Expert: Frederick R. Liewehr DDS, MS, FICD - 9/6/2007

Question
I had a two root canals done by a dentist 16 & 15 months ago.  With the first one (#18), the dentist took an xray after the procedure. With the second one (#30), the dentist did not take any xray.  I asked his assistant why he didn't take an xray with the second root canal.  She stated that "the dentist was sure he got everything".  I ended up leaving this dentist due to feeling uneasy about his way of practicing (there were other issues as well) dentistry.  Two months ago I went to a new dentist for the crowns.  Throughout my two months of visits for temporary crowns and impressions, I had extreme pain everytime this dentist would push down on a temporary or especially when he removed one.  When I raised my concerns regarding crowning these teeth, he kept assuring me that he would see how they did when he put the temporary on or even back on.  The teeth would usually settle down within a day or two, so I just figured he must know what he's talking about.  Never once did he ever take any xrays of either tooth to look for any possible infection or anything else wrong.  Two weeks after my #30 crown was complete I started having severe pain and swelling at the gum and jaw area.  My tooth itself didn't hurt, but I knew by the severity of the pain that something was wrong.  I went to see the dentist who did my crowns.  He informed me that one of the canals had a severe infection at the root tip.  He also stated that the first dentist must not have gotten the inert material down into the canal far enough. He then referred me to an endodontist regarding possible retreatment.  Upon visiting her she stated that I had an abscess and that she saw the same pocket at the end of my root tip.  She didn't want to take sides on the issue of who's fault it was that I was in this situation.  She stated that anybody could have a root canal go bad.  She also stated that it was unheard of to not take x-rays before placing a permanent crown. On top of my problems with #30, #18 has some sort of lesion on the gum on the inner side of the tooth.  Another thing I complained about all along the crown process.  It's almost as if the gum has deflated or is now concave.  Now I'm stucked with no insurance coverage for endodontist care.  It's going to cost me $1700 to have this endodontist drill through my crown and retreat the root canal. It is my belief that the first dentist screwed up my root canal, but that the second is at extreme fault by ignoring the problem and crowning anyway. What is your opinion?  Neither of these dentists including the insurance will take any responsibility.  They are blaming eachother.  What should I do?

Answer
I cannot possibly give you a worthwhile opinion without examinig you and seeing your radiographs. However, I will make a few comments. First, you cannot perform endodontic therapy without taking radiographs. Second, any dentist planning to place a crown on a tooth should take a radiograph before, to ensure that the tooth has no problems, and after to ensure that his crown is properly seated. It is not "unheard of" to ignore this step, but it is not good dentistry, in my opinion. Third, all is not lost - if you need retreatment, the endodontist can drill through the crown, and then it can be repaired afterward, so you shouldn't need a new crown. Fourth, $1700 is pretty pricey for a retreat. If there is a problem with the original root canal treatment that is obvious, you could go back to the dentist and tell him that you now need to have it retreated and you think he should help you with the cost. See what he says.