Dental Travel

CJay · 27-09-2011 6:51pm #1

I've completed a successful trip abroad to get my teeth sorted out and thought, given general interest I've come across on boards about this. I might speak up and say I've done it, it went well and does anyone have any questions for me?

I've travelled the path taken by 3 relatives too, almost exactly a year ago! So I came over feeling confident about who I was dealing with.

Oral Surgeon · 27-09-2011 7:12pm

Hi CJay,

So what treatment did you have and what was the timeframe? We won't get into cost as per charter rules.....

OS

CJay · 27-09-2011 7:42pm

I had 3 root canal treatments and 6 of my front teeth filed down in preparation for crowns, a few of the teeth had fibreglass rods inserted to strengthen them.

One of the teeth had an old, and because it was my tooth I feel I can say badly done, root canal treatment. At the top of the root there was a rather sever infection so bad that I could feel it 24/7, touching my gum wasn't necessary. The dentist removed the old root canal and decided to try and draw out the infection. He then re-did the root canal.

My gum has been pain free since! That alone makes it all unbelievably worthwhile!!

That was 2 weeks ago and I was booked in for two days, however I have a massive phobia with dentists, which he dealt with beautifully and once he started working and realised I'd totally calmed down he did all the work in one day rather than bringing me back in and going through the calming process again. A back tooth was also filled on the day, doddle of a job compared to the rest.

It was one hell of a day, I was wrecked, the dentist had a numb rear and one hell of a crick in his neck, but I felt he made the best choice in working straight through, it totally worked for me.

What felt like a million impressions were taken of my teeth and they sent me home with temporary crowns that could easily have done as permanent they looked so lovely compared to my old gnashers.

That said, I only needed 3 teeth crowned, a fourth was done because cosmetically it wasn't the best and we went with six for cosmetic reasons again as it was the best way to straighten my smile, (too old for braces anyway)

I returned for 4 days for multiple fittings and colour checks before they were finally happy and were sure I was happy with the result. And I am!

In 6 months time I need to re-visit the consultant in Cork for a check up and get another panoramic x-ray to make sure everything is going ok, I was told if the infection hadn't cleared I would need to return for surgery on the gum, but so far so good, fingers crossed.

If there are any issues I will be flown over to have it sorted, and given the efficiency I have experienced so far I don't doubt them at all! No question is too silly, emails are answered same day, and they didn't try to shove expensive treatments down my throat, I was given a range of recommendations and I picked what I wanted.

Oral Surgeon · 27-09-2011 7:53pm

Nice to hear a happy patient....:D

I'm always interested in the timing of treatments abroad, I feel that most are rushed IMHO....
Did they do the 3 root canals and then crown preparations on the same teeth in that same sitting or did they allow time before the crowns were made?
How long did you have the provisional crowns in place?
How long did they take from impressions to fitting of the permanent crowns (the time the labs took to make the crowns).

Nice to hear that they took time to try in and cement the crowns as this is important....

Sorry about all the questions,

OS

CJay · 27-09-2011 8:26pm

That's ok...you're getting a bit technical for me but I'll see if I can decipher.

The previous family members all had differently timed treatments, one guy's first trip took 3 days to complete a pretty similar procedure.

To explain his point of view on the day and why it was done in one go:

I should have had the root canal one day and the prep the next, I was supposed to have two well spaced out appointments more than 24 hours apart...however I started out so freaked that before anything had begun I was bawling my eyes out there in the chair and slapped the dentist, which he took very well (I only slapped his hand btw, he had picked up one of those awful picky torture things) The thing was I knew the infection was major and only going to get worse so he used that as a starting point to calm me. If he hadn't been able to I would have been sent away and he would have tried again the next day. Once I was calm he numbed my mouth slowly constantly checking until I couldn't feel anything and work began, once the root canal treatment was done I was sitting there happily numb and twitching my feet to the music, so he made a judgement call and ploughed ahead.

The provisional crowns, on checking my calendar, were in place exactly 15 days, including the time spent removing them and refitting as the permanent crowns were checked and rechecked, I could have done without the amount of rechecking as the prepped teeth were so ridiculously sensitive!!!

