A man, a plan, a root canal: Your endodontry stories pls?
July 17, 2018 7:37 PM   Subscribe

The bad news: My partner needs a LOT of dental work. The good news: For the first time ever, we have dental insurance (through my employer)! Now I’m reading the Schedule of Benefits, scratching my head. I’m totally new to endodontics. There are SO many choices. We are low income. Please help? I’m looking for suggestions based on your experience or research.

What prompted my partner to finally see the dentist (he has dental phobia) was his front tooth broke, leaving a very prominent gap. He got x-rays, an exam, and the dentist gave him a quick run down of what he might need (not a Treatment Plan, that’s not for another month).

Although my partner will need at least two other additional root canals, one other crown, multiple fillings, and probably some sort of gum surgery, we are prioritizing the front tooth first for obvious reasons, unless his dentist insists otherwise.

The dentist suggested root canal therapy and a crown for that front tooth. How long does this procedure usually take? I know he doesn’t want have this gap for much longer. What would be the quickest option? Should we ask for a temporary partial removable denture? Or will he get the permanent crown right after root canal therapy?

And what type of crown should he get? There are so many options like porcelain, resin, noble metal, base metal, titanium, and any number of combinations of these materials. How does he choose what to get?
These materials all look to be roughly the same price, though abutment supported crowns do cost more.

Finally, is there any good reason not to eschew the crowns and get a partial/bridge?

The problem I’m having is we’re totally new to all this, and though we trust the dentist to guide us, he has a business to run, as does the insurance company. We would be willing to spend a little more today to avoid problems in the future. (And I am grateful I am in a place financially to be able to say that). But we also are on a limited budget. I estimate that if we are very frugal we could save ~$6000 for the coming year for dental procedures.

YANAD/YANMD, I am looking for your personal experiences, whether happy or horror stories. Or any recommendations on how to research my options.
posted by shalom to Health & Fitness (20 answers total) 3 users marked this as a favorite
Hi, I'm 26 and have had 3 root canals (plus assorted other procedures throughout my life; I lost the dental health gene lottery pretty badly).

First off, an important thing that I didn't know about until very recently: your dental insurance likely has a maximum coverage cap. It's usually around $2000 per calendar year, could be more or less. That means the insurance will only pay out $2000 per year, according to the schedule of benefits (e.g. 80% coverage for a root canal, 60% coverage for a crown, etc.). I ran into this cap one year when I had the good fortune to schedule a gum surgery during the summer and then require a specialist root canal later in the year. Basically, one major procedure should be fine, two major procedures and you might hit the cap.

Here's the good news: it sounds like he doesn't need to have any teeth pulled. Implants are the really expensive part of dentistry (well, that and orthodontics). Absolutely go for the root canal and crown. Your alternatives are:

1) Pull the tooth, get an implant which takes months and runs thousands of dollars per tooth, often not covered by dental insurance.
2) Pull the tooth, get a partial/bridge which generally come with quality of life tradeoffs. You can research this pretty easily by looking for implant vs. denture comparisons. But the BEST option is to keep your natural teeth for as long as possible, with or without live roots.

Crowns should last for ~5 years and are indefinitely replaceable, assuming that the tooth doesn't take further trauma. My root canals were surprisingly as painless as getting cavities filled and they otherwise function like 100% normal teeth now. I just had the crown on my first root canal replaced, after 6+ years. Crown replacement is a non-urgent procedure, as long as the crown hasn't actually fallen off, so you can budget that out for the right year.

My two crowned teeth are both molars/pre-molars, so I'm not as familiar with the options for crowning a front tooth. (Third root canal is on a front tooth, but it was caused by invisible microtrauma so I didn't need a crown.) I got a temporary crown right after root canal therapy, then came back in 2 weeks later for the permanent crown to be fitted. For a visible tooth, I would definitely go with porcelain as the most lifelike option. I had a porcelain crown on a back molar for 6 years and it held up really well, other than wearing down in the middle to the metal core. My dentists have all preferred porcelain as far as crown materials go, not even asking me to make a decision on that front.
posted by serelliya at 7:54 PM on July 17, 2018 [3 favorites]

Crown follows root canal. There should not be a long gap in time. You go back to your regular dentist for them to take an impression/do a scan and put in a temp crown. Probably a couple of weeks to get the permanent crown back from the lab.

I know root canals are a byword for painful procedures, but mine (almost ten years ago now) had surprisingly little pain involved, either during or after. It was more boring than anything. If your partner has a phobia, you can try requesting that the dentist prescribe a small dose of an anti-anxiety drug for use before the procedure.

I don't think I've ever heard of anyone going voluntarily to dentures!
posted by praemunire at 8:48 PM on July 17, 2018 [1 favorite]

I also lost the dental health lottery, and my fubared mouth is full of root canal'd teeth, some with crowns, some molars needing crowns, but meh. No one else can tell.

You will almost certainly hit your yearly dental limit, so you'll need to prioritize the work. Also check how much your coverage will cover for things like crowns. I'm in Canada so things may differ (although I think the plan is the same for my American co-workers), but my pretty decent employer-paid plan only covers 50% of restorative things like crowns, and has a $2000 yearly limit. Something to keep in mind.

