Dental Issues

JGL10 · 19-10-2019 2:19pm #1

Recently I developed a pain in my gum/tooth . I have had an abscess before and the pain was exactly the same.
I went to my dentist immediately . He done an X-ray and said there was an issue with the nerve in the tooth and I had 2 options .
1 extraction
2 root canal.
I was undecided so he said he could take me out of pain and do the first part of the root canal and the following week either extract the tooth or finish the root canal so I agreed.
I stressed to him that I think I had an abscess before and the pain was exactly the same and could he check this .
The dentist said no it’s the nerve in the tooth so I said ok and he proceeded.
After the anesthetic wore off I was in the worst pain imaginable.
Two days later I got an appointment and
Got antibiotics as it turned out I had a huge abscess on me tooth.
When I went back the following week there was still an abscess on the tooth and I had the tooth removed.
Now I’m am left with a missing tooth and the only option now is a dental implant .
Do I have any comeback with the dentist ?

19-10-2019 2:37pm

An abscess is caused by inflammation/necrosis of the nerve, by your own admission you were undecided so he removed the source of the infection, the nerve to try give you time to come to a decision. The dentist did not cause the problem and you couldn’t decide on treatment, what “comeback” do you feel entitled to?

JGL10 · 19-10-2019 3:42pm

Dav010 wrote: »

An abscess is caused by inflammation/necrosis of the nerve, by your own admission you were undecided so he removed the source of the infection, the nerve to try give you time to come to a decision. The dentist did not cause the problem and you couldn’t decide on treatment, what “comeback” do you feel entitled to?

The fact that he performed the start of a root canal when I had an abscess and gave me no antibiotics?And this resulted in tooth loss instead of keeping the tooth ?

Fishorsealant · 19-10-2019 3:55pm

JGL10 wrote: »

The fact that he performed the start of a root canal when I had an abscess and gave me no antibiotics?And this resulted in tooth loss instead of keeping the tooth ?

Antibiotics not indicated for dental abscess.
Local measures such as starting an rct is the appropriate first line measure here.

Extraction was your decision, you could have continued with rct and abx if you wanted.

JGL10 · 19-10-2019 4:08pm

Fishorsealant wrote: »

Antibiotics not indicated for dental abscess.
Local measures such as starting an rct is the appropriate first line measure here.

Extraction was your decision, you could have continued with rct and abx if you wanted.

Wasn’t my decision the dentist said it was too far gone to proceed with the rct unfortunately

19-10-2019 4:20pm

JGL10 wrote: »

The fact that he performed the start of a root canal when I had an abscess and gave me no antibiotics?And this resulted in tooth loss instead of keeping the tooth ?

If you have acute pulpitis, you could walk around with a intravenous drip full of antibiotics, the pain would not go until the nerve was removed. As fissuresealant said, antibiotics are not indicated, a root canal or extraction is. You were offfered both, but as you couldn’t decide, he did the first stage to allow you time to decide. When the pain does not subside, as sometimes happens, extraction may be the only option, I’m at a loss to see how this is anyone’s fault but your own, you went in with an tooth with pulpitis, you were given the options, you couldn’t decide and ended up needing the tooth out even though the dentist did the correct treatment if you wanted to retain the tooth, remove the nerve.

btkm8unsl0w5r4 · 19-10-2019 6:23pm

And this is why dentistry can be the hardest job in the world.

JGL10 · 19-10-2019 6:25pm

Dav010 wrote: »

If you have acute pulpitis, you could walk around with a intravenous drip full of antibiotics, the pain would not go until the nerve was removed. As fissuresealant said, antibiotics are not indicated, a root canal or extraction is. You were offfered both, but as you couldn’t decide, he did the first stage to allow you time to decide. When the pain does not subside, as sometimes happens, extraction may be the only option, I’m at a loss to see how this is anyone’s fault but your own, you went in with an tooth with pulpitis, you were given the options, you couldn’t decide and ended up needing the tooth out even though the dentist did the correct treatment if you wanted to retain the tooth, remove the nerve.

Well the receptionist at the clinic said the fee was waved the day I had the extraction she said she was so sorry for what had happened and they shouldn’t have start a root canal knowing I had an abscess this is why I put up the post .
I’m not a dentist obviously you are and I was just looking to see if anyone has ever had be same problem , that’s all ðŸ‘

btkm8unsl0w5r4 · 19-10-2019 6:29pm

You do root canals to fix an abcess.

endacl · 19-10-2019 6:31pm

JGL10 wrote: »

Well the receptionist at the clinic said

A fully qualified receptionist?