I dunno about the labs, I guess they took pretty much the same length as the impressions were taken the same day as the temp crowns were fitted and they didn't consider the crowns fully finished until the final, final fitting.

I assumed they were fully finished by the time I returned but I think they did a final tweak while I was here, they did numerous bite impressions on my first visit and on the first day of my second visit...if that makes sense?

Oh, and they did colour checking both of those times too, spent ages on my second visit colour checking every tooth in my head and eventually coming up with best average.

btkm8unsl0w5r4 · 27-09-2011 8:41pm

So a badly infected tooth which had a root canal in the past had a new root canal & a permeant bonded fiber post cemented the same day as the root canal was completed (all done in one day, without placing a antibiotic dressing for a period of weeks in between) and the permanent crown was permanently cemented 2 weeks later without checking if the infection had resolved (not that in that time you could tell) , you will check in 6 months if it has, and if not have totally unpredictable apical surgery which has very poor long term success?

I dont think much of their sequence TBH, best practice would be to clear the infection and check its resolving before sealing the tooth with a post and crown. Also one visit root canal is not the best for teeth with previous infections or symptomatic teeth. Two visits with antibiotics in the tooth in between is best practice. Unfortunately you have welded the bonnet of the car shut now, so if the infection returns you have few good options left. I think your holiday schedule decided treatment not what was best for your teeth.

Panoramic X-rays are not diagnostic for root infections certainly not on front teeth as your spine gets superimposed over the teeth.

I am glad you are happy, I know you had problems with your teeth for many years, maybe you would post an in focus picture showing the gums so people can see the aesthetic result.

Oral Surgeon · 27-09-2011 8:51pm

Thanks CJay,

The root canal would concern me a little;
I was actually talking to a top endodontist today about this very subject (root canal timing). He said that he'll do a root canal start to finish in one sitting but for a symptomatic tooth he will always do a 2 stage treatment with a cleaning and temporary dressing in place done the first visit to allow a nice clean root filling on the second visit. Usually this dressing is in place for 1-2 weeks before the final root canal....

Some would debate if you should crown a tooth straight away following a root canal or leave it a few months to show that the root canal was successful.
Not really my area, opinions guys??

Sounds like a decent amount of lab time to make the crowns and sounds like they took care in adjustments etc so that's good.
The prosthodontist I work with does do an early check visit at about 2 weeks to make sure that there are no tiny flecks of cement under the gumline that could cause trouble, so 6 months is a little long for me....

Good stuff,
OS

CJay · 27-09-2011 9:19pm

The dentist was wary of the tooth, many options were discussed at length. Keep in mind I've had ongoing problems with this tooth for years and the dentist in Hungary has my full case history. In relation to the work he did, that was also a judgement call he made based on the previous, extremely extensive, work that was carried out.

I should also note I have gone to many many Irish dentists complaining of pain in this area and none could find the source, told me I was imagining it. I handed the consultant a panormic xray and asked for a quote on work, made a point of not mentioning pain, the first question I was asked was "How much pain are you in". This was confirmed with a more detailed x-ray when I arrived at the clinic itself.

I have spent a year tracking these guy's in blogs online and have come up with no complaints, no return trips to deal with problems arising from their work. I went for the consultation in July and was supposed to come over in August but I was terrified so I cancelled. Then in early September I was asking one family member to ask her bf (who's hungarian) if he knew of this clinic, she then told me about 3 family members who'd travelled for treatment, i interrogated them and booked my trip as a result.

Their work, looking at it first hand, was cosmetically excellent and they spoke so highly of the clinic. None of them have had problems either.

My Point Being you're perfectly well entitled to you opinion on how this work should be carried out. However this dental practice has proven itself knowledgeable in it's own techniques, and is equally entitled to carry out their procedures as they see fit.

