Dentistry/Root Canal Therapy
QUESTION: Dear Craig, ( I hope my use of first names is OK, I have written before)
Re: Root Canal Therapy
Thank you so much for your very kind words in your last email to me. May I please ask you a follow up question to the problem I wrote to you about on the 20th July 2013. [I have pasted my initial query (along with your reply) at the bottom of this message for reference.]
Following the appearance of an abscess, I am due to have root canal therapy (on an upper premolar) this Friday, (15th of August); and I have a follow up appointment also booked for the completion of the treatment on the 22 August.
I was given a prescription (Amoxylin I think) after the problem was first diagnosed, about a month and a half ago - which cleared up the swelling from the abscess. But a few weeks later the abscess returned (as the dentist's receptionist said it was likely to do) and I was given a new prescription (this time for Erythromycin). This prescription ended yesterday - and I am not sure if I should ask for a renewal prescription before treatment starts this Friday, a little swelling seems to remain? But my main question comes a little further down in this message.
I am very fearful that the dentist will say that he needs to remove the tooth. I had read, on Wikipedia, that there are alternative solutions that could be considered if root canal therapy is not recommended, and would like to try all that I can to save the tooth. I would not be able to afford a bridge if the tooth was removed. And a removal of a molar in childhood was the worst experience of my life - that lasted many months, and affected my self confidence.
I have been very concerned that my dentist does not seem very caring - he is not communicative. I only learned from the receptionist after the last appointment with my dentist, that my dentist would be away on holiday, and that a delay of more than a month would be involved. And it was also the receptionist who told me that the infection was likely to return after the first treatment. I would have wished that the dentist could have explained and reassured me of these points - but he did not indicate that there would be any delay. After the infection returned I called the dental surgery and the receptionist gave me a new prescription. In part my first fear was that a drug resistance would result from the need for a return prescription (part of my reason for first writing to you) as the receptionist was not someone I wanted to ask.
As a result of my concern I have arranged, after the treatment is completed on the 22nd of August, to move to a new dentist. After a recommendation I was advised to book an early appointment with the recommended dentist (to secure an UK NHS place), so I will be seeing him on the 27th of August for a our first 'routine' appointment. I do not intend to tell my current dentist that I am moving dentists, until the root canal therapy is completed. My main question is if my current dentist says he wants to remove the tooth can I say no and wait to see my new dentist on the 27th -- to at least get a second opinion? Is there another treatment I can ask about if the dentist says root canal therapy will not work? Can I ask either dentist to try root canal therapy even if he thinks it will not work? And should I ask for a new prescription before this Friday?
Thank you so very much,
My first question from 20th of July was:
"I am due to have root canal therapy on August 15th. Following an appointment with my dentist (a couple of weeks ago) I completed a 5 day course of antibiotics (for an abscess) one week ago. I am concerned that the appointment for root canal therapy is more than a month after completion of the course of antibiotics (my dentist is on holiday and there is no appointment available sooner). I do not want to loose the tooth. Is there reason for concern with the long delay? Should I try to go somewhere else for earlier treatment if at all possible? Does the delay risk unsuccessful root canal therapy? The first sign of the problem was from a temporary pain in the tooth about a month and a half ago - but an xray taken at that time did not reveal an infection and my dentist suspected a "strained ligament." The abscess appeared a few weeks later. Thank you so much!"
and your reply was:
"Hi Andy and thanks for your question.
What has been advised seems within normal limits for root canal treatment. Remember that the antibiotics have effect in clearing up the current infection and their action lasts much longer than the duration for which you take them. Even if there is some residual infection present in the tooth when root canal is started, this won't have any marked no the proposed treatment plan and the root canal can go ahead as planned. It might just mean that the root canal may need an additional appointment to complete, during which time the tooth is medicated from within to completely remove any and all signs of infection - but this your dentists will be able to give you a better idea of once the treatment has started and the degree of infection can be ascertained once the tooth has been "opened up" properly. So, I wouldn't worry about the month which you have to wait too much. Obviously, if the infection and pain symptoms return during this waiting period, then contact the surgery and let them make alternative arrangements or at least get the situation evaluated until your official appointment.
