Root Canal - Possible Root Remaining 
Author Message
 Root Canal - Possible Root Remaining

Hello:

Here's my story...

WHAT HAPPENED INITIALLY

About four months ago, I visited Dentist-A who advised me that I
needed a root c{*filter*}and a crown on an upper left molar. Dentist-A was
able to do the chosen porcelain-fused-metal crown, but as he was
unable to do root canals, he sent me to Dentist B, an endodontist, to
get this done.

At the time I had dental insurance, which I do not have now, which
paid for a percentage of the costs of the root c{*filter*}and crown.

WHAT HAPPENED AFTERWARDS

In the weeks and months following the root c{*filter*}procedure, the tooth
has never felt right, and "neutral" as all my other teeth do.

At first, I thought this feeling was just the tooth recovering from
the root c{*filter*}trauma, but lately, I have been feeling increasing
discomfort in this tooth - a dull / tingling / strange type of pain,
which is exacerbated whenever I place gentle pressure on the tooth,
such as from my tongue.

WHAT I DID NEXT

So a week ago, I went back to the Dentist-B, who had done the original
root canal. He said my pain could be caused by a few things - and one
of the causes he mentioned was teeth grinding, because the crown could
be too high.

He also said that what could be another cause of the pain (and this
was the first time he had told this to me, and had not raised it
during my root c{*filter*}procedure) was that he had been unable to find
one of the roots, and had only found three roots. He said that he had
"done his best" looking for the fourth root, and it could be this
remaining root causing the problem. I am very annoyed that I was not
informed of this during my root c{*filter*}procedure.

So he ground the crown down slightly, and said that if the pain still
persisted after a few days (which unfortunately it has done) I should
return to his office, and he would drill through the crown to get at
the fourth root.

This was about a week ago, and as I am still feeling pain in the
tooth, I am about to make an appointment for the follow up visit.

I have not yet asked, and do not know whether I have to pay for this
continuation of the root c{*filter*}procedure.

I am not happy that I am going to be left with a compromised, filled
crown, rather than the brand new one I purchased four months ago.

RESOLUTION - WHAT I WOULD LIKE TO HAPPEN

I want the pain to stop, and I do not want this to drag on. I would
like to have a successful root c{*filter*}procedure, resulting in being
free from pain now, and for a reasonable length of time into the
future.

I would also like to have a complete, new crown placed over this, not
have the existing crown opened and then filled.

Both of these procedures I would like without any further expense on
my part, having already paid a great deal of money once for them
previously.

QUESTIONS

1. What are my options? Is there anything I can do to achieve the
exact resolution I am seeking, or is it just my bad luck, and I have
to consider this as a new dental problem that needs treatment?

2. If I don't have many options, should I try to mediate - for
example, meet Dentist-B halfway with costs?

3. Why would a remaining root hurt? Is it because of the nerve still
being intact, or decay, or infection setting in, or other
possibilities? There's probably a lengthy medical answer to this...

4. Could Dentist-A not have sealed the tooth correctly when applying
the crown, and bacteria has got in?

5. Can Dentist-B demand payment for a new root c{*filter*}procedure, even
if after only four months since the first one, I am feeling pain?

6. I asked Dentist-A about the life expectancy of a (porcelain) crown,
and he answered "normally, it's about five years with the insurance
companies." I was never shown any kind of agreement or similar
documentation up front during my visits to dentists A and B, just
given a questionnaire about my medical history. Does any kind of
explicit, in-writing, "warranty" exist with dental work, and if so
does it vary by procedure? For example, something like - "this
[procedure] is guaranteed to be free from defects for a period of X
years from the date of it being performed, withstanding normal wear
and tear, and should defects arise, will be replaced or re-performed
without cost to the consumer."

7. Are dentists themselves insured against complications happening
after various procedures, allowing patients to be re-treated at no
cost to the patient?

8. What percentage of U.S. {*filter*}s have missing, or malformed, molar
roots, and how often are roots unable to be located during a root
c{*filter*}procedure? Where might I find such statistics if they are
recorded?

9. Is there any firm criteria as to when a dentist gives up the search
for a root during a root c{*filter*}procedure, or is this a gray area?

10. Like when they dentists say things like "this may {*filter*} a little"
when they do the injection, is there any "code of practice" stating
that Dentist-B should have told me during my initial root c{*filter*}that
he was looking for a fourth root, but could not find it?