I'm waiting on my before and after pics, I've only just asked for them, I can post them as soon as they do, or should I pm them?

btkm8unsl0w5r4 · 27-09-2011 9:21pm

Unfortunatly CJay best practice is the same everywhere, thats why it is called best practice. You have described some pretty big corners being cut. Wheather this will matter to you only time will tell.

Its good that you have finally gotten this sorted out, Are you going to show us the final result?

***Saw edit there, good post pics. In focus with gums showing. You can do this yourself in a mirror if you want.***

Oral Surgeon · 27-09-2011 9:34pm

CJay wrote: »

My Point Being you're perfectly well entitled to you opinion on how this work should be carried out. However this dental practice has proven itself knowledgeable in it's own techniques, and is equally entitled to carry out their procedures as they see fit.

Thanks CJay, but Fitzgeme's opinion is not really his opinion but is form the scientific literature.... so it's not really best practice to just do their own thing as they see fit...

The point being that even specialist endodontists get root canal failures but by doing the root canal, bonded post and crown in a short period of time- they have not allowed for a possible failure and re-root canal treatment without destroying your new crown and post...

Pics would be good:D:D

CJay · 27-09-2011 9:47pm

Well, I've had corners cut by Irish dentists, I've had them break roots, cause massive infections, botch root canals, which is why this work had to be done. My mother has the documentation to prove it) these dentists learned all about best practice and the science of it all too you know!

Note that I only needed 1 minor filling, I do and always have taken care of my teeth.

Don't judge least...

The clinic took detailed photo's, all sides and a close up of my gum before, perfectly clear, I'll post them up when I have them.

Oral Surgeon · 27-09-2011 10:01pm

Don't tar us all with that same brush CJay, some of us are good at our jobs...

Look forward to the pics, good luck with the new teeth,
OS

CJay · 27-09-2011 10:14pm

Oral Surgeon wrote: »

Thanks CJay, but Fitzgeme's opinion is not really his opinion but is form the scientific literature.... so it's not really best practice to just do their own thing as they see fit...

The point being that even specialist endodontists get root canal failures but by doing the root canal, bonded post and crown in a short period of time- they have not allowed for a possible failure and re-root canal treatment without destroying your new crown and post...

Pics would be good:D:D

aaah, ok, mentioning these things is helping shake loose the finer details!

The dentist discussed something like that with me, it's familiar...can you take my word that re my major problem tooth the treatment was discussed at length, including the antibiotics route. He didn't have a fly by the seat attitude, it involved alot of pacing and talking! It was a good hour before my first panic attack.

He started out partly convinced that I would need a full implant, that there was no way he'd be able to save the tooth. If I remember correctly he felt it was at a point that something needed to be done immediately about the infection and judging by the pricing I got he would have made more money out going the antibiotic route.

The decision was to attempt to correct the root canal, continue with the rest of the treatment and then re-visit the infection if it didn't clear. It's the first this he checked for when I landed in the chair the second time. Trying to jog my memory here but I'm certain that the consensus was if I was to pop up in two weeks time with the pain there or worse the plan was to revisit, do surgery and possibly remove the tooth entirely.

He felt is was worth attempting to save it as the root itself was still strong despite the infection and he based this on my panoramic x-ray, close up x-ray's he took of my gum (about 4) and an actual physical study of the gum and tooth itself, given ye haven't had the joy of any of that I'll beg ye to not pick holes in how it was handled. I have walked out on dentists when I've felt undermined, uncertain and insecure, I don't put up with mediocrity any more.

I also haven't mentioned that the main problem tooth wasn't complete, it had a temporary crown on it the past 15yrs!

CJay · 27-09-2011 10:19pm

Oral Surgeon wrote: »

Don't tar us all with that same brush CJay, some of us are good at our jobs...

Look forward to the pics, good luck with the new teeth,
OS

I'm not, I'm just saying I've managed to have the most horrifying and botched experiences with the dentists I've encountered, so I don't feel it's right to poke holes in someone else's dental practice because you don't agree with it, to the best of my knowledge his techniques works, with no bad comeback. I'm sure the dentists I had here studied the same textbooks as some amazing dentists I didn't meet...but they used their own techniques and caused me alot of pain and problems.