I'd prioritize anything that is causing pain today or is likely to cause pain in the near future, as well as anything bothering you cosmetically (ie the chipped tooth). Personally, I've put off the crowns on my molars (even though my dentist keeps nagging me) because it's $700 and literally no one can tell I just have a giant "temporary" filling there that's lasted longer than some crowns (albeit the other one did break eventually, so... meh. Then i got the crown.)

My experience is the root canal is done in one appointment, the next one is the mold or whatever for the crown, and then the third is super quick while the crown is placed. I literally have no idea what type of crown i have. Just ask your dentist. He's not going to get more than your $2000 (or whatever) insurance cap this year anyway, so he really has no real incentive to screw you over, and has more incentive to make you happy.

As long as your not one of these people who don't freeze well, root canals shouldn't hurt. For me, it's the anxiety that makes it 1000x worse, so ask about getting something like Halcion or similar before the appointment(s). He'll need someone else to drive if those are taken though.

Good luck!
posted by cgg at 8:56 PM on July 17, 2018

Root canals are not bad at all, just long. The good news is, a front tooth only has two canals, hence less time. Even if your regular dentist does root canal therapy, I would highly suggest going to an endodontist; it will be faster, less uncomfortable, and less likely to fail. Root canals take two appointments. You go in once, they clean out the canals, put in a temporary sealant, and maybe a temp crown. If you see an endodontist I bet the initial procedure would take about an hour, maybe even less for a front tooth. With a regular dentist I would expect at least two to three hours. If you have an infection, you'll be given a prescription for antibiotics. Then you go home or to work or whatever.

You come back in a week and I don't remember how long that appointment takes, maybe another hour or two? They will fill in the canals and place a permanent filling, and then do a mold for a permanent crown.

Then you have to come back again when the permanent crown is ready to get it put on, but that only takes a minute and a dental assistant can do it. You don't have to be numb for it.

Please don't get a bridge! Root canal therapy isn't painful. It's much better to treat the teeth and save them if you can. Once you pull a tooth it's gone and you can have bone loss.
posted by Violet Hour at 9:29 PM on July 17, 2018 [3 favorites]

Also, if you see a new dentist and they recommend a lot of work like that, get a second opinion. As with anything, some are more interventionist than others. Just treat the broken tooth for now. You would want to space the rest of it out over years as your benefits reset in any case, and to me it's weird that someone would push to more root canals for teeth that aren't broken or hurting.
posted by Violet Hour at 9:40 PM on July 17, 2018 [1 favorite]

I've had 2 root canals and one crown, most recently one root canal last year. Nthing that they take a while longer, but they're no more painful to get than fillings for cavities (which is to say, with properly applied local anesthetic, not at all painful). And, if performed correctly, a tooth with a root canal will no longer have nerves in them, so they'll never hurt again either. Given the choices of a root canal or an extraction, I'd *definitely* go with the root-canal.

I don't recall exactly what crown material I got; I'd say go over the choices with your dentist, as they should be able to give you a better handle on the pros and cons. For front teeth, I'd probably go for a natural-looking crown, but there may be tradeoffs with durability. That said, my oldest crown is one that I got in the 1990's, and the other root canal crown was done in 2003, and neither of them have needed a replacement in the time since.
posted by Aleyn at 10:03 PM on July 17, 2018 [1 favorite]

And what type of crown should he get? There are so many options like porcelain, resin, noble metal, base metal, titanium, and any number of combinations of these materials.

I've got several crowns now. The only choices offered me have been between porcelain and gold (which is I guess your noble metal.) And even though it's easier to work with, now my dentist doesn't want to use gold because it's so expensive. I have one crown that's half&half, porcelain on the outer surface and gold on the inner.

My impression is it's usually the dentist who specifies what the crown will be made of - it's not the patient's choice (and your insurance may also have some say in the matter).
posted by Rash at 10:08 PM on July 17, 2018 [1 favorite]

Response by poster: Thanks for the insight y’all. I’m going to show my partner your responses, I bet he’ll feel a lot better about everything. Thanks for letting me know about the annual cap, too; I’ll definitely look over my insurance plan again.
posted by shalom at 11:28 PM on July 17, 2018

don't let them talk you into not getting a crown on the root canal'd tooth: i had mine covered up/filled in with some kind of sealant bc my mom cheaped out on a crown, and the root canal failed spectacularly a few years later, leaving me with a severe bone abscess in my lower jaw that had to be cut out along with the rest of the tooth. after 4 bone grafts it still can't hold an implant so now i just have no tooth there, which is suboptimal. (maybe don't tell your partner the hideous details of this though.)
posted by poffin boffin at 1:10 AM on July 18, 2018 [3 favorites]

I’ve had one root canal, on a front tooth. It was due to many small traumas on the tooth so I didn’t need a crown.

But as for the root canal itself, the endo beforehand told me I was lucky it was a front tooth, as they’re much faster to do. Afterwards he told me my tooth was the longest front tooth root canal he recalled doing... but it still wasn’t that bad. Mostly it was pretty great that the tooth was not bugging me anymore.

