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Dr.Hans
Dr.Hans, Masters of Dental Surgery
Category: Dental
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Experience:  11 years of clinical experience in diagnosing and treating problems in oral and dental health.
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I had decay under an old filling. The dentist I had been seeing

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I had decay under an old filling. The dentist I had been seeing put a temporary filling in to try to save the tooth. When it started bothering me again a couple of months later, I got a second opinion and some antibiotics, then a third opinion. Both the other dentists said it was too late to save the tooth and that it needed to be pulled, implant, etc.
HiCustomer Thank you for asking your question on Just Answer.


While i was writing your answer and i was half way through, i realized that there were few things which dint come clear in your first post, so could be reply back these queries before i can answer you:

1) Didn't other dentists mentioned about saving the tooth by root canal therapy ?

2) As you told that the tooth is not hurting now- do you still have that temporary filling in there?

3) Did your dentist take the x-ray of the involved tooth at the time of removing the old filling?


Thank you again for trusting us with your problem. Please reply as soon as possible so that we can finish answering your question.
Customer: replied 8 years ago.

Answers:

 

Question 1:

 

All three dentists mentioned the possibility of a root canal.

 

Dentist # XXXXX referred me to an endodontist who took an x-ray and said it would be impossible to do a root canal because the canal(s) were calcified.

 

Dentists 2 (i.e., second opinion, but not in my dental plan) said that the tooth had canals, abeit narrow ones, but that the decay was too far advanced to save the tooth.

 

Dentist 3 (3rd opinion) said the same thing and referred me to an implant guy, who explained the process. I already know the process, because I had an implant in the adjacent tooth, which Dentist 1 crowned. I am still paying (different implant guy) for the first implant, completed 2 years ago.

 

Question 2:

Yes, the temporary filling is still there. When the dentist put it in, he said if it didn't bother me after a while he could do a permanent filling. However, he blew me off when I called to say I was having discomfort in the tooth area and felt generally sick--said that if my face wasn't swollen, it wasn't an abcess. He has never followed up to see how I'm doing or to schedule the permanent filling. It was a few weeks in between the temporary filling and when it started to bother me, although it was very sore for several days after the temporary filling.

 

Dentist No. 2 said that it was infected and prescribed the antibiotics. I scheduled an extraction, but cancelled after checking with my dental plan and finding that although the dentist accepts my insurance, he isn't in the plan, so I pay more and have to pay up front for every procedure.

 

I got a list of providers in my plan and checked their reviews. Dentist # XXXXX the one I ended up with, is in his 60s and well respected in Washington, DC. He doesn't need to be in my dental plan to build up his practice but retains the affiliation as a community service.

 

Question 3:

 

Yes, of course the dentist took x-rays at the time. It is inconceivable to me that he wouldn't have known when he put in the temporary filling that there was still decay and that the tooth could not be saved. Or, am I wrong about that?

 

He's a nice guy but he also did the soft tissue procedure that I mentioned and neglected to have it biopsied. Therefore, my insurer did not pay him and the $500 fee is showing up on my bill. I found out that he was required to do the biopsy to be paid by the insurer by calling my plan. When I spoke with him today he said he was still trying to get them to pay somthing, and told me not to worry about it.

 

The worst part is that I'm now having another problem in the same place--a lump or lesion on the inside of my lip. Dentist # XXXXX said I would need to go to an oral surgeon to get it taken care of.

 

What do you think? I realize this is more than one question and I am willing to pay another $15 to get some professional guidance.

 

Will not be home to check my computer for answers until about 10:00 pm

 

Thanks,

 

Perry Frank

XXX-XXX-XXXX home

XXX-XXX-XXXX cell

XXX-XXX-XXXX work


Hello and welcome to just answer.

I am sorry about the delay in response..I actually have been quite busy whole day and I needed good amount of time to read your reply.Thank you for the detailed information.I wish many patients at JA or even otherwise provide the detailed history the same way.


Coming to your queries,Lets discuss them one by one.



1) First, how bad is it that my regular dentist didn't catch this problem after doing x-rays of adjacent teeth while putting on a crown?


It is inconceivable to me too that your dentist missed the decay on the x-rays. Even if the canals were calcified and there was no possibility of him doing the root canal, he would have referred you right away to the Endodontist at the time instead of filling the tooth by temporary material.


When a root is calcified, that means your dentist was unable to locate and/or negotiate that root. However, if it is TRULY completely calcified, that is sort of Mother Nature’s way of doing a root canal. Usually, however, there is still a microscopic channel that is just not able to be treated.


The treatment of calcified canals involves several additional visits just to locate the canals. After which EDTA (Ethylenediaminetetraacetic acid), a synthetic amino acid is used to dissolve the calcified blockage in the obstructed canals. It is applied to the inside of the tooth where the openings of the canals are and the patient is recalled after a week to complete the procedure.


However if the blocked or calcified canals could not be instrumented during initial or retreatment, Endodontic surgery may be used to clean the rest of the canal where the infected tissue is removed from the end of the root.



2) How common it is to try to avoid pulling a tooth with a temporary filling even if all the decay can't be taken out because it's too close to the pulp?


A tooth which has an infection can get symptomatic anytime giving rise to sharp shooting pain and other symptoms like abscess/pus formation .An abscess itself is a serious manifestation which can give rise to various complications in future.



3) He hasn't followed up at all--I just called him and he said if it needed to be pulled we could work out a payment plan. This same dentist removed a soft tissue lesion inside of my lip, but he didn't have a biopsy done so the insurer won't pay.Should I ditch this dentist? One of the dentists I saw for another opinion is in my plan and is very well-respected.


I would also suggest you change your dentist as you probably do not trust the existing one, In such a case going back to him and getting treatment done will be difficult for you and you won't be comfortable at all. You will always have some fear in your mind which is just not worth it.The fact that he has not called you for a recall visit and neglected it to have the soft lesion biopsied which created problems in your payment plans alone argues for a different approach and for you to search for another dentist who re-assures you and at the same time guide you about the proper treatment plan.As you said that the 3rd dentist you found is well known and getting treatment done for him will be feasible for you! Also as you have a good communication with him, i am sure he will comfort you at his best!





I hope this helps!

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Dr. Hans

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