JGL10 · 19-10-2019 6:38pm

endacl wrote: »

A fully qualified receptionist?

Obviously the dentist told her not to charge me

19-10-2019 6:45pm

JGL10 wrote: »

Obviously the dentist told her not to charge me

Personally, if I gave you two options and you declined both, then came back later to have the tooth extracted, I certainly would have charged you for both appointments, so fair play if he did the extraction free of charge. Yet here you are feeling wronged.

It would be mind boggling for a receptionist to apologise for a root canal treatment being started on a tooth with an abscess, when the treatment to preserve an abscessed tooth, is a root canal.

JGL10 · 19-10-2019 6:59pm

Dav010 wrote: »

Personally, if I gave you two options and you declined both, then came back later to have the tooth extracted, I certainly would have charged you for both appointments, so fair play if he did the extraction free of charge. Yet here you are feeling wronged.

It would be mind boggling for a receptionist to apologise for a root canal treatment being started on a tooth with an abscess, when the treatment to preserve an abscessed tooth, is a root canal.

Where did I say I refused both ? I never did

19-10-2019 7:01pm

JGL10 wrote: »

Where did I say I refused both ? I never did

When offered extraction or root canal treatment to treat the pain, Which did you choose on your initial visit?

JGL10 · 19-10-2019 7:03pm

Dav010 wrote: »

When offered extraction or root canal treatment to treat the pain, Which did you choose on your initial visit?

I had the first part of a root canal done

19-10-2019 7:07pm

JGL10 wrote: »

I had the first part of a root canal done

So what is your gripe? Are you saying the dentist should have extracted the tooth instead, even though you were “undecided”? You are complaining you have lost a tooth, yet the dentist offered you the only treatment option indicated to save the tooth.

JGL10 · 19-10-2019 7:12pm

Dav010 wrote: »

So what is your gripe? Are you saying the dentist should have extracted the tooth instead, even though you were “undecided”? You are complaining you have lost a tooth, yet the dentist offered you the only treatment option indicated to save the tooth.

No I’d have presumed the dentist would have picked up that there was actually an abscess there & antibiotics should have been prescribed....which is what the dentist I saw after said should have been done. Then after the abscess had cleared up, root canal or extraction should have been discussed.

19-10-2019 7:19pm

JGL10 wrote: »

No I’d have presumed the dentist would have picked up that there was actually an abscess there & antibiotics should have been prescribed....which is what the dentist I saw after said should have been done. Then after the abscess had cleared up, root canal or extraction should have been discussed.

If you have pulpitis, antibiotics will not stop the tooth from hurting, it may bring down any infection under the tooth, but it will not stop the nerve in the tooth from being painful. At a lecture recently an endodontist (specialist in root canals) said prescribing antibiotics for an inflamed nerve is pointless, the treatment is either remove the nerve or the tooth.

Unfortunately I think you are under the assumption that as soon as you started taking the antibiotics, the pain/infection would go, that is not the way it works. Unless you remove the cause (nerve/tooth) the source of the infection is still there.

kirving · 19-10-2019 7:22pm

Dav010 wrote: »

When offered extraction or root canal treatment to treat the pain, Which did you choose on your initial visit?

In the first post, they said root canal. They chose an option, undecided would imply nothing was done.

OP, I think you were unlucky, and would have lost the tooth anyway. There wasn't much more that the dentist could have done.

A root canal is the correct treatment, but unfortunately in your case didn't fix the entire problem. The receptionist can be genuinely sorry about the stress and pain you were under, but it doesn't necessarily mean anyone has done anything wrong.

I recently have had major dental surgery, and one of the complications has meant I'll need a root canal on Monday, despite nothing being otherwise wrong with one of my front teeth.

I had a good look at x-rays myself with the surgeon and endodontist and I found it very helpful to understand the problem. Can't blame the surgeon, it's just an unfortunate consequence.

Since my surgery that is very visible to others, lots of people have asked about it. Almost everyone I've talked to is surprised that I know the level of detail I do, since their dentist never tells them specifics when they visit.

Make sure not to be fobbed off, and take as much time as you need with your dentist and endodontist to understand what exactly they're doing, and why. I think a lot of people leave the surgery and the second guess if what was done was correct.

Wesser · 19-10-2019 7:23pm

The general public believe that antibiotics will cure all ills... this includes both dentistry and medicine....if they leave with a script for an antibiotic they feel they have been taken seriously.