11. Should I have asked Dentist-B ahead of time, before the initial
procedure got started, "What can I/we do, if this root c{*filter*}doesn't
solve the problem?" or "How many years should I be trouble-free"? Or
are patients not expected to know all the questions, and this
information should be provided, or made easily accessible to the
patient, by the dentist?

12. Under what circumstances would Dentist-B be liable for the cost of
replacing the crown, even though he only did the root canal?

13. Has any person reading this had experience of a root c{*filter*}still
causing pain after a few months, with it needing to be re-done - and
also possibly a new crown needing to be drilled and replaced?

14. I am no longer insured with the insurance company that paid for
part of both procedures. Should they be involved? (I have not yet been
in contact with them.) An additional note - I was recently laid off ,
and presently I have no dental insurance with any insurance company.

Lots of questions. If anybody has information regarding any of them, I
would be most grateful.

Happy New Year, Simon.



Sun, 20 Jun 2004 17:05:59 GMT
 Root Canal - Possible Root Remaining
Well written post Simon and valid questions!

This situation is not too uncommon in everyday
dentistry. Even though I cannot answer (being non-
reisdent alien dentist) I am looking forward to
what the US restorative guys will respond.

Hey, both Steves, Joel, Charlie, Steven, Stan
and all the rest of the regular posters, where
are you?

Hans
=================================

Quote:
----- Original Message -----

Newsgroups: sci.med.dentistry
Sent: Wednesday, January 02, 2002 10:05 AM
Subject: Root C{*filter*}- Possible Root Remaining

Hello:

Here's my story...

WHAT HAPPENED INITIALLY

About four months ago, I visited Dentist-A who advised me that I
needed a root c{*filter*}and a crown on an upper left molar. Dentist-A was
able to do the chosen porcelain-fused-metal crown, but as he was
unable to do root canals, he sent me to Dentist B, an endodontist, to
get this done.

At the time I had dental insurance, which I do not have now, which
paid for a percentage of the costs of the root c{*filter*}and crown.

WHAT HAPPENED AFTERWARDS

In the weeks and months following the root c{*filter*}procedure, the tooth
has never felt right, and "neutral" as all my other teeth do.

At first, I thought this feeling was just the tooth recovering from
the root c{*filter*}trauma, but lately, I have been feeling increasing
discomfort in this tooth - a dull / tingling / strange type of pain,
which is exacerbated whenever I place gentle pressure on the tooth,
such as from my tongue.

WHAT I DID NEXT

So a week ago, I went back to the Dentist-B, who had done the original
root canal. He said my pain could be caused by a few things - and one
of the causes he mentioned was teeth grinding, because the crown could
be too high.

He also said that what could be another cause of the pain (and this
was the first time he had told this to me, and had not raised it
during my root c{*filter*}procedure) was that he had been unable to find
one of the roots, and had only found three roots. He said that he had
"done his best" looking for the fourth root, and it could be this
remaining root causing the problem. I am very annoyed that I was not
informed of this during my root c{*filter*}procedure.

So he ground the crown down slightly, and said that if the pain still
persisted after a few days (which unfortunately it has done) I should
return to his office, and he would drill through the crown to get at
the fourth root.

This was about a week ago, and as I am still feeling pain in the
tooth, I am about to make an appointment for the follow up visit.

I have not yet asked, and do not know whether I have to pay for this
continuation of the root c{*filter*}procedure.

I am not happy that I am going to be left with a compromised, filled
crown, rather than the brand new one I purchased four months ago.

RESOLUTION - WHAT I WOULD LIKE TO HAPPEN

I want the pain to stop, and I do not want this to drag on. I would
like to have a successful root c{*filter*}procedure, resulting in being
free from pain now, and for a reasonable length of time into the
future.

I would also like to have a complete, new crown placed over this, not
have the existing crown opened and then filled.

Both of these procedures I would like without any further expense on
my part, having already paid a great deal of money once for them
previously.

QUESTIONS

1. What are my options? Is there anything I can do to achieve the
exact resolution I am seeking, or is it just my bad luck, and I have
to consider this as a new dental problem that needs treatment?

2. If I don't have many options, should I try to mediate - for
example, meet Dentist-B halfway with costs?

3. Why would a remaining root hurt? Is it because of the nerve still
being intact, or decay, or infection setting in, or other
possibilities? There's probably a lengthy medical answer to this...

