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Medical Forum / General / Dentistry / January 2008Advice on RCT
I would be grateful for some advice from the resident experts here about a problem my daughter (in her late twenties) is having with one of her teeth. The tooth is an upper left molar (one in from the rear, the wisdom teeth having already been extracted), and a few weeks ago she started having fairly severe pain from it. She consulted a dentist who said it was being caused by an infection which was probably being caused by a deepish filling not having been been done too well in the past. The dentist removed the filling, put a temporary one in and told her to come back in two weeks - dosing herself up with painkillers in the meantime - when he thought root canal treatment would be required. Yesterday the pain was so bad that she had to seek the help of an emergency dentist, whom she wanted to extract the tooth. The dentist took an X-ray and advised against this, saying that because the tooth was just within the 'smile line' she should go ahead with the RCT, and try to save it - in the meantime he replaced the temporary filling. She is unsure what to do - we are in the UK, and she does not have access to NHS treatment where she lives. While the cost is not the paramount concern it is obviously a factor to be considered - and this is where I need some advice. The RCT treatment is likely to cost around £500, which wouldn't be too bad if that is the end of the matter - but is it likely to be? Even if the treatment is 100% successful - which I gather is not guaranteed - how long is it likely to last? Would it be more sensible to have the tooth extracted now and an implant fitted? After all, the £500 would cover a fair slice of this - particularly if she went to somewhere like Prague to get it done (around £1000). What would be the best thing to do? >I would be grateful for some advice from the resident experts here about >a problem my daughter (in her late twenties) is having with one of her [quoted text clipped - 27 lines] >cover a fair slice of this - particularly if she went to somewhere like >Prague to get it done (around £1000). What would be the best thing to do? While I have not examined your daughter's tooth IRL, from your description it sounds like tooth #14 (US numbering system) is the offending culprit. Well done Root Canal Therapy (RCT) can last a lifetime. In my neck of the woods molar RCT would run about $800-1,000 US . The tooth would then require a crown at about the same rate. I would say that £1000 is on the high end, but quite reasonable for a large metropolitan area. While extraction may seem to be the most expedient treatment, and perhaps kinder to your checkbook; for someone in their twenties it is best to save the natural tooth if it is within your budget. Know that implants do fail; though the rate is low @ ~3 - 5% About the same rate as RCT. There is also the consideration of the Maxillary sinus to consider in upper first molar implant placement. Other than implant there is also the option of Fixed Partial Denture. A 'bridge' to most. This involves preparing the teeth in front and in back of the "space" for crowns and suspending a pontic inbetween. If it were my tooth, and RCT and Crown were affordable, that would be my first choice of treatment. Feel free to ask additional questions that have surely been raised by my 'not so clear' answer. 8^) >> I would be grateful for some advice from the resident experts here about >> a problem my daughter (in her late twenties) is having with one of her [quoted text clipped - 57 lines] > Feel free to ask additional questions that have surely been raised > by my 'not so clear' answer. 8^) Re-reading the OP's post, I think you're right that it's the first molar and not the second that is at issue. It makes the "smile line" comment more comprehensible. We agree on the considerations. Steve > Re-reading the OP's post, I think you're right that it's the first >molar and not the second that is at issue. It makes the "smile line" >comment more comprehensible. We agree on the considerations. > >Steve Still don't get the "smile line" thingy though. Most show 1st Bi's and *maybe* the mesial of the 2nd. Still, think that the first molar in any quadrant is a key tooth. "Great minds think alike" -JME 8*]] > Well done Root Canal Therapy (RCT) can last a lifetime. > In my neck of the woods molar RCT would run about $800-1,000 US . > > The tooth would then require a crown at about the same rate. > I would say that £1000 is on the high end, but quite reasonable for > a large metropolitan area. This is off topic from the OP but I have a root canal question Almost thirty years ago I was in an accident resulting in a chipped L front tooth and RCT for the R front tooth. RCT was done on the R front tooth and bonding applied to the chip on the L front tooth. A crown was never put on the R RCT front tooth and I've had the bonding replaced on the chipped L front tooth two or three times. I believe a dentist told me the R RCT tooth was calcified. Another dentist told me it's