Expert: Frederick R. Liewehr DDS, MS, FICD - 5/20/2005

Question
Dear Fred/Dr. Liewehr:

I've just had root canal work done on my #4 tooth.  My regular dentist says that the job looks beautiful ... but I'm not sure if I was billed correctly for the amount of work done.  How many roots and canals does this tooth have?  Does this tooth always have the same number of roots/canals, or does it vary between people?

Thank you very much for your input.

Joseph Tein.

Answer
Many morphological studies have been done, and they always result in somewhat divergent numbers, so I can't give you an absolute percentage of teeth that have one or the other canal configuration. In tooth #4, studies say that from 25-60% have two canals rather than one, and a small proportion, less than 10% will have 3 canals. 1 is the easiest for us, then two, and three are usually astronomically more difficult to treat. Like any statistical study, the only question that really counts is, how many canals does your particular tooth have? If I tell you the average shoe size is 10 and you happen to wear a 7, the information is not of much use. The way we bill is largely driven by insurance companies, not by common sense. I can spend as much time on an anterior tooth that is severely calcified to the point that I can't even find the canal as I can on a 4-canal molar in a young person with large canals. I really think we should in some way be charging by how much time it takes to complete the procedure. But that is not how things work. In my early days I spent a lot of time working in a hospital setting, and I saw for example tubes placed in kids' ears that take less than a minute start to finish, for which the parents were billed $1000 at a pop 25 years ago, not counting all the hospital costs, anesthesia, and so forth. Sometimes the insurance says, "1 canal, 2 canals, or 3 canals". What they really mean is, "anterior, premolar, or molar" because for example 40% of mandibular anteriors have 2 canals, yet we have to call them 1 canal, and almost all mandibular first premolars have 1 canal, at least 75% of maxillary molars have 4 canals..., you get the idea. Don't worry, your dentist isn't trying to cheat you, just trying to work within the system.

Dr. Liewehr