Expert: Frederick R. Liewehr DDS, MS, FICD - 9/25/2007

Question
A few weeks ago, I noticed a lump on my  lower molar ( tooth #30) which had root canal treatment done five years ago.  I went to see my dentist who referred me to an endodontist.  The endodontist did root canal retreatment on tooth #30  two weeks  ago.  However,  the lump did not disappear  after the root canal retreatment and became even bigger especially in the morning.   I was given amoxicillin  before  and after the retreatment, then I was put on even stronger antibiotic called Clindamycin. The  lump is still there.  Does this indicate the failure of the root canal retreatment which the endodontist is reluctant to say to me?    What should I do now?  The retreatment used up all the money ($1200)  in my insurance account.  Is it reasonable to negotiate the charges for  the root canal retreatment , so I could have some money left in my account to get the tooth extracted.

Thanks.

Lina

Answer
It either means that the retreatment did not work, or that another tooth is involved, or that the "bump" has another cause. You need to find out which is the case.

Often non-surgical retreatment is not successful because the reason for the need for retreatment cannot be addressed without surgery. In that case, a surgical approach is necessary.

Financial issues are up to the individual practitioner. It is standard practice to attempt to retreat a tooth nonsurgically first, then surgically if necessary. However, the insurance companies will not pay for more treatment on the same tooth unless a year passes. This is stupid, flies in the face of standard practice, and amounts to the insurance companies playing doctor and dictating treatment. This is a big problem in all areas of medicine. What happens is that the patient winds up paying for the surgery, so only those who can afford this (and it costs at least as much as the retreat) get it; the others lose their tooth. Of course, the cost of the surgery is considerably less than that of an implant or bridge that is necessary to replace the lost tooth.

In our practice, if the treatment is not successful, we either refund some of the money or take the tooth out for you. This, however, is just our policy. Your dentist did all the work and so forth, and assuming he did a competent job, it is not his fault that you did not heal. So, ethically there is no problem with him collecting his fee. The way the insurance company handles things is the problem.