If an 11yr old child came into you with a chipped tooth would you carry out a root canal treatment?

Oral Surgeon · 27-09-2011 10:27pm

CJay wrote: »

If an 11yr old child came into you with a chipped tooth would you carry out a root canal treatment?

I don't do root canals but...;

Maybe, depends on the case...

The fracture does not have to be big to justify a root canal, in fact the tooth does not need to be fractured at all and often are not...

There are 2 main reasons for needing a root canal following trauma;

The fracture is big, involves the pulp, the pulp is irreversibly damaged or dead and therefore needs root canal

or

The tooth root is moved within the bone so as to damage the blood vessels and nerves entering the apex of the root and again causing death of the pulp contents. This happens all the time and could be you, I don't know....

CJay · 27-09-2011 10:37pm

I ground my teeth in my sleep, I chipped a tiny bit off the edge. That's all. My teeth weren't discoloured or decaying or dead nor had I fallen and damaged any of them. I ground them in my sleep, did for years after until it started to cause migraines and my doctor told me to sleep with my tongue sticking out, really weird but she said you instinctively won't hurt yourself so instinct make you stop when you start to bite.

My files were reviewed eventually, there's a letter at home somewhere stating the treatment was unnecessary, I was over 18 when they began the treatment for the temporary crown because the problem had, officially (this is fact not wild unwarranted accusation), been caused by...not me...

The scary thing is I've only just realised that I had root canal treatment done every month for about 6 months, until one time the back of the tooth didn't get sealed properly and an infection set in that caused my whole top gum to swell up. Never bothered with the braces I really needed on top and bottom...

But that's how it started, someone who studied the science made a decision.

btkm8unsl0w5r4 · 27-09-2011 10:43pm

Ok ok this is getting a bit ranty now.....Lets leave it there for the moment and post up the pics when you can.

CJay · 27-09-2011 10:48pm

Cool! I'm not feeling ranty just trying to get my point across, but there ya go! If I was really, properly ranting I'd be banned by now

Oral Surgeon · 27-09-2011 10:49pm

Fair enough, that doesn't sound right.... I'm not here to defend the treatment of every dentist in the country but I also can't listen to you criticize Irish dentistry as a whole...

The literature tells us what is best practice. It is up to all dentists Irish and foreign to follow it, I do and that is why I question your treatment. Sounds like your previous Irish dentist did not but also neither has your new dentist regarding root treatment of a symptomatic tooth....

Sorry if that's not what you want to hear but it is the truth.

Mingetoad · 28-09-2011 8:34am

Just to pop in here to pick up on one point- the single vs multiple visits for root canal treatment. Studies are out there that advocate either and it is often a personal opinion with endodontists, BUT the Cochrane Review published in 2008 concluded that neither method was significantly more successful than the other. The only slight diference noted was that people who had undergone single visit were more likely to need painkillers short term post-op. This may be due to the increased inflammation due to a longer working time.

btkm8unsl0w5r4 · 28-09-2011 8:50am

Mingetoad wrote: »

Just to pop in here to pick up on one point- the single vs multiple visits for root canal treatment. Studies are out there that advocate either and it is often a personal opinion with endodontists, BUT the Cochrane Review published in 2008 concluded that neither method was significantly more successful than the other. The only slight diference noted was that people who had undergone single visit were more likely to need painkillers short term post-op. This may be due to the increased inflammation due to a longer working time.

But whats described here is a apical infection of long standing. One visit endo on three teeth, same visit fibre post which are nearly impossible to remove and then 2 week later cementation of a final crown.

Single visit Endo is fine, although most Endodontists now prefer multi visit in necrotic cases or cases with sinus or long standing PARL. However the immediate cementation of a post and impression for a crown is pretty dubious

The cochrane review only glancingly mentions the most important fact also that is

"All the studies were performed in university clinics or hospitals, with the exception of Gesi 2006, which was undertaken in private practice. In all studies, the treatment was conducted by expert endodontists, except for DiRenzo 2002 and Mulhern 1982, in which the treatment was performed by postgraduate students, and for Ghoddusi 2006, in which the operators were general practitioners."