always a good idea to get crowns for both front teeth because it's very difficult to exactly color match, in different lighting the crowned tooth to original teeth. What's your advice? >> Well done Root Canal Therapy (RCT) can last a lifetime. >> In my neck of the woods molar RCT would run about $800-1,000 US . [quoted text clipped - 15 lines] > > What's your advice? If the right front tooth was not significantly damaged (you don't mention any restorations) it is one of the few situations where a root canal-treated tooth is likely to not need a crown. It's also a very good record to have only needed to have a bonded restoration in the left tooth replaced only 2 or 3 times over a period of 30 years. So both teeth have stood the test of time. IMO, this is largely an esthetic decision. You might also consider porcelain laminate veneers on these teeth. Yes, it is SOMETIMES difficult to do an exact match of two central incisors. But some patients' cosmetic needs and concerns are greater than others. I suspect if this was a big issue for you you would have done something about this long ago. Steve > If the right front tooth was not significantly damaged (you don't mention > any restorations) it is one of the few situations where a root [quoted text clipped - 9 lines] > > Steve You're correct no restorations. > I would be grateful for some advice from the resident experts here about > a problem my daughter (in her late twenties) is having with one of her [quoted text clipped - 27 lines] > cover a fair slice of this - particularly if she went to somewhere like > Prague to get it done (around £1000). What would be the best thing to do? Tough to say without seeing it. If we're talking about an upper second molar, it's unusual for it to be in the "smile line" unless she's Julia Roberts. But this is not a trivial tooth. The tooth will almost certainly require a crown or onlay restoration--an additional expense. OTOH, this is often not an ideal area for an implant--they are certainly done in this area, but the bone tends to be spongy and sometimes a sinus is in the way, necessitating a bone graft and sometimes a surgery called a sinus lift to get enough bone support for an implant. This possibility should be investigated if possible before extracting the tooth. Steve >> I would be grateful for some advice from the resident experts here >> about a problem my daughter (in her late twenties) is having with one [quoted text clipped - 40 lines] > > Steve Thank you both for your excellent replies. I think, from your advice, I will recommend to her the RCT route. Very many thanks. >> Tough to say without seeing it. If we're talking about an upper >> second molar, it's unusual for it to be in the "smile line" unless she's >> Julia Roberts. Never thought that JR was pretty. But also think that Brooke Shields is butt ugly. Guess it's a matter of taste, and some say I have none. <hehe> >>The tooth will almost >> certainly require a crown or onlay restoration--an additional expense. >> Steve > >Thank you both for your excellent replies. I think, from your advice, I >will recommend to her the RCT route. > >Very many thanks. SB is correct, without a final restoration of either a crown or onlay (covering the cusps) most RCT teeth are ultimately doomed to failure. Most consider one month to six weeks the maximum time that should elapse between RCT and final restoration. My advice to you is to find out the total cost of RCT +plus+ crown then relate that to your budget. If you ask me £500 is a bit pricey for just a molar RCT. Don't know if there are endodontists in your area, but it may be wise to consult one if possible. To learn more about root canal therapy: www.aae.org >>> Tough to say without seeing it. If we're talking about an upper >>> second molar, it's unusual for it to be in the "smile line" unless she's [quoted text clipped - 28 lines] > To learn more about root canal therapy: > www.aae.org Thanks again. Yes, she will try and get a few quotes - and a recommendation, if possible. Will definitely advise a crown after RCT. > Never thought that JR was pretty. But I've seen photos of her that show her second molars when she smiles. > But also think that Brooke Shields is butt ugly. > [quoted text clipped - 18 lines] > > If you ask me £500 is a bit pricey for just a molar RCT. Don't know the exchange rate now, and I'm a little afraid to look. The specialists around me (Brooklyn) are charging about $1200. for molars. Steve > Don't know if there are endodontists in your area, but > it may be wise to consult one if possible. > > To learn more about root canal therapy: > www.aae.org >> Never thought that JR was pretty. > > But I've seen photos of her that show her second molars when she smiles. Would that be a VBSEG ? >> If you ask me £500 is a bit pricey for just a molar RCT. > > Don't know the exchange rate now, and I'm a little afraid to look. The >specialists around me (Brooklyn) are charging about $1200. for molars. > >Steve £1 ~= $2 Considering your urban location that doesn't suprise me. |
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