One dentist found a ton wrong that another one didn't?

[4WD]

Several comments in this thread have been from people who have had root canals followed by crowns that failed in one way or another. Root canals fail if the root canal system remains contaminated (failures shortly after completing procedure) or if the root canal system gets recontaminated due to leaky crowns and buildups. Crowns fail because cavities start adjacent to the crown and eventually undermine the crown.

Implants do not fail for either of these reasons because there is no root canal system to get infected or natural tooth to decay. So in this respect, they are superior. Implants fail due to failure to integrate into the bone (short-time after placement) or if there is a physical failure of the implant, abutment, or crown. All of these can be remedied even if it means removing the implant and starting over and they are much more rare than failed root canals and or recurrent cavities.

At least 20 years ago (I'm peds), the approximate cost of a root canal + build up + crown is the same as an implant + abutment + crown. It only gets really expensive when you had a root canal + build up + crown that fails and now need an implant + abutment + crown.

So you can see why someone might jump to the implant right away assuming medically it's appropriate and the implant site is appropriate.

I have had one root canal - paid about double for who was the best according to my steady dentist - and he did it through a crown. He was not just impressive - the whole clinic/staff was.
Not something to do low bid IMO …

 

[PWMDMD]

I had a gold crown - very back, for years. Doc then said it was too shallow for a white crown so it was gold.

Years later It fell out. Doc said the tooth was too shallow for a crown period - so had to go to a specialist - forget what there called, to do something or other to build up the root and put a pin in. Now it has a white crown.

I saved the gold crown (hey, its my gold). I should melt it down. I think its still around.

Every single thing in dentistry has a finite life span and will need to be redone if you live long enough. It is really a brutal environment of constant bacterial assault and as a class III lever, the jaws generates tremendous forces.

 

[4WD]

Gold lasts longer on average/fails less on average and it's kinder to the opposing dentition as far as wear. It also requires "less space/less tooth reduction" compared to white crowns.

I know they do more in house - is the ceramic easier to machine?

 

[PWMDMD]

I know they do more in house - is the ceramic easier to machine?

Yes, ceramic can be CAD/CAM chair side for same day delivery and no need to fabricate a temporary crown while gold must be cast after being "waxed up" - typically this takes a few weeks in a lab.

 

[SC Maintenance]

Every single thing in dentistry has a finite life span and will need to be redone if you live long enough. It is really a brutal environment of constant bacterial assault and as a class III lever, the jaws generates tremendous forces.

No complaints on the original dentist or the one that replaced it.

I have had a couple really good dentists, and a couple really bad dentists. The good ones seem to be re-doing the mistakes of the bad ones most of the time. Anyway I am happy with the one I have now. Young girl - can't be more than mid 30's - so hopefully she isn't retiring anytime soon.

 

[PWMDMD]

No complaints on the original dentist or the one that replaced it.

I have had a couple really good dentists, and a couple really bad dentists. The good ones seem to be re-doing the mistakes of the bad ones most of the time. Anyway I am happy with the one I have now. Young girl - can't be more than mid 30's - so hopefully she isn't retiring anytime soon.

She can't afford to retire any time soon! Lol...you're safe!

 

[1lieutenant]

Dentist here with 20 years of experience.

No one here can give you any answers. In general and this is not dental advice:

I have seen teeth go from restorable to non-restorable in a year.

I have seen small "incipient" cavities go from not needing treatment to root canals in a year.

I have seen obvious pathology get missed.

I have seen dentists over diagnose.

I have seen two very reasonable minds with good intentions see the same case very differently.

The only direct advice I can give you is go get a second opinion if you are questioning what you've been told.

Dentist/periodontist here with 45 years of experience. I concur with the above but would also add that I have seen early to moderate periodontitis (gum disease) progress to advanced left untreated for a year. Unusual, but there are aggressive variants. Also, keep in mind that untreated periodontitis can increase the risk of heart disease and stroke. The bacteria responsible for periodontal disease produce byproducts that are absorbed systemically. Certain bacteria associated with aggressive disease have been implicated in development of amyloid plaques associated with Alzheimer's disease. I know, a bit off topic, but certainly relevant to delayed treatment.

