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Medical Forum / General / Dentistry / November 2007Interim treatment for tooth until insurance kicks in
..Seems this week my teeth have decided to stage their revolt. Last April I had a large filling in #19 replaced, with another large amalgam. Since then it has been extremely temperature sensitive, to both hot and cold, has been throbbing, and is progressively getting worse. Obviously something needs to be done, however, I exhausted my dental insurance this year until Jan 1. Aside from extraction, is there any low cost procedure a dentist could do ( I am extremely limited in funds ) and then "finish" once the insurance kicks in? Also would an insurance policy even cover a half finished job? ( in case youre wondering I have united concordia ) Is a pulpectomy + temp filling without filling the roots a viable ( and inexpensive ) option? At this point, I'm seriously considering saying screw it and yanking the tooth, unless somebody can suggest otherwise. > ..Seems this week my teeth have decided to stage their revolt. > [quoted text clipped - 15 lines] > saying screw it and yanking the tooth, unless somebody can suggest > otherwise. It can be, but that depends upon the state of degeneration of the pulp. Pulpotomies are generally frowned upon as definitive treatment for adult teeth--not only because they frequently don't work, but because they can stimulate secondary dentin formation that can make definitive root canal treatment more difficult when it finally is done. But if the alternative is only extraction, it might be worth doing--as long as you're prepared for the possibility it won't hold up until next year. Steve I have read Bornfeld's response and while I generally agree with his opinions this time I mus differ. First off enroper said "pulpectomy" not pulpotomy. Perfectly acceptable treatment to buy some time or for a canal that cannot be dried. Read intertwined responses below. >..Seems this week my teeth have decided to stage their revolt. > >Last April I had a large filling in #19 replaced, with another large >amalgam. Since then it has been extremely temperature sensitive, to >both hot and cold, has been throbbing, and is progressively getting >worse. OK, sounds like irreversible pulpitis to me. >Obviously something needs to be done, however, I exhausted my dental >insurance this year until Jan 1. If your ins. carrier will not change then if you have a pulpectomy, then this will not become a 'pre-existing condition' after Jan 1. However, to ins code this in a different way would probably be better for your best monetary interest, as well as for the treating dentist. Use either 'open and medicate' or 'emergency endodontic procedure'. Am not sure which is the current acceptable insurance terminology, but the procedure is exactly the same. Open the tooth, clean out the diseased pulpal tissue and medicate with CaOH. It is important to have a good coronal seal if this must last for more than a day. Personally prefer Fuji 9, IRM or Cavit are no longer acceptable IMO since they leak like a sieve. >Aside from extraction, is there any low cost procedure a dentist could >do ( I am extremely limited in funds ) and then "finish" once the >insurance kicks in? Also would an insurance policy even cover a half >finished job? ( in case youre wondering I have united concordia ) Though you would have to ask my staff about explicit ins. questions, much of the denials of coverage have to do with pre-existing conditions. See above statements. >Is a pulpectomy + temp filling without filling the roots a viable >( and inexpensive ) option? At this point, I'm seriously considering >saying screw it and yanking the tooth, unless somebody can suggest >otherwise. There are alternatives to extraction even in cases of minimal momentary monetary deficits. ;o]] Recommend: Pulpectomy with cleaning and shaping of canals, interim RC fill with CaOH, and coronal sealing with either Fuji 9, or a well placed composite <flowable over orfices, with bonded composite>. The coronal seal is extremely important, leakage leads to re-infection and pain. Don't have your tooth extracted. #19 is a key tooth in the arch. Discuss your situation with your dentist. Best wishes, -NB > I have read Bornfeld's response and while I generally > agree with his opinions this time I mus differ. I agree that your plan is more clinically acceptable. Mine was offered only in the interest of minimalism. No question pulpectomy and sealing access will have greater chance of success. Steve > First off enroper said "pulpectomy" not pulpotomy. > [quoted text clipped - 59 lines] > > -NB >> I have read Bornfeld's response and while I generally >> agree with his opinions this time I mus differ. > > I agree that your plan is more clinically acceptable. Mine was offered >only in the interest of minimalism. No question pulpectomy and sealing >access will have greater chance of success. Knew that you would see it my way <hehe> 8^]] Still, my recommendation *is* minimalist and wouldn't take a minute longer. As you stated, with an increased chance of success, it seems apparent to me that a CaOH pulpotomy with a good coronal seal just makes good sense. >Steve >> >> First off enroper said "pulpectomy" not pulpotomy. Don't forget your Flexible Spending Account (if you are lucky enough to be employed where one is offered) Right now is the time of year when you normally sign up for your annual election. Be sure to put in enough money to handle your co-pay on the rtc and crown, or even enough for the whole deal if it looks like your insurance is not going to pay. The Flex plan allows you to pay with pre-tax money, and makes the whole amount of your election available on Jan 1, effectively giving you an interest-free loan. Vaughn >Don't forget your Flexible Spending Account (if you are lucky enough to be >employed where one is offered) [quoted text clipped - 7 lines] > >Vaughn Excellent advice. |
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