One weird thing for me was that pressure sensing is separate from pain sensing, and not as strongly affected by the local anesthetic; it kind of weirded me out that I could feel various scrapings in the tooth area (but it didn’t hurt).
posted by nat at 1:15 AM on July 18, 2018

I had a root canal recently, on a far back tooth. It didn't take long, 45 minutes. Honestly I had been in so much pain that I enjoyed it. Knowing it wasn't going to hurt any more was such a relief.

This may be unpopular or bad financial advice, but I have good insurance and I still had to open a Care Credit account to pay for some previous dental work a few years ago. I also used it for the root canal, which was less than $500. They offered six months interest free, but of course if you don't pay it off they get you good. So far I haven't had any issues with them on the two procedures I've used it for. Sometimes you just don't have several hundred bucks lying around, it's nothing to be ashamed of.
posted by CheeseLouise at 4:21 AM on July 18, 2018

Be careful flossing around a temporary crown - I popped one right entirely off
posted by thelonius at 5:41 AM on July 18, 2018 [2 favorites]

I too have lost the dental lottery and at 30 I’ve had several root canals (first at 17), a couple of crowns and cavities between LITERALLY every single one of my molars. This year was 8 cavities alone (in addition to the crowns and root canals last year).

Ask the dentist to prioritize the work and talk with the front desk A LOT about insurance. I had hit my insurance cap last year and because the pricing wasn’t that different I went to an out of plan provider, hit my limit and from there couldn’t even have a cleaning covered. Now I’m at an in practice provided that’s a lot less fancy but has seem to have done a decent job.
posted by raccoon409 at 6:04 AM on July 18, 2018

generally speaking dental insurance is basically only worth about the tax arb.
posted by JPD at 6:46 AM on July 18, 2018

I went on a dental spree about 10 years ago, after i finally got dental insurance. I was mostly embarrassed about having let my teeth get to the point where i needed root canals, gum work, and a couple pulled. My dentist was pretty good, but the woman who worked the front desk was amazing. It was a small office and i think she was the only person who worked the desk. She was very knowledgeable about all of the procedures and was always willing to take time to make sure all of my questions were answered. She was more personable than my dentist and it was easier and more comfortable planning with her than with the dentist. She told me she had seen a lot of people who came in needing a decent amount of work and she worked with me to figure out the order of procedures to really max out all of my benefits. I paid what i could every time i came in (about every other week for several months), she kept me informed about what my insurance was doing, we worked out how the calendar worked with the insurance company so we could plan on waiting for some things, and kept a pretty accurate estimate of how much i would still need to pay after insurance. I don't remember all the details, but it was all very managable, on both the dentistry and the financial side. The great news was that once i got back to a good place with my teeth, maintenance has been easy. I get compliments frequently on how nice my teeth are. So i guess my advice is to find a dentist office where you can form a good relationship with the person doing the billing/dealing with the insurance company. She ended up being a great advocate for me and lessened my dental anxiety.
posted by August Fury at 8:32 AM on July 18, 2018

I have had multiple root canals on the same front tooth followed by an (apparently successful) apicoectomy. The procedure was pretty easy, especially after the first time when the nerve was removed, and my endodontist said the front tooth is the easiest to do. My impression is that the root canal is the first thing they try since it's not surgical; you can just remove the contents of the canal through the tooth and fill it in afterwards. As others have said, it is usually a temporary filling followed by a permanent filling, though sometimes the endodontist put in the filling and other times they asked me to go to my regular dentist for the filling (I didn't get a crown). The entire procedure was not particularly painful other than the clamping around my tooth for the dental dam.

That being said my root canal failed three times probably because one of the times somebody left a little extra filling material inside the lesion.
posted by Comrade_robot at 12:40 PM on July 18, 2018

In addition to the cap, dental insurance often has a waiting period for big stuff (like root canals and crowns), and restrictions on the number of any kind of procedure they'll pay for within a specific time period. Definitely read your Schedule of Benefits very carefully.
posted by still_wears_a_hat at 2:57 PM on July 18, 2018 [1 favorite]

I have a pretty bad dental phobia and when one of my molars cracked in half I was given advice from my dentist to pull the tooth and get an implant. He said if I were a regular patient he would go with a root canal and try to save the tooth- but because of my phobia he said it would be better to get a permanent solution instead of kicking the problem down the road a few years. Root canals and crowns are not forever and will need to be fixed. If he is young (and will heal well) and you can afford it- I 100% reccomend implants.
posted by KMoney at 6:37 PM on July 18, 2018

I have spent a lot of my life in and out of the dentist. I recently got great insurance through my employer and also invested the maximum I could in an FSA. I just had 5 teeth out, I had a root canal and will be going in to have two crowns fitted next week.
My main advice is to ask about cost/insurance at the dental office. They contact my insurance for me and let me know exactly what I'm going to have to pay. They're super helpful.
posted by emotionalmotionsickness at 10:46 AM on July 25, 2018

Oh God, this just happened to me today. I'm off to an emergency root canal in an hour and don't have dental coverage. They don't too bad. They just suck.
posted by Che boludo! at 12:00 PM on July 31, 2018

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