All the treatment were done under strict research criteria by either specialist or experienced operators and only one tooth per sitting, certainly not on a day where 3 teeth were being root canalled and 6 crowns prepared impressed and temporised.

Mingetoad · 28-09-2011 9:27am

Harmoni Chilly Pipe wrote: »

But whats described here is a apical infection of long standing. One visit endo on three teeth, same visit fibre post which are nearly impossible to remove and then 2 week later cementation of a final crown.

Single visit Endo is fine, although most Endodontists now prefer multi visit in necrotic cases or cases with sinus or long standing PARL. However the immediate cementation of a post and impression for a crown is pretty dubious

The cochrane review only glancingly mentions the most important fact also that is

"All the studies were performed in university clinics or hospitals, with the exception of Gesi 2006, which was undertaken in private practice. In all studies, the treatment was conducted by expert endodontists, except for DiRenzo 2002 and Mulhern 1982, in which the treatment was performed by postgraduate students, and for Ghoddusi 2006, in which the operators were general practitioners."

All the treatment were done under strict research criteria by either specialist or experienced operators and on one tooth per sitting, certainly not on a day where 3 teeth were being root canalled and 6 crowns prepared impressed and temporised.

Fair enough, but on the one hand I don't think professionals should talk about "scientific best practice", then claim that as that very best practice is based on strict research criteria so not applicable to the real world. By the way I was solely picking up on the point about the endo not being done properly, not the overall message you are giving. Pedantic, maybe, but important I feel as many other "top endodontists" would not agree with the guy Oral Surgeon quoted. Obviously I agree that a very large treatment plan was carried out in a disturbingly quick timeframe.

CJay · 28-09-2011 9:43am

The timeframe had full knowledge of my history behind it and should have been longer, I caused the speed up on that, also I didn't get a fibre post in the big issue tooth.

See I started this thread to inform, I really don't think ye have a right to pick holes in my treatment when ye haven't seen my teeth, don't know (or want to know) my full case history....and I have only mentioned a fraction of it here, the first two years maybe, I've have 20 frustrating years of regular dental trips. Why don't ye see sit back and how it goes for me? Longterm!

I'm not tarring all Irish dentists with the same brush, however it tends to happen with all foreign. And it's part of the reason I've gone abroad too, whenever I go to an Irish dentist and try to give them my case history, as soon as I try to go through it they get prickly and I get eaten for saying anything against a fellow Irish dentist, they just won't hear it! I end up getting told that I'm lying and I must have caused most of the damage myself...so

a) How can a dentist make an informed choice on treatment if they refuse to listen/ believe a word I say.

b) how can I have any faith in a dentist who thinks so little of me.

Oral Surgeon · 28-09-2011 10:27am

Mingetoad wrote: »

Just to pop in here to pick up on one point- the single vs multiple visits for root canal treatment. Studies are out there that advocate either and it is often a personal opinion with endodontists, BUT the Cochrane Review published in 2008 concluded that neither method was significantly more successful than the other. The only slight diference noted was that people who had undergone single visit were more likely to need painkillers short term post-op. This may be due to the increased inflammation due to a longer working time.

Would you do a one stage endo on a tooth symptomatic for years? Would you advise a dental student to do the same?

CJay · 28-09-2011 10:39am

Oral Surgeon wrote: »

Would you do a one stage endo on a tooth symptomatic for years? Would you advise a dental student to do the same?

Would you do a root canal treatment on a child who, quite obviously, didn't need it?

Oral Surgeon · 28-09-2011 10:53am

CJay wrote: »

Would you do a root canal treatment on a child who, quite obviously, didn't need it?

I think I've answered that one and I couldn't say that you obviously didn't need it unless I saw you on that particular day and assessed you clinically and radiographicaly....

btkm8unsl0w5r4 · 28-09-2011 11:01am

CJay what kind of preventive regimen and recall schedule is in place now for prevention?

