Medical Forum / General / Dentistry / July 2006
No crown with root canal?
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gdelzer - 03 Jul 2006 19:49 GMT Hello. My tooth (upper-left, fifth tooth back starting from front) broke yesterday morning while eating cereal. Its a tooth I had a root canal done on about three years ago, and now the inside half is gone (to the gumline--I believe the root is still there), the outer half and the filling are both still intact.
I've called around for prices, etc. and it looks to be $750 to $1000 to fix, but the other response I keep getting is, "They should have put a crown on when the root canal was done. Otherwise, they become brittle and crack in a couple years." Now, I had decent dental insurance at the time, but, of course, no dental insurance now. So, I am a bit steamed at the prospect of laying down a thousand for work that I wouldn't have had to pay for when it should have been done. Is this a legitimate complaint? Are crowns regularly done when there is a root canal?
--Greg
Mark & Steven Bornfeld - 03 Jul 2006 22:01 GMT > Hello. My tooth (upper-left, fifth tooth back starting from front) > broke yesterday morning while eating cereal. Its a tooth I had a root [quoted text clipped - 12 lines] > > --Greg It's tough to make presumptions and draw specific inferences to your own situation. Generally, premolars that have required root canal due to caries or fracture should be crowned or onlays placed after root canal. There may have been extenuating circumstances--perhaps there was a possible problem with the root canal, suspicion of fracture etc. that could have made placement of the crown a waste if the tooth was subsequently lost. Maybe more likely you just fell through the cracks due to a disorganized office. Whatever the cause, if the fracture isn't too far under the gumline, hopefully the crown can be done now.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
gdelzer - 05 Jul 2006 18:30 GMT Thank you for your reply.
I don't believe there were any extenuating circumstances with the root canal. None that I was told of anyway. It was due to a deep cavity.
And I don't think a disorganized office is the cause. This was an office/clinic of a reasonably large dental insurance/clinic corporation, the type of place that you can't even call direct to make an appointment--you have to call one of those 1-800 numbers.
So, I know you dentists love to hear this term, but I don't see how this wasn't malpractice. I know you can't comment on this without the particulars. I also know that even if it technically is malpractice, the costs of proving this would be well beyond what I might possibly recoup. So, that point is moot.
Here's what I am wondering. Does it make sense at all to call this company or maybe show up at the dental office (which is near my home) and explain the situation and complain? Would I have a leg to stand on? Would I possibly get any recompense other than a "We're sorry."? Or is my time better spent setting up an appointment elsewhere and taking my lumps?
--Greg Delzer
> > Hello. My tooth (upper-left, fifth tooth back starting from front) > > broke yesterday morning while eating cereal. Its a tooth I had a root [quoted text clipped - 31 lines] > Brooklyn, NY > 718-258-5001 Mark & Steven Bornfeld - 05 Jul 2006 19:33 GMT > Thank you for your reply. > [quoted text clipped - 20 lines] > > --Greg Delzer The problem with your situation is that while generally crowns or onlays should be done after root canal, there may have been extenuating circumstances which caused the dentist to make an exception. You are certainly within your rights to ask why a crown wasn't made at the time; one can even argue that damages could be demonstrated if you lost the tooth. But if your complaint is that it's going to cost you now for a crown because you no longer have dental insurance, I don't think that's going to fly. The decision not to crown is a clinical judgement, and each judgement must be made individually--not general rules. You may find a sympathetic ear and the dentist may feel like being a nice guy and making an adjustment in the fee for a crown, but IMO he/she is under no obligation to do so--esp. if there is a rationale we're not hearing about. If there is no explanation that makes sense to you, you should consider whether you want to stay with this dentist.
Steve
>>>Hello. My tooth (upper-left, fifth tooth back starting from front) >>>broke yesterday morning while eating cereal. Its a tooth I had a root [quoted text clipped - 31 lines] >>Brooklyn, NY >>718-258-5001
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
gdelzer - 05 Jul 2006 22:39 GMT I agree with the extenuating circumstances possibility, but none of that was discussed with me at the time. If extenuating circumstances did exist, I would have expected to have been told of that and further why no crown was advisable.
