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Medical Forum / General / Dentistry / March 2008pulp cap
I'm going in to have a large amalgam removed that has decay around the edges. The dentist put down root pulp cap on the estimate that he gave me and that immediately got me to worrying. I'm thinking, pulp cap, I've read about them - root canals and painful teeth. Is it necessarily the case that a pulp cap implies the tooth sensitivity from now on or is that my neurosis and overactive imagination talking? The tooth currently isn't sensitive so far as I can tell, so does that imply that the dentist is covering his bases in case the decay underneath is worse than expected? The replacement will undoubtedly be a composite, since he works exclusively with them - and does good work too. > I'm going in to have a large amalgam removed that has decay around the > edges. The dentist put down root pulp cap on the estimate that he gave me [quoted text clipped - 7 lines] > than expected? The replacement will undoubtedly be a composite, since he > works exclusively with them - and does good work too. He may be "covering his bases". Pulp capping implies that either the pulp has been exposed by the decay (direct pulp cap) or that the dentist expects that removing that last bit of decay will expose the pulp, so a medication is placed over the deep part of the cavity in hopes that the pulp will heal. Although there is some promising work being done with new materials, direct pulp caps do not work well in adult teeth. Indirect pulp caps may, except that you have to assume the pulp has not yet been infected and hope for the best. In cases like yours where there have not been symptoms I have seen indirect pulp caps work well. Of course there is the chance that removing that last bit of decay would NOT expose the pulp, and it was unnecessary. Alternatively it could be an "unbundling" of services to bump up the fee. No way to tell from here. However, while I will tell a patient beforehand that a cavity is deep and the pulp may be at risk, I certainly won't figure in a separate fee beforehand, since I don't consider this a routine service anymore. If the pulp is threatened, honestly you will get a more predictable result with a root canal treatment. Steve >> I'm going in to have a large amalgam removed that has decay around the >> edges. The dentist put down root pulp cap on the estimate that he gave [quoted text clipped - 28 lines] > > Steve Well I'm hoping he's just covering his bases then. I've been going to this dentist for 8 years and he's not one to pad his bills and it's not like I'm obligated to pay the estimate. Actually he's never actually given me an estimate before, so perhaps the OA that handed me the estimate was just giving out standard materials. He certainly didn't mention a root canal. Sometimes dentists get to a point where they don't feel things are working the way they want or deserve. They get a practice management counselor and start a whole new approach with the business end of things. Time will tell, Steve > Well I'm hoping he's just covering his bases then. I've been going to this > dentist for 8 years and he's not one to pad his bills and it's not like I'm > obligated to pay the estimate. Actually he's never actually given me an > estimate before, so perhaps the OA that handed me the estimate was just > giving out standard materials. He certainly didn't mention a root canal. Top Posting ditto. >> I'm going in to have a large amalgam removed that has decay around the >> edges. The dentist put down root pulp cap on the estimate that he gave me [quoted text clipped - 28 lines] > >Steve HMO or PPO Right?  Signature/ Amatus / > I'm going in to have a large amalgam removed that has decay around the > edges. The dentist put down root pulp cap on the estimate that he gave me [quoted text clipped - 7 lines] > is worse than expected? The replacement will undoubtedly be a composite, > since he works exclusively with them - and does good work too. > HMO or PPO Right? IOWs, the pulp cap might just be a fee the guy throws in there to up the total bill since the insurance plan limits the amount he can bill as the restoration itself. It is also possible that this dentist lines all posterior work with some type of glass ionomer to prevent sensitivity after the composite is placed. This isn't needed with the right bonding material and technique, but this dentist could just be the 'belt & suspenders' type. D Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big belt buckle to work in a rural setting? Signature/ Amatus / > >> HMO or PPO Right? [quoted text clipped - 10 lines] > > D > Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big belt > buckle to work in a rural setting? Doubles as a cow catcher? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 LOL Signature/ Amatus / >> Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big >> belt buckle to work in a rural setting? > > Doubles as a cow catcher? > > Steve LOL! Not really. Just leave the fancy Italian suits at home in the closet and wear some casual shoes. :-) Steve > Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big belt > buckle to work in a rural setting? I already convinced the practice-owner to attend an opera with us this Spring. :-) I may have to go out any buy some flannel shirts for myself. {They do still make those, don't they?} Signature/ Amatus / > > LOL! Not really. Just leave the fancy Italian suits at home [quoted text clipped - 5 lines] >> Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big >> belt buckle to work in a rural setting? Can I get a beer at the opera? If so, I might go....once. <G> Flannel shirts are great for the colder climes, but just too hot for me to wear in the office. I just grab a polo and khakis. :-) Steve > I already convinced the practice-owner to attend an opera with us this > Spring. :-) > > I may have to go out any buy some flannel shirts for myself. {They do still > make those, don't they?} >Can I get a beer at the opera? If so, I might go....once. <G> Great minds... >Flannel shirts are great for the colder climes, but just too >hot for me to wear in the office. I just grab a polo and >khakis. > >:-) >Steve Scrubs and a Tee. >> I already convinced the practice-owner to attend an opera with us this >> Spring. :-) >> >> I may have to go out any buy some flannel shirts for myself. {They do still >> make those, don't they?} They serve beer at the opera ? Who knew. The big buckle sure helps at the rodeo. >I already convinced the practice-owner to attend an opera with us this >Spring. :-) [quoted text clipped - 10 lines] >>> Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big >>> belt buckle to work in a rural setting? Have you seen that commercial where the guy smuggled bottled beer into the opera? Cans are the way to go. ;-) Steve > They serve beer at the opera ? > Who knew. Yeah, but I don't drink bud lite. How about some Fosters instead ? <hehe> >Have you seen that commercial where the guy smuggled >bottled beer into the opera? Cans are the way to go. [quoted text clipped - 4 lines] >> They serve beer at the opera ? >> Who knew. Actually,,,,,,,,,,,,, you can get one at the bar during intermission. Most folks get the champagne instead. Signature/ Amatus / > > They serve beer at the opera ? [quoted text clipped - 17 lines] >>>> Speaking of "belt & suspenders",,,,,,,,,,,,,,, will I need a really big >>>> belt buckle to work in a rural setting? >> HMO or PPO Right? > [quoted text clipped - 9 lines] > > D I wore a nerd pack in my pocket in high school. That probably explains everything. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
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