4. Could Dentist-A not have sealed the tooth correctly when applying
the crown, and bacteria has got in?

5. Can Dentist-B demand payment for a new root c{*filter*}procedure, even
if after only four months since the first one, I am feeling pain?

6. I asked Dentist-A about the life expectancy of a (porcelain) crown,
and he answered "normally, it's about five years with the insurance
companies." I was never shown any kind of agreement or similar
documentation up front during my visits to dentists A and B, just
given a questionnaire about my medical history. Does any kind of
explicit, in-writing, "warranty" exist with dental work, and if so
does it vary by procedure? For example, something like - "this
[procedure] is guaranteed to be free from defects for a period of X
years from the date of it being performed, withstanding normal wear
and tear, and should defects arise, will be replaced or re-performed
without cost to the consumer."

7. Are dentists themselves insured against complications happening
after various procedures, allowing patients to be re-treated at no
cost to the patient?

8. What percentage of U.S. {*filter*}s have missing, or malformed, molar
roots, and how often are roots unable to be located during a root
c{*filter*}procedure? Where might I find such statistics if they are
recorded?

9. Is there any firm criteria as to when a dentist gives up the search
for a root during a root c{*filter*}procedure, or is this a gray area?

10. Like when they dentists say things like "this may {*filter*} a little"
when they do the injection, is there any "code of practice" stating
that Dentist-B should have told me during my initial root c{*filter*}that
he was looking for a fourth root, but could not find it?

11. Should I have asked Dentist-B ahead of time, before the initial
procedure got started, "What can I/we do, if this root c{*filter*}doesn't
solve the problem?" or "How many years should I be trouble-free"? Or
are patients not expected to know all the questions, and this
information should be provided, or made easily accessible to the
patient, by the dentist?

12. Under what circumstances would Dentist-B be liable for the cost of
replacing the crown, even though he only did the root canal?

13. Has any person reading this had experience of a root c{*filter*}still
causing pain after a few months, with it needing to be re-done - and
also possibly a new crown needing to be drilled and replaced?

14. I am no longer insured with the insurance company that paid for
part of both procedures. Should they be involved? (I have not yet been
in contact with them.) An additional note - I was recently laid off ,
and presently I have no dental insurance with any insurance company.

Lots of questions. If anybody has information regarding any of them, I
would be most grateful.

Happy New Year, Simon.



Mon, 21 Jun 2004 07:19:04 GMT
 Root Canal - Possible Root Remaining
Answers in text due to the number of questions.

SWF DDS

Quote:

> QUESTIONS

> 1. What are my options? Is there anything I can do to achieve the
> exact resolution I am seeking, or is it just my bad luck, and I have
> to consider this as a new dental problem that needs treatment?

This is a known complication of upper molar endo.

Quote:

> 2. If I don't have many options, should I try to mediate - for
> example, meet Dentist-B halfway with costs?

That's between you and the endodontist.

Quote:

> 3. Why would a remaining root hurt? Is it because of the nerve still
> being intact, or decay, or infection setting in, or other
> possibilities? There's probably a lengthy medical answer to this...

Basically, if you don't remove all of the "crud" and fill the space, bad
things can happen.

Quote:

> 4. Could Dentist-A not have sealed the tooth correctly when applying
> the crown, and bacteria has got in?

Not likely.

Quote:

> 5. Can Dentist-B demand payment for a new root c{*filter*}procedure, even
> if after only four months since the first one, I am feeling pain?

"Can he"?  Sure.  

Quote:

> 6. I asked Dentist-A about the life expectancy of a (porcelain) crown,
> and he answered "normally, it's about five years with the insurance
> companies." I was never shown any kind of agreement or similar
> documentation up front during my visits to dentists A and B, just
> given a questionnaire about my medical history. Does any kind of
> explicit, in-writing, "warranty" exist with dental work, and if so
> does it vary by procedure? For example, something like - "this
> [procedure] is guaranteed to be free from defects for a period of X
> years from the date of it being performed, withstanding normal wear
> and tear, and should defects arise, will be replaced or re-performed
> without cost to the consumer."

"Warranties" are not part of dental/medical practice.  Individual
dentists have widely varying policies for retreatments/replacements of
procedures/restorations.

Quote:

> 7. Are dentists themselves insured against complications happening
> after various procedures, allowing patients to be re-treated at no
> cost to the patient?

Only by themselves.  Retreatments cost the dentist money.

