Such conservative treatment really necessary?

[marynyc]

So, I had nearly a month between my root canal appointment and the other large filling I needed to have done. A complication now is that I found out I am pregnant. It's still very early so I had to get approval from my DR for the dentist to do the filling.

Otherwise, it went well, except that she stopped and said it also needs a root canal (which is becoming a pattern and I'm starting to not trust her since with 30+ years of experience and being faculty at Columbia University, shouldn't she be able to tell if it's that bad before she starts and puts me through EXTRA appointments??). She said the root isn't exposed and there's no infection but she thinks because the cavity is too deep.

Is there ANY way to avoid the RC? It's not because of anxiety, because I'm working on that actively and trying to be proactive, but it seems so counter intuitive to me if there is ZERO pain, the root isn't exposed, there is no infection - why kill perfectly good tissue???? She put a temporary filling in again and I see her next week to work on the crown for the other tooth.

In the meantime, I am seeing a midwife this weekend and I am 100% sure she's going to say soemthing as extensive as a root canal, especially one that's not emergent, needs to wait until after I have the baby. Regardless, the original RC/crown and this filling alone, put me at my insurance limit of $1500 for the year so we wouldn't even be able to afford to do another RC this year anyway.

She refused to put a permanent filling in yesterday but next week I think I will ask her to do that until the baby comes because I wouldn't be able to do the RC anyway.

However, the question I have, is it even necessary? Is it worth having a second opinion? She said she is very conservative with treatment but this conservative-ness just seems like it's going to do more harm than good here. It's tooth 18 and I have all my wisdom teeth so it's second from the back.

Is it worth trying to get a second opinion about? Will she even do a regular filling in the meantime? because these temporary ones are crap and scratch up my tongue :/ Other than the injection site (way in the back of my jaw, ugh) pain keeping me from opening my mouth much, I don't have any pain - not even sensitivity to hot & hold, on that tooth.

 

[MountainMama]

I would get a second opinion for sure. I can't even imagine an endodontist would do a root canal without it testing positive for root issues.
I had a crown replaced that ended up needing a root canal, due to a deep filling, but the dentist wanted me to wait until it actually started hurting before she referred me for a root canal. Then the endodontist put me through a seriesof tests to determine if I needed one.
A month later I had another molar that needed a deep filling. The dentist put a desensitizing gel on it, and went ahead and filled it, and told me to let her know if it still hurt. A week later it hurt, but she put more desensitizing gel and told me to wait. Two weeks later, still hurting, and the dentist tested it with endo ice and percussion, and it didn't show up as an issue. So my filled tooth has been aching for three months and still doesn't need a root canal. So I can't imagine yours would need one.

 

[grumpybear]

A deep filling can be traumatic for the nerve and irritate it. Sometimes the nerve doesn't recover, sometimes, it does. Also, I have read that in a deep cavity, bacteria can travel beyond the site of the cavity and into the nerve and when that happens the nerve cannot recover and will begin to die. Hence it maybe why your dentist cannot tell for sure because sometimes it does heal and I'm not sure if the dentist can really predict with certainty or even see if the bacteria have started to "travel out".

That said, I certainly would opt not to jump into getting a root canal and wait it out. I second getting a second opinion.

 

[marynyc]

Thanks to both of you.

What is endo ice?

I don't know if I should see someone in the same practice, or someone else - I worry someone in the same practice may just agree with her without question but finding a whole new place could be a hassle. Right now there is mild sensitivity to cold - like any other filling I've had - but no pain when chewing, etc.

Regardless, I won't be able to get a root canal even if it really is needed, until June or later, because of my pregnancy. Since it's clearly not urgent (infect, exposed, etc), then I wouldn't take that risk.

I'll start calling around and see what I can find out.

 

[grumpybear]

Endo ice is basically a spray used in a cold test. The dentist or endodontist sprays some of it onto a ball of cotton and then place this cotton on the suspect tooth to test for a reaction or response from the tooth.

I'd say to get the second opinion from someone outside of the practice. If possible, you could also get the second opinion from an endodontist.

 

[MountainMama]

I was referred to an endodontist for my tooth. The dentist first checked it by tapping on the surrounding teeth and that tooth, to see if it hurt. Then he used the endo ice. When neither of those tests were abnormal, he referred to the endodontist. The endodontist did the same tests, plus an x ray and said it wasn't ready for a root canal.