JGL10 · 19-10-2019 7:31pm

Dav010 wrote: »

If you have pulpitis, antibiotics will not stop the tooth from hurting, it may bring down any infection under the tooth, but it will not stop the nerve in the tooth from being painful. At a lecture recently an endodontist (specialist in root canals) said prescribing antibiotics for an inflamed nerve is pointless, the treatment is either remove the nerve or the tooth.

And I’m meant to know to know all of the above ? That’s what I went to the dentist for...maybe I should advise my dentist to attend the same lecture you did.
As it turns out, the antibiotics did treat the infection, which in turn lessened the pain dramatically.
None of this is any use to me now,I’m left researching an implant, costing up to a couple of grand.
I will continue to attend the dental practice as I rate them,I will just avoid the dentist who treated me on my 1st visit.

Fishorsealant · 19-10-2019 7:35pm

JGL10 wrote: »

And I’m meant to know to know all of the above ? That’s what I went to the dentist for...maybe I should advise my dentist to attend the same lecture you did.
As it turns out, the antibiotics did treat the infection, which in turn lessened the pain dramatically.
None of this is any use to me now,I’m left researching an implant, costing up to a couple of grand.
I will continue to attend the dental practice as I rate them,I will just avoid the dentist who treated me on my 1st visit.

Let’s get this right...
The first dentist did the correct initial treatment, refunded you and extracted the tooth. Now you want to avoid them?

I’d say the dentist will be devastated losing you as their patient.

kirving · 19-10-2019 7:46pm

Fishorsealant wrote: »

I’d say the 1st dentist will be devastated losing you as their patient.

C'mon, not exactly a helpful reply.

I think it's totally fair for the OP to feel aggrieved as two professionals have told them conflicting information, without the underlying nuances that actually allow the patient to understand.

Fishorsealant · 19-10-2019 7:50pm

Kevin Irving wrote: »

C'mon, not exactly a helpful reply.

I think it's totally fair for the OP to feel aggrieved as two professionals have told them conflicting information, without the underlying nuances that actually allow the patient to understand.

Hi Kevin, who was the second professional that gave conflicting information? A receptionist??

19-10-2019 7:52pm

Kevinirving, having reread the op, my understanding is that the dentist removed the source of the pain, the inflamed nerve and the op left the surgery to decide on whether he/she wanted a root canal or extraction, being “undecided” whilst there and having been given both options, maybe I am not seeing something you are.

JGL10 · 19-10-2019 8:02pm

Fishorsealant wrote: »

Let’s get this right...
The first dentist did the correct initial treatment, refunded you and extracted the tooth. Now you want to avoid them?

I’d say the dentist will be devastated losing you as their patient.

I’d say your devastated that you are wrong....I was refunded nothing,please keep up. And whose word are you going on that it was the “correct” treatment? A diagnosis by a random person on a thread on the internet, well done.

And considering that the dentist stayed on after hours to write me a prescription, wavered the cost for follow up visit & was extremely apologetic for the treatment I got on my 1st visit, that I was charged €150 for.
She was aware the treatment wasn’t satisfactory & that an abscess was missed after rechecking the X-ray.
she also advised she would be discussing this incident with the 1st dentist.
Now, please don’t make an ejit of yourself again by not reading it properly the 1st time, I would be “devastated” for you to have to be corrected again.

kirving · 19-10-2019 8:03pm

I think the biggest problem here is communication. The first dentist did nothing wrong - root canal only would normally be the first course of action as understand it.

Edit above: Perhaps not after the second dentist's opinion shared above.

I had to have a root canal after a sinus infection, and am now due a second due to nerve being damaged during jaw expansion weeks after a SARPE surgery.

In both cases however, my dentist, surgeon and endodontist (all excellent) have been explicitly clear in telling me the risks and complications up front and ensuring I was aware of them all. It can be terribly frustrating as a patient not to have the full story.

JGL10 · 19-10-2019 8:05pm

Dav010 wrote: »

Kevinirving, having reread the op, my understanding is that the dentist removed the source of the pain, the inflamed nerve and the op left the surgery to decide on whether he/she wanted a root canal or extraction, being “undecided” whilst there and having been given both options, maybe I am not seeing something you are.

The part you are missing is that there was an abscess there that he missed,

19-10-2019 8:15pm

JGL10 wrote: »

The part you are missing is that there was an abscess there that he missed,

He would not have offered you a root canal unless he diagnosed inflammation/infection. What you fail to understand is that acute pain indicates pulpitis, antibiotics will not clear pulpitis, only removal of the nerve/tooth is indicated for this.