I hope this helps and wish you all the very best further and a speedy and uneventful root canal treatment ahead. Take care.
Dr Craig Peck"
Thank you again!
ANSWER: Hi Andy and thanks for your question.
Firstly, let me express my sincerest of apologies for my horrific late reply to this question, but I have in in hospital for a chronic ailment that flares up from time to time, without warning. My only regret is that I have let you down and I only hope that will be able to find it in your heart to forgive my "abandonment" of you in your hour of need.
I take it that you have seen your dentist in the interim for the root canal treatment. Please feel free to continue with your questions and allow me to give you the peace of mind you so deserve on this matter. Please touch base with me and we can go from there. once again, my sincerest apologies for my tardiness, take care.
---------- FOLLOW-UP ----------
QUESTION: Hi Craig,
My goodness! Thank you so very much for your, such kind, email! I am really overwhelmed by your caring. Thank you so much! I have been away staying with a friend over a long bank holiday weekend - I am sorry for the delay in writing. I very much hope you have recovered fully, and that the future will not include serious illness. I hope I do not intrude in expressing this.
Can I also say that I have been concerned to express that the source of any advice you would give me, would never be passed on to my dentist in the UK. Just having more knowledge allows me to ask questions here.
It is very hard to express well, how wonderful I think your willingness to help people, as fully as you do, is (having read the support emails you have written to others - from the dangers of an abscess infection, to your advice to a student thinking of becoming a dentist). At the very least, for my part, may I say how I feel that your willingness to help people is one of the most touching acts of human kindness I have encountered. Thank you. i would hope that others would express the same.
I guess what I most wanted to say is that a very few people are fortunate enough to have a good friend who could advise on such problems, or have a very good relationship with a dentist in the private sector. But most do not. What you do means a greater equality - thank you so much for that.
I had the second, and last session, of the root canal therapy last Thursday. It seemed to go well. The tooth is still too tender to put pressure on. But I will be contacting my dentist tomorrow to ask if he can grind down the crown filling further, as the occlusion seems too high. (I think he drilled through the crown to carry out the root canal therapy).
May I ask you: my dentist showed me the x-rays at the end of the sessions and pointed out that the root canal (before the final cleaning) did not reach to the bottom of the root; and he explained that the second xray showed how he had cleaned the root canal down so that it went right down to the bottom of the root. Could this mean that a future infection could enter the jaw bone itself, rather then form a abscess on the side of the gum? If this could happen should I look out for any early symptoms of this? If an abscess does return is there any other possibility other then extraction? i read of "3Mix-MP procedure" on Wikipedia. But when I asked my old dentist, before reading of 3Mix-MP", he said there was no other possible procedure. If there is, I could seek a dentist here willing to try it.
Many thanks again,
and best wishes,
Hi Andy and thanks for your very kind words and follow up.
The procedure as you have had it done, is completely acceptable. The root canal treatment should be filled to the end of the anatomical end of the tip of the root, so as to prevent a re-infection of the tooth from the deeper parts of the bone. When this has been done successfully, the future of the tooth will have a good prognosis and I would imagine that you would not have any further issues with this troublesome tooth. As far as 3Mix-MP is concerned, yes, it is a viable treatment option but I feel that more clinical research is needed to support its longevity and effectivity in the clinical arena, as compared to more traditional and reproducible methods. It certainly has not been accepted equally well worldwide by clinicians but the data is promising. I would have rather suggested that you find a clinician who is trained in this technique to advise you on 3Mix-MP as an option for your root canal treatment originally, as the it is not possible to combine these 2 very different techniques of root canal treatment. I hope this helps and wish you all the very best further.