 

[marynyc]

Thanks, that's helpful. There's no pain when I bite on it, I've been chewing normally since the anesthetic wore off. I'd say, it took longer for me to get numb with this (she did an injection way in the back of my jaw - I was numb up to my ear but it took ages for my actual mouth to get numb) and so although I didn't feel pain for much of it, there were times when I sort of knew she was in there. Like it wasn't quite numb enough but it didn't hurt. It's hard to describe - she claimed because of this, that meant it needed a root canal.

I dunno, when I tap on them, none of my teeth hurt, including this one. I've started contacting dentists for second opinions - waiting to hear back from the in-network ones. One out of network wanted $175. Ha!

 

[MountainMama]

Thanks, that's helpful. There's no pain when I bite on it, I've been chewing normally since the anesthetic wore off. I'd say, it took longer for me to get numb with this (she did an injection way in the back of my jaw - I was numb up to my ear but it took ages for my actual mouth to get numb) and so although I didn't feel pain for much of it, there were times when I sort of knew she was in there. Like it wasn't quite numb enough but it didn't hurt. It's hard to describe - she claimed because of this, that meant it needed a root canal.

I dunno, when I tap on them, none of my teeth hurt, including this one. I've started contacting dentists for second opinions - waiting to hear back from the in-network ones. One out of network wanted $175. Ha!

That is silly about feeling awareness meaning it needs a root canal. If that was the case all my teeth need root canals.

I hope you can get in somewhere else

 

[marynyc]

An update: I had a cold and couldn't breath through my nose on the day of my last appointment (Sept 13) so they rescheduled it...for October 30! The earliest she could see me.

So now the temporary filling has been in for about 3 weeks and is definitely uncomfortable & has shifted. I called to see if I can get in sooner, and they said October 11. I called a second opinion dentist to see if she thinks it needs a root canal, and I will see her this Thursday afternoon. When I called the office, the doctor is the person I spoke to so that was reassuring. I'm so frustrated by how long this takes but understand this is a busy time of year with the end of the year approaching and everyone rushing to be seen.

Here's hoping I get an informative second opinion on Thursday. She seemed shocked my dentist won't see me sooner when the temporary filling is bothering me so much. I can't even floss between the two teeth because I'm worried it'll come out and it's literally right up against the other tooth in front of it on the edge, so I just know food is probably getting stuck :/

 

[marynyc]

Also, any of the mild post-cavity-filling cold sensitivity I had, has completely gone - even with the wonky temporary filling. I see this a positive!

 

[MountainMama]

Also, any of the mild post-cavity-filling cold sensitivity I had, has completely gone - even with the wonky temporary filling. I see this a positive!

That is definitely a positive! Usually increased sensitivity that lingers is indicative of needing a root canal. So that is good news! I hope your appointment goes well and you get good news.

 

[marynyc]

Well, my second opinion visit was both good and bad.

Good: I loved her - she was fantastic. Kind, generous with her time (busy time of year with everyone getting cleanings in before the end of the year when insurance resets). I had sent her my xrays last night and she looked over them as best she could in the format my dentists office sent them, and she said had I been seeing her, she never would have touched the tooth herself, but sent me right to an endo. That's the bad - she thinks it definitely needs a root canal - she'd advise it be done ASAP. In lieu of the cost (my biggest concern) she said I could wait until January if it was asymptomatic with the temporary filling and although it may be annoyed to me, she doesn't think food is getting stuck and my dentist should be able to polish down the rough edge.

As for everything else, she said she only sees one other cavity - meaning I had 3 total areas of concern. She examined all my teeth, etc. My dentist said 5 total cavities. This new one though, went through the xrays with me and showed me on there and talked to me like I was more than just a set of teeth, which was really nice.

She won't touch this tooth herself because my dentist already started it, but I plan to ask her for an endo recommendation since the last one was so awful, for once I am done with my pregnancy, or it becomes symptomatic. She advised I prioritize this root canal + the other filling and hold off on the crown for the other tooth in January when insurance resets.