Kevinirving needs a root canal, but by the sounds of things he does not have acute pain/pulpitis, You can have an abscess/necrotic nerve and have no pain, you may have swelling or tenderness, but acute, head banging pain is due to an inflamed nerve, antibiotics will not help in that case. The abscess/swelling follows the pulpitis, that is why it is important to remove the nerve/tooth as soon as possible when the pain is acute.

Op, if the dentist is apologising for the first dentist removing the nerve from an inflamed tooth, considering that is the recommended treatment for a tooth which the person wants to retain, I would expect the conversation between the two of them to be very brief.

Unfortunately sometimes it is just easier to placate the patient and move them on. You think antibiotics will cure all, they don’t if the inflammation is acute, you are much better off taking an anti inflammatory than an antibiotic after the nerve is removed, the inflammation in the tissues goes down and they begin to heal. If the pain persists after the nerve is removed, at that stage you have to make a call on whether it is better to remove the tooth rather than persist with a treatment which has a poor chance of success.

This is now symptomatic of the blame culture which exists here, someone has to be to blame even though the fact is that the op attended with acute pain from a compromised tooth and received the recommended treatment, which unfortunately did not work.

Dianthus · 19-10-2019 9:29pm

Appointment 1- acute pain, x-ray, discussion re treatment options, first stage root canal treatment
Appointment 2 (2 days later)- swelling, antibiotics given
Appointment 3 (1 week later)- swelling still persisting despite antibiotics, extraction

It reads as though every effort was made to control the bacteria as& when symptoms/signs arose.
Antibiotic resistance & allergies are huge issues so clinicans tend to be conservative in prescribing. Drainage of pus is preferred where possible .
It's very frustrating for all parties when treatment fails, or the patient is resistant to treatment, but unfortunately when it comes to the human body you cannot succeed 100% of the time. In medicine, you lose a limb, an organ, or a life. In dentistry, you lose a tooth

Contact the DCRS (Dental Complaints Resolution Service) to discuss your options

Oral Surgeon · 20-10-2019 8:36am

OP, go to dental school and after those five years you will realize that in medicine and dentistry, nothing is 100% certain, nothing is 100% successful and the situation does not remain the same over time.....

You had a problem and you chose the sit on the fence option.... In most cases this would tide you over... Maybe there was an infection there at the time maybe not... If there was though, one would imagine that the dentist would recognize it... It is more likely that your pulpitis then developed into an acute apical infection later.... There is a phenomenon called a phoenix abscess too... look it up, it may have happened with you and happens unpredictably....

Even if an infection was "missed", there is no reason why you couldn't get antibiotics then, let it settle and then return for the root canal. For it to be "too far gone" in that space of time suggests that the tooth was unrestorable from day one anyway.... hence the option of an extraction, which you didn't go for....

Receptionists know nothing about dentistry and yours was trying to appease you... don't take that as an admission of guilt....

The dentist was being fair with not charging for the extraction as you had already paid for the first stage root canal, don't take that good will gesture and deduce that they must be in the wrong.... it was a good will gesture.... if it was my clinic and your procrastination was resulting in more treatments and more use of my time then I'd charge you....

If they went with the extraction from day one then you'd probably be on here giving out that they took out a good tooth and now you need an expensive implant...

You need to take a bit of ownership of your situation here, you went in with a crappy tooth and after the appropriate attempts to save it, it still needed removal.... The first dentist did not cause this situation and did no irreversible treatment, you still had the option of removal or root canal leaving the first dentist. Regarding the "infection" afterwards there are so many factors to developing an infection- you and your mouth being the biggest and your dentist being the smallest!!

Your efforts would be better spent minding your other teeth than giving out about this dentist....

kirving · 20-10-2019 3:35pm

I don't understand the "sit on the fence bit". What else could they have chosen out of A) Extraction or

Root canal, which they did?

I'm sure it's frustrating for dentists on here to have people question their work, it happens all the time. Do you think this is a symptom of Dentists not explaining treatment fully?

Only the last two posts above this one state that the it's the intricacies are what make the difference in treatment, while the OP has been told conflicting basic information from two different professionals in person (not a receptionist).

btkm8unsl0w5r4 · 20-10-2019 4:17pm

In the very first post the opt say they were undecided. Your also putting a lot of weight on the OP to have listened properly and now related the dentists advice to the thread accurately.