My complaint is that if indeed this current situation arose because a crown SHOULD have been done but wasn't, that some fault lies with the original dentist (or office, or company, etc.). The insurance part of this is that I wouldn't worry so much if I currently had insurance, as the brunt of the cost of the mistake would still be paid by the insurance. So, my lack of insurance currently means that I am paying out-of-pocket for a problem that possibly shouldn't exist if the correct procedures were done at the time.
And I don't even have all the information yet, so I am speculating. But my complaint is certainly due to the unexpected expense I may have to lay out, yes.
I did put in a call to the corporate offices. They called the particular office and relayed my situation. Unfortunately, the office manager is on vacation until next week (this seems to be a popular week for dental office vacations--my timing is never good), so I should receive a call back on Monday.
--Greg
> > Thank you for your reply. > > [quoted text clipped - 80 lines] > Brooklyn, NY > 718-258-5001 gdelzer - 10 Jul 2006 22:03 GMT Well, the initial response I received from the office manager is that crowns are routinely placed on molars that have root canals but not pre-molars because pre-molars aren't used for biting down as hard. This strikes me as completely arbitrary.
Does this make sense from a scientific or dental standpoint?
The dentist himself is supposed to contact me tomorrow.
--Greg
> > Thank you for your reply. > > [quoted text clipped - 80 lines] > Brooklyn, NY > 718-258-5001 Mark & Steven Bornfeld - 10 Jul 2006 22:33 GMT > Well, the initial response I received from the office manager is that > crowns are routinely placed on molars that have root canals but not > pre-molars because pre-molars aren't used for biting down as hard. This > strikes me as completely arbitrary. > > Does this make sense from a scientific or dental standpoint? No. Speak to the dentist.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
gdelzer - 13 Jul 2006 00:10 GMT Finally got a call back from the dentist today.
"The data doesn't indicate that crowns are necessarily a good idea on pre-molars that have root canals."
Of course, he didn't have immediate access to what he meant by "the data" (nor did I expect him to), but he said that if I researched studies related to outcomes of root canals on pre-molars that I would find that the need for crowns isn't generally indicated.
Does anyone know more specifically what data or study/studies he might be referring to?
Do I follow up with the dental corporation (I'm guessing that naming them is against decorum, though I'm not sure how to refer to the conglomerate.)?
Thanks again for any help.
--Greg Delzer
> > Well, the initial response I received from the office manager is that > > crowns are routinely placed on molars that have root canals but not [quoted text clipped - 12 lines] > Brooklyn, NY > 718-258-5001 Mark & Steven Bornfeld - 13 Jul 2006 00:56 GMT > Finally got a call back from the dentist today. > [quoted text clipped - 16 lines] > > --Greg Delzer This is a clinical judgement call--the rules aren't set in stone. If you're referring to the dental group this dentist works for, if you explain the situation they may feel like making a concession on the fee (but they're under no legal obligation to do so). As far as the reputed "data", IMO almost all of these teeth need either onlays or crowns. Since porcelain or resin onlays are relatively new (though they certainly have their advantages), most of the time this means a crown. And if there's any research contradicting this well-established, time-honored conviction which any dentist who's been around the block can verify by remembering all the patients with your experience (I'm out of school 30 years now), I would LOVE to see it. If they aren't sympathetic, chalk it up, and find another dentist.
Steve
>>>Well, the initial response I received from the office manager is that >>>crowns are routinely placed on molars that have root canals but not [quoted text clipped - 12 lines] >>Brooklyn, NY >>718-258-5001
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
Pat Coghlan - 05 Jul 2006 18:25 GMT Getting a crown may be more invasive than Cerec. It's probably worth looking into the latter. My mother-in-law is in the same situation right now.
> Hello. My tooth (upper-left, fifth tooth back starting from front) > broke yesterday morning while eating cereal. Its a tooth I had a root [quoted text clipped - 12 lines] > > --Greg Joel344 - 11 Jul 2006 02:06 GMT This was a Seinfeld episode where George wanted a crown with his root canal but the tooth Nazi said, "What? You get no crown with your root canal."
PS~! In your case a crown may have been indicated, but its hard to guess from here
-- Joel34
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