooth is her upper left side rear molar. >We have been told that our 10yr old daughter needs a root canal. We made an >appointment with an endodontist to have this done. He gave her one shot to [quoted text clipped - 14 lines] >Can you please just try and give me some information I can work with to make >the right decision? > I should also tell you that the tooth is her upper left side rear molar. Then I, for one, don't see why the Endo could not do the proceedure. He might have to do some apexification (root closure), but again: if this rear molar is her permanent tooth, I think the Endo should be able to handle this. I hope you get some more opinions on this. Did the Endodontist say _why_ he couldn't finish the root canal therapy? Is it just possible that your insurance policy doesn't pay very well for root canals? Maybe that's why he backed out. SP  SignatureTake out the TRASH to reply >Is it just possible that your insurance policy doesn't pay very well for >root canals? Maybe that's why he backed out. HMO crap . You may not be able to find anyone to do the procedure for HMO fees. Especially if the kid does not have perfect behavior. Amatus >> I should also tell you that the tooth is her upper left side rear molar. > [quoted text clipped - 11 lines] > >SP .. Amatus . >>Is it just possible that your insurance policy doesn't pay very well for >>root canals? Maybe that's why he backed out. [quoted text clipped - 17 lines] > > . I would say for a 10 yr old she did have perfect behavior. If the endo had just stuck with it, it would have been fine. But he left her there to get scared. > >>Is it just possible that your insurance policy doesn't pay very well for > >>root canals? Maybe that's why he backed out. [quoted text clipped - 20 lines] > just stuck with it, it would have been fine. But he left her there to get > scared. There ya go.... go up to the dental school and find an Endo there to do it. S/he'll be able to afford to spend more time and it will be well done. Hope you are able to get it done. Would be a shame to have to extract it, but the worst is to just leave it in there for long periods of time with no treatment. SP SignatureTake out the TRASH to reply >> I should also tell you that the tooth is her upper left side rear molar. > [quoted text clipped - 11 lines] > >SP He did not say why....After the first shot she teared up (who wouldn't) He said then that he didn't think he could do it. He just walked out. We had to get the nurse to go see what he was going to to. That whole time she was sitting there getting more and more nervous. When he finally came back he started to give her another shot and she started crying again. He just put his stuff down and said he wouldn't do it. I don't have any HMO it is more of a discount program. The total I was going to pay was $400. Not to darn shabby if you ask me. > He did not say why....After the first shot she teared up (who wouldn't) He > said then that he didn't think he could do it. He just walked out. We had to [quoted text clipped - 4 lines] > I don't have any HMO it is more of a discount program. The total I was going > to pay was $400. Not to darn shabby if you ask me. Firstly, the... 'individual' should have been up front with you that your 400$ is really not a sufficient sum to do this procedure, especially if it takes more than one visit. Hell, I'm in Kanada, and even here, where destistry is cheaper, that is not enough. He was probably trying to figure if he could do it in one sitting. He hasn't had too many kids and is was not confident. Your little girl sensed that and the jig was up. She can hang together if the treating dentist can. We know that. For instance, I've had kids burst into tears as I approach discretely with the syringe. I keep talking and I reassure them that as long as they DO WHAT I ASK, it will NOT hurt. And after all is said and done, they will be proud of themselves for having gone through the procedure. But this is _not_ because I'm good, it's because I _know_ that I can anesthetize them without it hurting, as long as they don't bounce around. I also know that even if they are wound up like springs at the start, they will relax as things go along, as long as I don't become impatient. I've seen it enough to be confident that it will happen in the present situation as well. You need someone who can work through the tears if they happen again, and without forcing, while she calms down again naturally. I stick by my original suggestion: phone up to the Dental School at the local University and inquire about anyone on their staff feeling up to doing an Endo on a 10 year old brave little girl. If they can't help you, they can perhaps suggest an Endo, or even better, a generalist who knows how to handle kids. That's the best I can think of right now. Cheers, hope it gets done soon. SP SignatureTake out the TRASH to reply > He did not say why....After the first shot she teared up (who wouldn't) He > said then that he didn't think he could do it. He just walked out. We had to > get the nurse to go see what he was going to to. That whole time she was > sitting there getting more and more nervous. When he finally came back he > started to give her another shot and she started crying again. He just put > his stuff down and said he wouldn't do it. Sounds like he just couldn't bring himself to "inflict" pain on a child? > > He did not say why....After the first shot she teared up (who