CJay · 28-09-2011 3:38pm

Oral Surgeon wrote: »

I think I've answered that one and I couldn't say that you obviously didn't need it unless I saw you on that particular day and assessed you clinically and radiographicaly....

Which is exactly why you can't make judgement on the treatment I have currently undergone. You haven't seen me, my x-ray's or my full history.

fitzgme, I emailed the dentist to check and basically it's 50/50 in his opinion re: the tooth and whether it settles or not. He felt because of the amount of treatment carried out on this one tooth that he was very limited in what he could do.

I am listed as priority, If anything goes wrong or the pain comes back I will be brought into the Dublin clinic for assessment and flown immediately to have the whole thing removed and an implant work started. If the infection settles then the crown will stay in place and will be perfectly fine. He was trying to cater for all possible outcomes. If all goes well I'll be called to Dublin every 6 months for the next 18 months for a check up.

He's confident the root canal treatment worked well, he didn't think he'd be able to remove the old one and replace it but felt it was worth trying to save the original root as it is healthy and strong, however if he couldn't replace it I would have been straight down the implant route anyway. He said the previous root canal was 2mm too short...? which is what caused the infection.

I probably should have noted I'm on a 3 months of antibiotics for a blood infection, this is a separate issue I think, my own GP put me on them before this treatment began. This is something I had written onto my form in the clinic on my first visit.

Since he replaced the root canal that part of my gum is painfree, all I feel now is this general discomfort because the new teeth are so different.

Personally I don't have an issue with the distance. Firstly I only have to go to Dublin to have it all checked over by a dentist. Secondly...don't make me go into detail about the lack of follow up I've had in this country.

I'm happy with the work/ schedule/ dentist/ treatment/ result.
I've had really really bad experiences with dentists.
Keep picking holes in the treatment I'm gong to keep going on and on about my bad experiences.
I'd like ye to please stop killing my happy buzz!!

Oral Surgeon · 28-09-2011 3:56pm

CJay wrote: »

Which is exactly why you can't make judgement on the treatment I have currently undergone. You haven't seen me, my x-ray's or my full history.

I know enough....

CJay wrote: »

I probably should have noted I'm on a 3 months of antibiotics for a blood infection, this is a separate issue I think, my own GP put me on them before this treatment began.

Do you have Malaria??

CJay wrote: »

I emailed the dentist to check and basically it's 50/50 in his opinion re: the tooth and whether it settles or not.

Not good odds...

CJay wrote: »

I am listed as priority, If anything goes wrong or the pain comes back I will be brought into the Dublin clinic for assessment and flown immediately to have the whole thing removed and an implant work started.

That's good

CJay wrote: »

I'd like ye to please stop killing my happy buzz!!

Sorry about that Ted.....

btkm8unsl0w5r4 · 28-09-2011 5:20pm

CJay wrote: »

all I feel now is this general discomfort because the new teeth are so different.

Thats not normal.....I would have that checked out. Who pays for the flights, hotel, time off work if you have to go back twice for implants or remedial treatment? Short notice flights are not cheap.

Mingetoad · 28-09-2011 10:08pm

Oral Surgeon wrote: »

Would you do a one stage endo on a tooth symptomatic for years? Would you advise a dental student to do the same?

Yes, if I felt confident I had correctly diagnosed the problem and that all stages of the root canal have gone as I would have hoped. The jury (literature), as explained, is still out on whether it makes a difference which you do. If all endo principles are satisfied- proper cleaning, shaping and sealing, then there is nothing to say it should make a difference. While one camp say the intra-canal medication will kill more bugs, others say it provides a source for bacterial growth that a good root canal obturation and seal would eliminate.
Regarding the dental student, it would depend on their experience and competence. If it was their first root canal, certainly not. If I were happy they had a good endo knowledge and technique, I would have no problem, as the scientific literature does not say they shouldn't.
I'm aware this is off topic, but I feel any critisism of treatment done by a fellow professional (regardless of where they are from) should be irrefutable. In this case I do not see a problem with doing a single stage endo. What happened afterwards though....

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