However, I am super concerned with my ability to sit through a root canal on a molar. My other one was maybe 35 min after I was numbed, but it was a bicuspid. Molars are more complex. I am 7 weeks pregnant and I can barely go an hour without needing to use the bathroom, and I am very nauseated all the time. They can't exactly stop working and let me go pee in the middle of a root canal! Not to mention stuff in my mouth while I feel nauseated.

So, I feel disappointed that it's needed but I'm coming to terms with it - I just don't know how I'm going to manage it (financially or physically) before the baby comes.

 

[MountainMama]

Well, my second opinion visit was both good and bad.

Good: I loved her - she was fantastic. Kind, generous with her time (busy time of year with everyone getting cleanings in before the end of the year when insurance resets). I had sent her my xrays last night and she looked over them as best she could in the format my dentists office sent them, and she said had I been seeing her, she never would have touched the tooth herself, but sent me right to an endo. That's the bad - she thinks it definitely needs a root canal - she'd advise it be done ASAP. In lieu of the cost (my biggest concern) she said I could wait until January if it was asymptomatic with the temporary filling and although it may be annoyed to me, she doesn't think food is getting stuck and my dentist should be able to polish down the rough edge.

As for everything else, she said she only sees one other cavity - meaning I had 3 total areas of concern. She examined all my teeth, etc. My dentist said 5 total cavities. This new one though, went through the xrays with me and showed me on there and talked to me like I was more than just a set of teeth, which was really nice.

She won't touch this tooth herself because my dentist already started it, but I plan to ask her for an endo recommendation since the last one was so awful, for once I am done with my pregnancy, or it becomes symptomatic. She advised I prioritize this root canal + the other filling and hold off on the crown for the other tooth in January when insurance resets.

However, I am super concerned with my ability to sit through a root canal on a molar. My other one was maybe 35 min after I was numbed, but it was a bicuspid. Molars are more complex. I am 7 weeks pregnant and I can barely go an hour without needing to use the bathroom, and I am very nauseated all the time. They can't exactly stop working and let me go pee in the middle of a root canal! Not to mention stuff in my mouth while I feel nauseated.

So, I feel disappointed that it's needed but I'm coming to terms with it - I just don't know how I'm going to manage it (financially or physically) before the baby comes.

I am so sorry to hear you need a root canal, but good that you found a dentist you like!

You can ask the endodontist to split the appointment between two visits. My root canal was on my 2nd molar, the most complex one, and it was a difficult one with twisted and fused roots. My first appointment was an hour, and would have been shorter if she hadn't had to double check all the root measurements due to the fused roots. I am glad she took the time, though. The second appointment was only half an hour.

If you are not having symptoms, and need to wait for finances, I understand, but just a thought: will it be more difficult later, as your pregnancy progresses, to sit through it if it becomes a problem? If finances are an issue, maybe they can work out a payment plan?

 

[marynyc]

Honestly, even one visit is so stressful, the thought that it could be 2 is so nerve wracking to me. I am already concerned about the stress all of this is putting on my pregnancy. Having to go for multiple appointments just makes it worse. But then, I may not have a choice and once they start they can’t just let me go run to the bathroom. And needing breaks for waves of nausea will make it an even longer appointment.

The discomfort of the entire thing (keeping my mouth open & TMJ symptoms, injections, hands in my mouth while I’m nauseated, the dental dam, the smells since I’m so sensitive right now) has me even unable to sleep now. I woke up at 3am and haven’t been able to get back to sleep and now it’s 4:30.

My husband won’t even let me think about just pulling it since it can be saved. I’m just so exhausted by all this. The X-ray doesn’t show the root on that tooth so I can’t even look to see if it’s twisty.

Not to mention the first endo I saw was so awful that I was just retraumatized by my only other root canal experience. I’m a mess all over again. I was starting to feel empowered taking care of all this but now I just feel beaten down and like it’ll never be fixed and it’s all my fault anyway so I deserve the discomfort

 

[MountainMama]

Honestly, even one visit is so stressful, the thought that it could be 2 is so nerve wracking to me. I am already concerned about the stress all of this is putting on my pregnancy. Having to go for multiple appointments just makes it worse. But then, I may not have a choice and once they start they can’t just let me go run to the bathroom. And needing breaks for waves of nausea will make it an even longer appointment.

