Root Canal and Rubber Dam

[Mercedes]

I had to have a few emergency NHS dental appointments last week as I had really bad toothache on a deep filled bottom pre molar. The dentist I saw eventually removed the nerve and touch wood its been okay since then. I went back today to see my regular dentist who is doing a private partial upper denture for me and I was asking about what the protocol is at the practice for using a rubber dam when doing root canals as apparently that's what I now need on the tooth in question. I was surprised when my query was met with an uncertain response, as if I were asking for something not usually requested. The answer I got was that it's a 'clinicians decision' whether to use one or not and they will ask the dentist I am seeing if she is prepared to use one.
I'm just wondering if I'm being unreasonable in asking for her to use one as I've had 2 root canals done in the past by an endodentist and both said they wouldn't consider not using one. I have read the NHS guidelines and they seem to suggest a dentist should use one, so why isn't it considered normal practice? In an ideal world I'd just go and see an endodontist again, but after just paying out £900 for the partial plate I really can't justify paying out the prices I am seeing online for a referral and treatment with an endodontist.
I just wonder if I am being unreasonable expecting this on the NHS or not and can I really trust an NHS dentist to even attempt a root canal considering they don't have the same equipment that an endodontist has.
Thanks

Lyn

 

[letsconnect]

Hi Lyn, yes, using a rubber dam is the standard of care. Unfortunately NHS dentistry is pretty stretched so things are not always done to the standard of care - there's often simply not enough time allocated, especially to something as intricate as root canal treatment. Sadly, it's not unusual for corners to be cut to save time. If they don't use the rubber dam and the treatment fails, you can follow the steps outlined here:

How to make a complaint or get a refund

Make a complaint about dental care, services or treatment or get a refund. 1. complain to the dentist or practice. 2. Contact the NHS or Dental Complaints Service. 3. Go to the health ombudsman or a solicitor. Our guide explains the dental complaints process.

www.gdc-uk.org

I don't think you're being unreasonable expecting this on the NHS, but going by their reaction, I personally wouldn't trust them to complete the treatment. If you can afford it, an endodontist would likely have a higher success rate for a bottom premolar.

 

[Mercedes]

Thanks for the reply. I went back to the dentist today and she did use a rubber dam for the procedure. I thought it would all be okay as when she had done the xray she was positive it was a very straight root and wouldn't need a referral. However at some point she mentioned that there was in fact a slight kink at the end of the root, which I assume hadn't shown up on the xray. So she tried her best and put a temporary filling in and I have to go back in 3wks. However she didn't manage to get down to the very tip of the root so I'm not really feeling very optimistic and now wish I had gone to an endodontist. I'm worried it's going to flare up again, worried that we have Easter in a couple of weeks and no dentists will be open during that time. I'm not sure whether to try and see an endodontist instead of waiting for that appointment or just ask her to take the tooth out. It's not a big tooth but I don't have a tooth the other side of it, so it will create more of a gap. I know the success rate of redoing a root canal isn't as high so I'm a bit disappointed with it all.

Lyn

 

[letsconnect]

Good to hear that she's conscientious and did use a rubber dam , it seems to be depressingly commonplace these days for NHS dentists to take shortcuts.

Sorry to hear she wasn't able to get down to the tip - apparently bottom premolars can be a bit tricky, with unexpected kinks. Sounds like she did her best but it's a trickier job than anticipated. I suppose it all boils down to how much you want to keep this tooth and whether it's financially viable... if this is the route you'd like to take, then trying to see an endodontist instead of waiting for the next appointment (or at least getting their opinion on the chances of it being successful) would seem the logical next step?

 

[Mercedes]

Good to hear that she's conscientious and did use a rubber dam , it seems to be depressingly commonplace these days for NHS dentists to take shortcuts.

Sorry to hear she wasn't able to get down to the tip - apparently bottom premolars can be a bit tricky, with unexpected kinks. Sounds like she did her best but it's a trickier job than anticipated. I suppose it all boils down to how much you want to keep this tooth and whether it's financially viable... if this is the route you'd like to take, then trying to see an endodontist instead of waiting for the next appointment (or at least getting their opinion on the chances of it being successful) would seem the logical next step?

Thanks for the reply. I was thinking the same, even though it's not a big tooth I really would rather keep it if I can. I'd rather not spend a lot of money, but as the tooth is if I stay with the NHS dentist it's either pay out more for the crown, which may fail or like you say go and see an endodentist. I don't think I can just carry on with the temporary filling as it's on the side of the tooth rather than in the middle so quite fragile I imagine. I had a couple of other teeth done at a private dental practice in Northwood, Middx and looking on their website they seem very well qualified, so I was thinking, as you suggested, about just going for a consultation to see what they think.

Lyn