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Dentistry/two opinions


I have a dentist that I trust. I had a chip off of a tooth and I went to him. He told me that he could see the nerve but that the nerve was not effected and he thought I could avoid having a root canal, but I would need a crown. He built up the tooth and I went back after 6 weeks to see how it was doing. There was no pain and the build up held up. However, he wanted 1300 dollars for a crown. I said I would have to check around because I am in a very big money hole and he agreed and said he understood.

I went to another dentist who advertised cheap crowns and he did a "cold test". He said he thought that I needed a root test because he said I flunked the cold test and therefore the tooth was dead. It has no been 7 1/2 weeks and there is still no pain. The new dentist wants me to go to a specialist to verify the tooth is dead. I think he knows I trust the other dentist so he is getting as second opinion to verify his. I dont know this other dentist. As you can tell I dont trust a lot of dentists and am afraid of getting unneeded Dental work. What should I do? Trust the cold test from an unknown dentist or trust my trusted dentist?

Hi Bill and thanks for your question which I am answering from the question pool.

I fully understand your confusion with he situation, because the truth is that although dentistry is an exact science, the interpretation therefore is left up to humans, where inevitable differences occur as to what the best treatment is. No 2 clinicians work alike and we all have discovered, with time and experience, what treatment modalities work best in our hands and which do not. Getting a second, or even a third opinion, is never a waste of time and should be seen as your desire to get the correct treatment for you that you are most comfortable with and which you are certain that you need - and understand why you need it. In today's economic climate it can do no harm to shop around for comparative prices - the only problem is that this becomes quite a mine-field as prices vary greatly due to the vast array of materials used, which affect the the laboratory fees quite substantially.  The other down-side, is that you may well find a cheaper crown but don't necessarily trust the dentist from whom you obtained the cheaper quote.  As far as I'm concerned, the most important aspect of dentistry is the patient-dentist relationship and developing that is the key to your success during every treatment. Every hitch and unforeseen problem can be overcome quickly and effectively when the patient trust the dentist and believes that those are the hands which are healing him.  Likewise, breakdown of this relationship brings forth a multitude of problems and at that stage, the best option would be for the patient to find another clinician whom they can learn to trust again.

That being said, back to your problem.  The truth about vitality testing, is that the results have to be interpreted correctly and never used in isolation to base a diagnosis on.  There are 3 vitality tests - hot, cold and electrical and all these 3 have to be performed on the suspected tooth and the results interpreted as compared to a "standard norm" for you - which can be taken as an otherwise healthy, unfilled and "virgin" tooth, preferably not in the same quadrant as the suspected dead tooth. Using only 1 test to base a diagnosis of non-vitality is pretty brave and even I would question the validity of the results, although it may give an indication of some underlying pathology.  

To give yourself the peace the mind you deserve over this matter, you could get a referral to see an endodontist, a root canal specialist, who would be the best person to advise you further, because once the root canal has been performed, the tooth should be crowned within 6 months to prevent fracture of the now-weakened and more brittle tooth. You could also simply discuss this matter with your original dentist, whom you trust and don't worry about having a second opinion - it's pretty normal and acceptable practice and won't be taken as insulting behaviour. You have to get the peace of mind that what you are having done is vital for you and you must be happy with the terms of the treatment, including the cost thereof. In order to get that peace of mind, you must believe that you are in the best hands for the best reasons, without feeling cheated in anyway - and that includes financially.  You could always discuss these concerns with your dentist and even arrange a payment plan, possibly split over time or with some deposit in advance.  Either way, your first task is to get an accurate diagnosis on the vitality and health of the affected tooth, because it makes no sense to crown a known non-vital tooth because the long-term prognosis of the tooth has not yet been established, which is greatly affected by the integrity of the root canal seal obtained after treatment.

I hope this helps and wish you a speedy and uneventful resolution of this matter. Best of luck and I have no doubt that you will choose what is best for you, because without doing that, you are doing yourself a personal injustice.  Take care

Kind regards
Dr Craig Peck.  


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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)


I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.


I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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