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Medical Forum / General / Dentistry / September 2007opinions wanted on filling gone bad
Hi folks. I'm a 41 year old male. In general, I have good teeth and have only one other filling from 20 years ago. I had a 2 surface filling done on tooth #18 (left back molar). It was filled with a white composite. That was 6 weeks ago, and I still have all the classic symptoms of acute pulpitis that just won't go away. I've been to the DDS since, for a bite adjustment and x-rays. The x-rays don't show really anything alarming. I take advil when needed, and do not chew on that side of my mouth. The DDS referred me to an endodontist, who put a piece of ice on my tooth and confirmed what I already knew - the pulp was still sensitive, and she advised a root canal to be done. The initial cavity was very small and by the xray I saw not close to the nerve. This wasn't a replacement filling. It was a brand new filling. However, I find myself in the unfortunate situation of being told I now need a root canal due to complications from this filling. My questions are the following: 1) Are there any alternative therapies to RCT? For example, what about MTA pulp capping? I don't feel the entire pulp is irreversable. The top of the tooth is definitely irritated though for 6 weeks now, with no sign of respite. 2) Not that I'm going to make wild accusations, or make a big deal about this - but I feel the original DDS (just out of grad school) may have very well nicked the pulp, or somehow caused the underlying damage with aggressive over drilling (my wild guess). He has since left the practice, and now I am dealing with the partners - whom are more experienced dentists. I've been a good sport about the whole thing and realize that these things happen, and it is what it is. I have (crappy) insurance, but these bills are starting to add up ($177 WITH insurance on the filling) and who knows what for the RCT. Would it be unreasonable to ask the DDS to "eat" that $177 on the premise that the work on the original filling is what caused the irreversable pulpitis? > My questions are the following: > > 1) Are there any alternative therapies to RCT? EXTRACTION > For example, what about MTA pulp capping? > Nope > I don't feel the entire pulp is irreversable. The > top of the tooth is definitely irritated though for 6 weeks now, with > no sign of respite. You sure are describing early pulpal necrosis > 2) Not that I'm going to make wild accusations, or make a big deal > about this - but I feel the original DDS (just out of grad school) may > have very well nicked the pulp, or somehow caused the underlying > damage with aggressive over drilling (my wild guess). Possible but not very likely. >He has since > left the practice, and now I am dealing with the partners - whom are > more experienced dentists. I've been a good sport about the whole > thing and realize that these things happen, and it is what it is. Treating humans is never predictable. >I have (crappy) insurance, Tell you employer you would rather have better insurance and less money in your paycheck. > but these bills are starting to add up ($177 > WITH insurance on the filling) and who knows what for the RCT. Usually about $1K >Would it be unreasonable to ask the DDS to "eat" that $177 on the premise > that the work on the original filling is what caused the irreversable > pulpitis? Nope. He only treated the tooth. You grew it. Unless you have some sort of magic ball that will display the tooth before treatment, display the depth of the decay, and display the tooth with the decay cleaned out prior to filling,,,,,,,,,,, there is no way anyone could possibly comment on the quality of the preparation. You could certainly be the victim of bad dental treatment, but there is no way to determine that after the fact. I find most patients who complain as you do simply have not had any dental care in many years, not felt pain, but had problems building up that got their attention, then when the treatment is performed and discomfort ensues, the patient tries to blame the dental office for lousy care. Most cases are due to neglect for years followed by **poor communication** from the dental office. It is much better when the office warns you about such a possible outcome ****during*** treatment. For a variety of reasons, communication is not always ideal in this world. ok thanks. I ended up getting the filling taken out, and a medicated temporary filling put in it's place (at no charge). Last resort to RCT. It does feel better - but we need to give it 2 weeks or so. The endiodontist wanted to do a root canal, but I opted to give the a replacement filling a second crack. The RCT involves 2 hrs in the chair, plus it's split into two sessions, plus I would need a crown, plus plus plus... Why would I want to go right to an RCT? The endodontist was ready to start an emergency procedure, but there was really no symptoms for an emergency. Also I always get comments on my 40 year old calcified nerve in my front tooth from the endodontists. They want to rip it right out, but I always explain that it's been like that for 40 years. If it's not broke, don't try to fix it. So that would be my one gripe with the endiodontists is not to use scare tactics, but to present a balanced amount of information. I did like the disclaimer regarding RCT failure rates and the such, and the explanation of the fees. However, my tooth is not going to explode on an airplane, although I'm sure there are some rare stories in this regards. The "banging heads while kissing" is a legitimate scenerio. Could a dead calcified nerve in the front tooth (dating back to early childhood) really cause a problem should the tooth get traumatized? . By the way, the original cavity that initiated the filling was not that bad. It was on my x-rays going all the way back to 2003. But it was certainly "on the road" to trouble - but could have gone a year or two more. Even the partner agrees with that, and he is telling me that what is happening with me is "rare", and he sees it about "once a year". I asked him point blank if maybe the prep triggered the problem and he said it was a possibility. So anyway, I got to sleep for the first night without advil. woohoo! Man, you don't know how good that feels. This medicated filling has lifted my spirits. Cheers, ta. Studies show that the ultimate fate of the tooth is not effected by the use of a medicated temporary filling. All it does is buy you some time. Sorry.  Signature/ Amatus / > ok thanks. I ended up getting the filling taken out, and a medicated > temporary filling put in it's place (at no charge). Last resort to [quoted text clipped - 27 lines] > first night without advil. woohoo! Man, you don't know how good that > feels. This medicated filling has lifted my spirits. Cheers, ta. Is there any possibility that our predecessors named it "irreversible pulpitis" for a reason ? And when it 'blows up' at 11:26 PM on a Friday, don't expect a quick response for *emergency* treatment. And if you do manage to get a dentist to treat you at that inconvenient time for a problem that you 'sat on', expect to not only have your tooth opened and cleaned out but your wallet too. Best wishes, since *luck* has nothing to do with it.... >Studies show that the ultimate fate of the tooth is not effected by the use >of a medicated temporary filling. All it does is buy you some time. Sorry. [quoted text clipped - 30 lines] >> first night without advil. woohoo! Man, you don't know how good that >> feels. This medicated filling has lifted my spirits. Cheers, ta. > Is there any possibility that our predecessors named it > "irreversible pulpitis" for a reason ? > > And when it 'blows up' at 11:26 PM on a Friday, don't expect > a quick response for *emergency* treatment. Keep some penicillin and morphine handy. > And if you do manage to get a dentist to treat you at that > inconvenient time for a problem that you 'sat on', [quoted text clipped - 39 lines] >>> first night without advil. woohoo! Man, you don't know how good that >>> feels. This medicated filling has lifted my spirits. Cheers, ta. |
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