The discomfort of the entire thing (keeping my mouth open & TMJ symptoms, injections, hands in my mouth while I’m nauseated, the dental dam, the smells since I’m so sensitive right now) has me even unable to sleep now. I woke up at 3am and haven’t been able to get back to sleep and now it’s 4:30.

My husband won’t even let me think about just pulling it since it can be saved. I’m just so exhausted by all this. The X-ray doesn’t show the root on that tooth so I can’t even look to see if it’s twisty.

Not to mention the first endo I saw was so awful that I was just retraumatized by my only other root canal experience. I’m a mess all over again. I was starting to feel empowered taking care of all this but now I just feel beaten down and like it’ll never be fixed and it’s all my fault anyway so I deserve the discomfort

I am so sorry! My endodontist is amazing, which made all the difference. I can't imagine going through that while pregnant. I had severe morning sickness and was nauseous all the time. Has your doctor prescribed odansetron? It is an anti-nausea and works wonders! It helped me be able to keep working.

I don't know how much things cost where you are, but you should look into the cost of an implant. I had always heard how expensive they were, but after my root canal failed, I ended up having to have a retreatment, and honestly I could have bought an implant for the cost of the root canal, retreatment, and crown (if the tooth settles). I have another molar on the bottom that is infected now, and I am pulling it and getting an implant. It is actually cheaper than the root canal and crown, and I pay in stages, so it gives me time to save up.

 

[marynyc]

I haven’t seen my midwife yet and won’t until 10 weeks. I’m not even vomiting, just constant nausea.

I live in NYC so implants are astronomical. My husband has to have a tooth pulled because it fractured under his crown and they just gave him the treatment plan printout with the extraction and implant on it as though it was a given and the implant alone was nearly $4,000 - and our insurance doesn’t cover implants at all because it doesn’t deem them medically necessary.

Whereas a root canal is covered to 60% and my other one cost about $900 so we paid a portion of that out of pocket already, not counting the crown, which will likely be another $500ish. I had a tooth pulled five years ago and will likely never get an implant for it. Who has that kind of money?!

 

[MountainMama]

I haven’t seen my midwife yet and won’t until 10 weeks. I’m not even vomiting, just constant nausea.

I live in NYC so implants are astronomical. My husband has to have a tooth pulled because it fractured under his crown and they just gave him the treatment plan printout with the extraction and implant on it as though it was a given and the implant alone was nearly $4,000 - and our insurance doesn’t cover implants at all because it doesn’t deem them medically necessary.

Whereas a root canal is covered to 60% and my other one cost about $900 so we paid a portion of that out of pocket already, not counting the crown, which will likely be another $500ish. I had a tooth pulled five years ago and will likely never get an implant for it. Who has that kind of money?!

Yikes! That is expensive! Mine is about $2000 total for the extraction and implant. My insurance doesn't cover it either. Then the crown is covered at 50%.

 

[marynyc]

Updating this thread so there’s back story instead of starting a new one:

Now that I’m well into my second trimester and it’s the new year so my insurance has reset, I solicited recommendations for a good dentist (skill & bedside manner!) to do the second root canal - since the first was so traumatizing with that dentist.

A local mom friend recommended a dentist but he isn’t an endodontist. He does take both my and my husbands plan so the out of pocket costs would be very low, if anything, which is a big draw.

Is it better to find an endodontist or is a good general dentist just as capable? My dentist already went in and cleaned it out and it’s had a temporary filling since October (so I don’t want to wait much longer to get it taken care of really). But she doesn’t do them and he is the ONLY person that does root canals in that entire office, so I’m not going back.

Now to just give myself a pep talk to get back into it and not let the anxiety overtake me!

 

[MountainMama]

I am glad your tooth held out until your insurance rolled over! I would definitely go to an endo for a molar root canal. They can be tricky with the roots and the endo has a microscope. My dentist will not do root canals in molars at all.

 

[grumpybear]

I would also say to go to an endodontist for a molar root canal. Molars have more canals and accessory canals which can be tricky to locate and access without the help of a microscope. Endodontists do root canals exclusively so they have alot more experience than a general dentist in this area. If it's a front tooth or smaller teeth, I think the general dentist is fine.