Need dentist second opinion.

March 19, 2008 8:33 PM

Teeth Grinding and Root Canal. Should I get a second dentist's opinion?

So apparently I've been grinding my teeth so much one of them has a big hole in it. I thought it was a cavity, but the dentist said it was from the griding. That tooth had hurt for a while in contact with hard foods or sweet stuff, but now it doesn't hurt anymore.
Anyway, I thought it needed a filling but the dentist said root canal outright. He said it a bit too soon, in my opinion, I don't think the X-Rays were even developed at the time. (I haven't seen the X-Rays myself)
Besides the root canal I would get a point, I think that's what it was called, also a crown, and then I would have to see someone else for the night-time grinding and the existing damage to my teeth. He did, however, recommend I get a night time teeth guard from the pharmacy which I did.
I also have been having a sore throat and was prescribed antibiotics by the dentist for it...can they do that? Didn't get my teeth cleaning because of the sore throat, which means probably another copay when time comes for that.

So, doing a bit of research here, it seems that with my insurance coverage I would pay about 100 dollars for a root canal. From what I understand root canals are needed when the tooth is decaying. My problem is not an infection, but rather mechanical action. I'm not sure the nerve is exposed, he said that the 'red' you can see at the bottom of the hole is due to the nerve being close to the surface, and the pain is cause by the nerve swelling and then going back down for periods of no pain.

Should I get a second opinion? The catch is that since it's hard to get a dentist appointment soon enough during the weekend or off work hours I would have to take some time off from work, which I have been doing a lot lately.

But I really feel the diagnosis was a rushed and the dentist shifty.
Is there a chance the root canal is not needed?
That another dentist might say a filling and using an OTC nightguard is enough?

posted by spacefire to health (10 comments total)

Here's the operative sentence in your narrative: But I really feel the diagnosis was a rushed and the dentist shifty.

If you don't feel comfortable, then of course you should get a second opinion.
posted by amyms at 8:38 PM on March 19

If you don't fully trust the dentist, then definitely get a second opinion.

I'm in a similar situation right now, and I have a second opinion appointment scheduled for tomorrow. You're damned lucky you have insurance though -- I don't, and I was quoted $2000 (!!!) for the root canal and crown [a big factor in my seeking a second opinion].
posted by qxntpqbbbqxl at 8:58 PM on March 19

I would get a second opinion. Diagnosing you before the x-rays were done (and not even showing them to you) is a big red flag, as that would be a main indicator of whether you have decay in your tooth (cavity!) or if its fine (grinding!). This is vital information you need to make an informed decision.

X-rays will also outline how much of your tooth is gone and help determine whether it's only the dentin that's exposed or the pulp of the tooth. (Percussive action, sugar, and sensitivity to hot and cold is going to cause pain in either situation.) Can you actually see the red in your tooth?

$100 is a great price for a root canal. Does that include the post and crown? Crowns in particular are expensive and separate in cost.
posted by greenland at 9:04 PM on March 19

I did have to have a root canal caused at least partially by teeth grinding. The structural damage caused the root to die. In my case I had two different dentists recommend it to me in a non-urgent way, over a period of a few years, before I got it done because it actually started hurting a bit again. Why? Because although that particular tooth couldn't feel anything, eventually the dead innards of the tooth allowed an infection to form and that hurt.

But get that second opinion-- both of my dentists definitely looked at x-rays and made me feel very comfortable that their recommendations made sense.

One last comment: When I got the root canal done, the endodontist told me it was one of the more difficult ones he'd done. He thought it was because I ground on the tooth for so long, it made the inside really calcified and so it was hard to clean. So you might not wait as long as I did if you do end up doing it.
posted by nat at 10:20 PM on March 19

Could be that the dentist has seen this sort of thing before, and often enough to offer up an educated guess based on the initial observation.

Furthermore, X-rays don't take any time at all to develop... they're done digitally these days and the images are ready near-instantly. In all likelihood while the X-rays were being taken, he was on the other end of a computer screen confirming his suspicions.

The reason I defend the dentist in this case is because I, too, had to have a root canal after grinding a nice-sized hole in my tooth. It's unreliable to use pain as a measurement tool because the decay is often slow enough that you will go through peaks and valleys of pain and slowly develop a tolerance to it. Until the nerve is actually exposed, that is. Then you will simply be in pure, unadulterated, throbbing PAIN.

The risk of waiting is that you could already have an infection. If that's the case, the longer you prolong fixing it the higher your chance of developing something really bad. Root canals are straightforward (if expensive) and can at least be treated without anesthesia. If you get an abscess or an infection that works its way to the jaw, you're looking at Trouble.
posted by Civil_Disobedient at 12:26 AM on March 20

update: I called the dentist to get a copy of the X-Rays, he said it was 25 dollars and they couldn't fax them or email them to me.

Should this be another factor for me to consider a second opinion or is this the norm?


@greenland: I meant $1000 after insurance, based on my coverage and some estimates here on metafilter. I'll chekc my benefits and try to get some quotes.
posted by spacefire at 9:44 AM on March 20

also, I just called my insurance and found out I wasn't supposed to have been charged for a copay.
posted by spacefire at 10:28 AM on March 20

I don't think x-ray film would be fax or scan-able, but I'm not certain about that. $25 for the x-rays is pretty standard. I would go down to his office and get them, as the dentist will be able to point out what's normal on them and what isn't.

Is that $1000 after insurance include the root canal appointments, post, and crown? Otherwise that seems like a rip-off.
posted by greenland at 2:18 PM on March 20

I'm pretty sure spacefire meant the whole procedure (including posts & crown). $1000 sounds about right--with a good dental plan. Just a root canal in a reasonably-sized metropolitan area is going to run you $600 on the low-end. And the crown almost always doubles the price. I had forgotten about the middle-stage period where they put the posts in--naturally all that's extra.
posted by Civil_Disobedient at 3:24 PM on March 20

I'm not a dentist and never will be. But, I did manage dental offices for a while. Radiographs are generally not faxable or emailable because if they were taken digitally you get the best diagnostic use out of them when viewing them with dental software. If they were not taken digitally then they are little tiny pieces of film, about the size of two quarters next to each other. Little smaller, actually.

Yes, they can prescribe antibiotics for anything going on in your mouth. Your throat counts.

Probably a post and crown. I've never heard of a "point" being done with a crown. Yes, the post often adds costs to a crown procedure.

Not only should you get a second opinion, but the fact that you don't trust this guy 100% in your mouth and your wallet, you shouldn't have him do any of your work. If something goes wrong...well you've already got an inkling that he's up to no good. And dentistry is as much an art as a science. Remember that any practitioner is first and foremost a human being. It's possible that the tooth would be fine and not hurt you a bit for another year, or ten years. But it's also possible that the infection could worsen in a bad way quickly, when it does worsen. There are dentists who do root canals that 99/100 other dentists would insist you pull the tooth because it's so far gone, and dentists where they do a root canal where lots of others would say "let's wait and see."

Is there a chance the root canal is not needed?
That another dentist might say a filling and using an OTC nightguard is enough? Yes, these are certainly possibilities. But there is also the possibility that you go get a second opinion, he knows you want to hear that you don't need a root canal, he just gives you a filling, you feel comfortable with him. Then, in two months, or six years, that nerve goes kablooey. Doc #2 has you on the hook for the filling now and the root canal in the future. This is the chance you take with dentistry. Very few docs are actively trying to scam their patients out of scads of money. They use their best judgement, which is more informed than ours, sure. But it's still a human brain in that head.

Anyway, let us know what you end up doing. I'm always curious!
posted by bilabial at 4:04 PM on March 20