wouldn't) > He [quoted text clipped - 6 lines] > > Sounds like he just couldn't bring himself to "inflict" pain on a child? I mean perhaps he went out back to dry his own tears? > > > He did not say why....After the first shot she teared up (who wouldn't) > > He [quoted text clipped - 11 lines] > > I mean perhaps he went out back to dry his own tears? The thing is, you DON'T inflict pain on the child. Giving painless injections is no big deal: you use topical anesthetic on a dry mucosa for at least a minute and then you inject s..l..o..w..l..y. We've _all_ seen that demonstrated to us. There are even little gizmos that will inject automatically at a very low rate if you are too impatient. Like I said, once you see what effect that has on a child, you KNOW you can best the situation. You just have to tough it out. I think that would have worked in this situation, as the description seems to be of a scared but moderately cooperative child. If they won't cooperate, well, sometimes you win, sometimes you don't. .... and you DON'T inflict pain on the child by abandoning her when she needs a gentle hand on the shoulder and some reassuring words more than anything else. This guy was not upfront either with her or himself. He may even have become an Endo so as to not be obliged to see many children. IIRC, you're in Belgium, and things there are quite equivalent to what goes on over here. In your home country of GB, however, where the NHS meter is running and the dentist really has to haul a.s to make any money, I bet this kind of thing is quite common: RUSH through the anesthesia, rush through the procedure. This Endo found himself in that situation, as the Insurance doesn't pay for the full procedure. So he was perhaps figuring he could rush through it. Then he saw that he was going to have to work a bit harder, and invest some emotional energy in the case, and he just wasn't up to that. Anyway, I hope the father finds a generalist who is comfortable with kids. SP SignatureTake out the TRASH to reply > The thing is, you DON'T inflict pain on the child. <snip> Point taken - perhaps "distress" would have been a better word to have used than "pain". > > The thing is, you DON'T inflict pain on the child. > <snip> > Point taken - perhaps "distress" would have been a better word to have used > than "pain". Yes... what I meant was that you keep talkin' to reassure her, and you let her know that if the anesthesia phase gets to be too painful, she can tell you with a sound. She has a bit of control that way, and she lets you know how fast you can inject. You let her know it's gonna take about five minutes, so to be patient. It _never_ takes five minutes.... Once you've got her with some painless anesthesia in the area, she will have more confidence. If she was crying during the anesthesia, she will be starting to calm down. Once you have that done, the rest is easier, especially with a root canal on that first permanent molar, with the rubber dam in place and all that... Cheers SP SignatureTake out the TRASH to reply > We have been told that our 10yr old daughter needs a root canal. We made an > appointment with an endodontist to have this done. He gave her one shot to [quoted text clipped - 14 lines] > Can you please just try and give me some information I can work with to make > the right decision? Is this a baby tooth or the permanent first molar? Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } >> We have been told that our 10yr old daughter needs a root canal. We made an >> appointment with an endodontist to have this done. He gave her one shot to [quoted text clipped - 5 lines] > >Steve I am not sure if it is a permanent or first molar. How would I be able to tell this? Any advice? > >> We have been told that our 10yr old daughter needs a root canal. We made an > >> appointment with an endodontist to have this done. He gave her one shot to [quoted text clipped - 8 lines] > I am not sure if it is a permanent or first molar. How would I be able to > tell this? Any advice? She is ten years old. Unless she is quite behind in tooth eruption, the last tooth in the back will be a permanent Molar. That is why she was sent to the Endo. At least, that's what I think. Cheers SP SignatureTake out the TRASH to reply >>>We have been told that our 10yr old daughter needs a root canal. We made an >>>appointment with an endodontist to have this done. He gave her one shot to [quoted text clipped - 10 lines] > I am not sure if it is a permanent or first molar. How would I be able to > tell this? Any advice? I agree that (given your description that your child was not flailing around wildly) the endodontist should be able to do this (absent other problems we aren't hearing about). At the very least, he should be able to discuss this with you. I infer the endodontist has a management problem (at this point I think from your description it is the endodontist and not your daughter who has the problem) only because the attempted referral was to a pedodontist and not another endodontist. If this is a PPO situation I'd ask my general dentist for a referral to another endodontist if possible, esp. if another endodontist is on your insurance list. If this is one of those American Dental Plan kind of "reduced fee plans", this scenario becomes more understandable. Many of us have heard stories of treatment delayed or deferred if it is not a slam dunk--and other problems as well. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Re: 10 yr old - Root Canal or Pulpotomy??? REPLY TERMINOLOGY: Pulpotomy means literally, a "cutting" of the pulp as with the word "tome" or tomography or osteotome. ROOT CANAL THERAPY is officially a "pulpECtomy" as with appendECtomy, or tonsillECtomy. "EC" suggests complete removal as opposed to The term pulotomy above. Deciduous teeth are treated with pulpotomy. Permanent teeth are treated with pulectomy. Period. Exceptions are included below. DISCUSSION Normally speaking, a ten year old could require a root canal therapy on the "first permanent molar" (that is the official name, what is in quotes). This is also called the SIX-YEAR molar meaning by age ten, decay could have progressed for four years if unchecked. These teeth would be possibly numbered 3, 14, 19, and 30 in the U.S. or 1-6, 2-6, 3-6, 4-6 if in Europe where they use FDIS ~ Federation Dentaire Internationale Systeme. So if you know the number I can tell you which tooth. We also use the Palmer system meaning a couple of squigglies that might be tough to draw with a computer keyboard. Imagine 6 _| but now squish the six a quarter inch to the right putting it into the open ended-box. The designation above would suggest tooth #3, on the patient's right (and on my left) as I view him. (PS-Here's a little plug for DentalCom ......... If I were showing you this and transmitting this in http instead of nttp, you would see the image as I have described it above. You know, a picture is worth a thousand words!) So, if this is the permanent molar ... its good investment. In fact I will never remove such a tooth. Its the beginning of a lifetime of dental troubles, tipped teeth, tooth drifting, food impaction areas due to poor contacts, crowns, periodontal problems. NEXT CASE WOULD BE ,,,, if its the permanent second molar ... UN-UH, can't be ...... that's the 12-year molar ....... which is not there yet. CASE THREE: Its a deciduous (baby) molar with no permanent tooth under it. Yes, this happens, its not common but can be seen on an x-ray. If you post the x-ray on the internet, we can tell you in four seconds if that's the case. Again, a little DentalCom plug is inserted here. CASE FOUR: Deciduous (baby) molar with a permanent tooth under ..... that would be a permanent PREMOLAR coming in to replace the deciduous molar. IF CASE FOUR is your situation, forget it. The tooth will exfoliate (fall out, as in leaves of a tree are foliage) within one year. Joel Joel M. Eichen D.D.S. Philadelphia PA On-site Dental Implants and Restorative Dentistry University-Trained Periodontists on staff. . or On Sat, 24 Sep 2005 05:43:26 GMT, "brehjf via MedKB.com" <forum@MedKB.com> wrote: >>> We have been told that our 10yr old daughter needs a root canal. We made an >>> appointment with an endodontist to have this done. He gave her one shot to [quoted text clipped - 8 lines] >I am not sure if it is a permanent or first molar. How would I be able to >tell this? Any advice? > IF CASE FOUR is your situation, forget it. The tooth will exfoliate > (fall out, as in leaves of a tree are foliage) within one year. The Endo would have caught THAT.... and she wouldn't have ended up at the Endo's doorstep with an exfoliating upper second primary molar... Personally, I think the treating dentist was scared to do the Endo, and so referred the case. If he doesn't want to do it, fine. But, as SB said so clearly, HE should take it upon himself to find another generalist who is OK with kids. JMO SP SignatureTake out the TRASH to reply >> IF CASE FOUR is your situation, forget it. The tooth will exfoliate >> (fall out, as in leaves of a tree are foliage) within one year. > >The Endo would have caught THAT.... Hah! Hah! Right. >and she wouldn't have ended up at >the Endo's doorstep with an exfoliating upper second primary molar... Hah. Oh you never saw that? You never saqw puloptomy and stainless steel crown(s) placed on teeth that were about to exfoliate? Joel >Personally, I think the treating dentist was scared to do the Endo, and >so referred the case. If he doesn't want to do it, fine. But, as SB said [quoted text clipped - 3 lines] >JMO >SP the Pipe blathered: > >and she wouldn't have ended up at > >the Endo's doorstep with an exfoliating upper second primary molar... [quoted text clipped - 5 lines] > > Joel Of course... but not just before they exfoliated. You're better to exfoliate them with a forceps and place a maintainer. I just find it very hard to swallow that both the referring generalist and the Gutless Endo would both mistake a second primary molar for a permanent tooth needing Endo. I mean, they both must've at least had a gander with the mirror before deciding what to do. .... No....? Thanks SP SignatureTake out the TRASH to reply > I am not sure if it is a permanent or first molar. How would I be able to > tell this? Any advice? If the tooth is the last one in the back, it is a permanent molar -- assuming she has the usual teeth of a ten year old child. Get another endodontist on your plan to do this. Some endodontists are experienced with children. Endodontists are generally more familiar with root canal treatment on young first molars than most pediatric dentists are, so it shouldn't be necessary to go to a pediatric dentist over 50 miles away. Don't give up. Ask your dental plan for the names of two or three more endodontists. - dentaldoc |
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