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Medical Forum / General / Dentistry / March 2007

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Root Canal - is this reasonable?

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John - 01 Mar 2007 18:18 GMT
I posted a few prior times about a problem tooth (second bicuspid)
that was sensitive and painful on and off over the past 60 days.  It
was filled once 17 years ago, then refilled 6 weeks ago to see if that
would solve the problem.  It didn't.  So, I went to an endodontist
today to get a root canal.  After getting numbed, I was in the chair
with him drilling and rasping for at least 30 minutes.  He then put in
a temp filling and I'll be going back at least 2 or three more times
to have the root canal completed.  He estimated today that he was only
15 - 20 % done!  His bill is going to be $1295.  Now, this happens to
be a difficult case with a complicated root structure: there are two
or three root canals that are intertwined (as seen on the xray, but he
couldn't be sure without going in and looking).  And he seemed to be
busy the whole time, diligently drilling and rasping, and not dilly-
dallying at all from what I could tell.

My questions are: what do the dentists here think about this?  Is how
this is going so far a sign of competence or incompetence?  What about
the price?  $1295 seems steep to me, but I have nothing to compare it
with.  I'm on Long Island, NY, so that probably contributes.  I'm
pretty sure this is well over the "reasonable and customary" fees that
my dental plan will pay 70% of.

Of course, my know-it-all coworker says all the root canals he's had
done took only one visit and he was never billed more than $700 per.
His guy usually had 3 or 4 patients going at the same time, perhaps
indicating efficiency of operation and probable competence.  In
contrast, I was the only patient I saw during the time I was there.

At this point, I'm almost sorry I didn't just opt to have the tooth
pulled, or wait it out for a few more months to see if the cyclical
pain (some days good, some bad) eventually goes away, but neither this
endodontist nor my regular dentist were confident it would.
Steven Fawks - 01 Mar 2007 19:27 GMT
> My questions are: what do the dentists here think about this?  Is how
> this is going so far a sign of competence or incompetence?  What about
> the price?  $1295 seems steep to me, but I have nothing to compare it
> with.  I'm on Long Island, NY, so that probably contributes.  I'm
> pretty sure this is well over the "reasonable and customary" fees that
> my dental plan will pay 70% of.

There is no way to really tell over the internet.  Some dentists
like the multiple operatory, assembly line practice.  Some dentists
like to slow things down and only work on one patient at a time.

Good quality work can come out of either kind of office, and crappy
work can come out of either kind of office.

Finding the fastest, barely acceptable technique for any procedure
may work well for the bank account, but it may not be in the best
interest of the patient.

Spending needless visits, and extra time on details that will not
improve the quality of the final treatment isn't good either.

The length of healthy service after the root canal is the final
test of whether the work was done properly.  (and $1300 for a
RC that lasts 30 years is a whole lot better than $700 for one that
only lasts for 5 <G>)

Steve

> Of course, my know-it-all coworker says all the root canals he's had
> done took only one visit and he was never billed more than $700 per.
> His guy usually had 3 or 4 patients going at the same time, perhaps
> indicating efficiency of operation and probable competence.  In
> contrast, I was the only patient I saw during the time I was there.
Mark & Steven Bornfeld - 01 Mar 2007 19:49 GMT
> I posted a few prior times about a problem tooth (second bicuspid)
> that was sensitive and painful on and off over the past 60 days.  It
[quoted text clipped - 28 lines]
> pain (some days good, some bad) eventually goes away, but neither this
> endodontist nor my regular dentist were confident it would.

    This is not an unusual fee.  An endodontist's fees naturally will be
higher than those for a general dentist doing a root canal--and should
be.  The endodontist generally is going to be treating the more
difficult teeth.
    Most endodontists are highly competent in my experience--but obviously
there's no way to tell in your particular case.
    OTOH, I had an office on the South Shore in the 1980s (Lindenhurst),
and I know some of the endodontists out there.  ;-)

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

jim beam - 01 Mar 2007 23:50 GMT
This guy is an artist ,I endorse the other dentists comments ,only time will
tell if its money well spent.Hindsight is a wonderful thing.
Dr Jim

>I posted a few prior times about a problem tooth (second bicuspid)
> that was sensitive and painful on and off over the past 60 days.  It
[quoted text clipped - 28 lines]
> pain (some days good, some bad) eventually goes away, but neither this
> endodontist nor my regular dentist were confident it would.
Ameloblast - 02 Mar 2007 11:44 GMT
Steve, actually, correlating post-endo sequela to the quality of endodontic treatment can lead to wrong conclusions.

The best care can still flare-up and require post-op antibiotics, the best care can still fail. No endodontic outcome studies have ever shown that the prognosis of orthograde treatment or retreatment is 100
Dartos - 02 Mar 2007 14:12 GMT
> Steve, actually, correlating post-endo sequela to the quality of
> endodontic treatment can lead to wrong conclusions.
[quoted text clipped - 3 lines]
> shown that the prognosis of orthograde treatment or retreatment is
> 100% -------------- Posted via http://www.dailydentistry.com

You are most certainly correct.

However, poorly done endo will fail at a much higher rate than
endo that was performed correctly.

With careful, complete cleaning, shaping, disinfection, and obturation,
routine cases can come very close to that 100% ideal figure.

Cases that have been treated previously, complex root anatomy,
and cases that have been necrotic for years reduce the odds of
success.

D
John - 02 Mar 2007 16:58 GMT
> > Steve, actually, correlating post-endo sequela to the quality of
> > endodontic treatment can lead to wrong conclusions.
[quoted text clipped - 15 lines]
> and cases that have been necrotic for years reduce the odds of
> success.

Thanks to all for your input.  I'll post again when the root canal is
complete.

John.
Steven Bornfeld - 02 Mar 2007 20:52 GMT
> Steve, actually, correlating post-endo sequela to the quality of endodontic treatment can lead to wrong conclusions.
>
> The best care can still flare-up and require post-op antibiotics, the best care can still fail. No endodontic outcome studies have ever shown that the prognosis of orthograde treatment or retreatment is 100%
> --------------
> Posted via http://www.dailydentistry.com

    Not sure if you're replying to me--certainly never meant to imply
flareups were ipso facto evidence of quality issues.  And no, I've never
seen anyone claim 100% success for ANY clinical procedure.
    As I said, most endodontists I've known are highly competent, and I
refer a significant number of endo cases to specialists.  I have known
specialists though to whom I would NOT send patients.  No, I'm not
naming names.
    Why am I talking to an ameloblast???

Steve
Newbie - 05 Mar 2007 21:04 GMT
>> Steve, actually, correlating post-endo sequela to the quality of endodontic treatment can lead to wrong conclusions.
>>
[quoted text clipped - 12 lines]
>
>Steve

The amoeba was busy dinoflagellating the paramecium ? <G>
Dartos - 05 Mar 2007 21:10 GMT
Of course.  How cilia of me.

D

>>    Why am I talking to an ameloblast???

> The amoeba was busy dinoflagellating the paramecium ? <G>
Newbie - 05 Mar 2007 22:52 GMT
Think it was just a phage that you were going through.

>Of course.  How cilia of me.
>
[quoted text clipped - 3 lines]
>
>> The amoeba was busy dinoflagellating the paramecium ? <G>
 
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