All you think you know is what the OP is saying. The dentists on the thread have treated thousands of patients with the same issues, and are letting the thread know that this is an issues with the OP and not the dentist, because they (we) know exactly how the conversation went.

Dentist: " Well Mr. JGL10 after looking at the tooth, listening to your symptoms and looking at X-rays I can tell you you dont have a visible abscess. You likely have a inflamed pulp in the tooth this is probably irreversible. The only option is to remove the nerve in the tooth (a root canal) or remove the tooth itself. A root canal costs more that an extraction and you will need a crown on it afterwards. What do you want to do?

Mr. JGL10 " I dont knowm I want to save the tooth, but the root canal is expensive and I want to be out of pain. I there nothing else can be done"

Dentist "Well I could do a quick first stage root canal treatment, it will probably take away the pain but its not as complete as a proper root canal, it will give you time to think on this and come back next week for definitive proper treatment"

Mr. JGL10 "ok so long as the pain goes away, I had a toothache before you know."

Dentist "Yes I know, we should probably talk about prevention once this painful episode is over and I see you have not returned for a checkup and only ever attend in pain"

Few days later

Mr. JGL10 "Dentist I am still in pain, you said the last treatment would fix this tooth, just take it out I cannot be dealing with this pain or paying for root canals"

Dentist "OK, the first stage root canal was X amount and thats more than an extraction so I will comp that as a very kind gesture of goodwill as I appreciate you are in pain and I am a nice dentist. "

Two days later on the internet

The dentist did a root canal treatment that didn't work and now they should pay for me to have an implant...

kirving · 20-10-2019 10:49pm

Judith Handsome Earplug wrote: »

Dentist "Well I could do a quick first stage root canal treatment, it will probably take away the pain but its not as complete as a proper root canal, it will give you time to think on this and come back next week for definitive proper treatment"

What does "first stage" mean in this context? I'm genuinely curious as I have a planned root canal tomorrow, and two follow up visits already booked.

It was my understanding that root canals always took more than one visit, hence the "first stage", and so the OP proceeding with it was best right course of action but were still berated for being undecided.

I didn't know it was something that could be "done on the cheap" for want of a better phrase, and to be fair that wasn't explained at all until the last couple of posts.

Oral Surgeon · 20-10-2019 11:17pm

Kevin Irving wrote: »

What does "first stage" mean in this context? I'm genuinely curious as I have a planned root canal tomorrow, and two follow up visits already booked.

It was my understanding that root canals always took more than one visit, hence the "first stage", and so the OP proceeding with it was best right course of action but were still berated for being undecided.

I didn't know it was something that could be "done on the cheap" for want of a better phrase, and to be fair that wasn't explained at all until the last couple of posts.

I'm no endodontist but....
Root canals can be done in one or multiple sittings for various reasons.
Typically the first stage was the cleaning and shaping of the canals and the second stage being the filling of the root canal system.... other combos can be done.... If definite on having the root canal, then great care is taken in the cleaning and shaping of the canals for filling later...

The "first stage" that has been mentioned above usually refers to a quick opening and cleaning of the root canal system with little or no shaping of the canals for eventual filling. It aims to remove the inflamed pulpal tissue and placement of a calming dressing in the canal. This also should remove the dead/dying material that would lead to apical infection above the tooth root.
It usually helps most patients but residual pain can remain if not all pulpal tissue was removed because of odd canal anatomy or infection can still develop because bacteria can sometimes still proliferate despite our best efforts....
A first stage can get a patient out of pain until they make up their mind.... It can also be a great interim treatment for the dentist who may not have the time to do the root canal properly there and then...
A first stage without a definitive clean shape and filling will eventually fail as bacteria eventually get into the unfilled canal again....

kirving · 21-10-2019 11:28am

Hi Oral Surgeon,

Thanks for taking the time to explain this, I really appreciate the detail you've gone to - it could certainly be a sticky.

I hope that the OP will also understand that the dentist seems to have made the best effort they could but was unfortunate in the outcome at no fault of the dentist.

Off topic:
Had mine this morning, done and dusted in 30 minutes as it seemed to be a relatively incomplex procedure since the tooth was just discoloured as opposed to any infection being present (yet). I know people often complain about the cost, and it's certainly expensive, but in my case there were three staff to one patient, and a lot of single-use equipment used. I buy optical equipment in work all the time, and I can say you'd buy a nice car for the price of the microscope that was used. As they say, you're paying for the years experience, not the minutes.

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