Quote:

> 8. What percentage of U.S. {*filter*}s have missing, or malformed, molar
> roots, and how often are roots unable to be located during a root
> c{*filter*}procedure? Where might I find such statistics if they are
> recorded?

Probably in some endo texts somewhere.  MB-2's are not in the "missing,
malformed" category.  They are simply a secondary small c{*filter*}that is
very often present in upper molars.

Quote:

> 9. Is there any firm criteria as to when a dentist gives up the search
> for a root during a root c{*filter*}procedure, or is this a gray area?

Pretty gray.

Quote:

> 10. Like when they dentists say things like "this may {*filter*} a little"
> when they do the injection, is there any "code of practice" stating
> that Dentist-B should have told me during my initial root c{*filter*}that
> he was looking for a fourth root, but could not find it?

At least you had a dentist that was aware of the MB-2 c{*filter*}and tried to
find it.  Some do not (though the vast majority of endodontists do).

If I ran a narrative of the entire treatment with all of the possible
complications as I was working, it would scare the heck out of ME, much
less the patient <g>.

Quote:

> 11. Should I have asked Dentist-B ahead of time, before the initial
> procedure got started, "What can I/we do, if this root c{*filter*}doesn't
> solve the problem?" or "How many years should I be trouble-free"? Or
> are patients not expected to know all the questions, and this
> information should be provided, or made easily accessible to the
> patient, by the dentist?

It's nice when the patient and dentist communicate and understand the
expectations, fees, and possible complications before treatment is
begun.

Quote:

> 12. Under what circumstances would Dentist-B be liable for the cost of
> replacing the crown, even though he only did the root canal?

I didn't read close enough to be sure.  Basically, I retreat any of my
own endo's free if there is a problem.  If I have a failed endo that I
have to refer, I usually refund my original fee.  That's just my policy,
not a rule for other dentists.  When a friend of mine crowned one of my
own teeth and it ended up with a root canal, I just had the endo access
opening filled with composite.  No new crown yet after 2 years.  I also
paid for the endo without trying to blame my friend for causing it in
doing the crown.

Quote:

> 13. Has any person reading this had experience of a root c{*filter*}still
> causing pain after a few months, with it needing to be re-done - and
> also possibly a new crown needing to be drilled and replaced?

Yes.  Stuff happens.

Quote:

> 14. I am no longer insured with the insurance company that paid for
> part of both procedures.

Probably irrelevant.
Quote:

> Happy New Year, Simon.



Mon, 21 Jun 2004 22:27:17 GMT
 Root Canal - Possible Root Remaining
Just a thought here... if you are considering changing dentists and do this
often, what incentive does a dentist have to keep you as a good patient?
Getting work redone like this is something the dentist doesn't have to do, but
*may* do if he sees you as a desireable patient.

Best regards,
LadyAndy2 in Los Angeles, CA (remove "nospam" to reply)
Check out our website too--do you love oak furniture?
http://www.barnfurniture.com  



Tue, 22 Jun 2004 08:44:48 GMT
 Root Canal - Possible Root Remaining
Hi, my two cents (half a penny US$)
Sometimes completing 3 of the 4 canals in an upper molar works clinically
for many years.
By clinically I mean free of symptoms.
All root canals have the potential for failing.
Some fail after many years, others after a short while. Every dentist I know
takes pride in their work and wants it to go well. Discuss the fees up front
with the dentists, if the 4th c{*filter*}is found and filled by the same dentist
I would expect to pay for the single c{*filter*}and not a 4 c{*filter*}retreatment,
but ask him about his policies.
Structurally, the crown should be OK, the "value" of a crown in my opinion
is protection of the cusps (sides) of the tooth from fracture. An access
opening through the top of it won't compromise that.
Good luck
Rob


Wed, 23 Jun 2004 18:48:06 GMT
 Root Canal - Possible Root Remaining
What kind of failure? i had a root c{*filter*}done in my upper canine 5 years ago.
Now, in the corner of my nose, where it meets my upper lip, I can feel sort of
an air/liquid sac, that when I massage it long enough it goes away and so does
the congestion of my nose on that side. Xray shows no infection, but isn't it
still possible to have infection and it not show? Maybe the rod in the tooth
has penetrated? Air sac? I don't know. Please help. Thanks

<< All root canals have the potential for failing.
Some fail after many years, others after a  >>



Thu, 24 Jun 2004 03:59:23 GMT
 
 [ 6 post ] 

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