 

[97prizm]

I'm very confused. About a year ago one of my pre molars broke in half. They said I could get a root canal and a crown put on or pull it. Fast forward to just a few days ago, I go get a second opinion on what I should do as I don't want it to get infected and cause more problems. Anyways, this particular dentist which was more thorough than the other finds all kinds of stuff wrong. He says the broken tooth, needs to be pulled as there isn't enough to attach a crown to. He says I need a root canal on the same exact tooth on the other side, and about 3 fillings done. He referred me to an oral surgeon and an endodontic for the root canal. What I don't understand is why didn't the first dentist mention all this? They took xrays. We're probably talking about $6-$7k once the surgeon and orthodontist gets paid. The dentist alone wants $3500 The only thing I can think of is maybe the first dentist thought that's all I was worried about?

I guess I could always just have both pre molars pulled out and then keep an eye out and make sure they don't start shifting around. Tooth number 13 and 4

Opinions? I almost think I need a third opinion now. All I wanted was a simple tooth pulled, and everytime you go to a dentist they want to do a whole exam, then tell you they don't pull teeth. This second dentist lied to me as I asked if they did tooth extractions before I even set up the appointment.

If you waited it's possible that there were extra issues that popped up. I had an upper molar that had a soft spot in it and a piece chipped off. The first dentist that I visited had ALOT of expensive new tools/gadgets. Their first response was "nope can't be fixed has to have a crown." They quoted a little over 5k. Another place in town had great reviews and is ran by a guy and his son. A lot of reviews mentioned listening to concerns etc. They were able to epoxy fill the crack for a few hundred dollars not 5k. They did tell me they'll go that route but it may need a crown at some point.

 

[97prizm]

I’m sure that he gets his oil changed at the dealership. Sadly he only has 7000 km on it so he doesn’t drive it that much View attachment 268870

And it's Acid Green! One of my favorite colors Porsche offers. Bronze or gunmetal polished rims would set it off nicely.

 

[1lieutenant]

With regards to dental implants. They can fail either early (failure to integrate/bond to the bone) - rare. According to the literature about 1-2% when done by a specialist higher if completed by a general dentist. Or they can fail late due to physical overload or bacterial break down of the surrounding bone likely due to poor home care. Very difficult to treat.

 

[PWMDMD]

With regards to dental implants. They can fail either early (failure to integrate/bond to the bone) - rare. According to the literature about 1-2% when done by a specialist higher if completed by a general dentist. Or they can fail late due to physical overload or bacterial break down of the surrounding bone likely due to poor home care. Very difficult to treat.

As peds...I will let you take over from here as it's not really my wheelhouse anymore and I'm struggling to remember +20 years ago restoring Straumann implants in my AEGD...lol.

 

[Cujet]

My dentist ripped me off terribly. I'll fix a broken tooth with JB weld before I go back.

If possible, consider repairing a damaged tooth with filling material even if the result is not cosmetically perfect. Try it before ever getting an onlay, crown, root canal, or implant. Because that's the rapid progression. And my god is it expensive.

 

[1lieutenant]

My dentist ripped me off terribly. I'll fix a broken tooth with JB weld before I go back.

If possible, consider repairing a damaged tooth with filling material even if the result is not cosmetically perfect. Try it before ever getting an onlay, crown, root canal, or implant. Because that's the rapid progression. And my god is it expensive.

Not necessarily a good way to proceed. When I diagnose and treatment plan a case, I make sure my patients fully understand the issues and present all possible treatment plans (assuming there are more than one) with risks and benefits. It is my job to be sure they can make an informed decision. Not only must they understand the need for treatment and what's involved (number of appointments and overall timeframe), but they must understand the financial implications of each plan.

 

[Mechanician]

A good Dentist is like a good mechanic, except you can always buy a new car.
I've had the same type experience with hygienists - some try to up-sell everything.
I had one that wouldn't even clean my teeth, until after a full $1600 "Deep Clean" was performed. - I left
Went a couple of weeks later to another dental office - with no problems found - other than needing a cleaning.
If you have a good Dentist , and a good hygienist - stick with them even if it's a long drive.

 

[Vil_Riker]

With regards to dental implants. They can fail either early (failure to integrate/bond to the bone) - rare. According to the literature about 1-2% when done by a specialist higher if completed by a general dentist. Or they can fail late due to physical overload or bacterial break down of the surrounding bone likely due to poor home care. Very difficult to treat.

I had a root canal fail and the remnants extracted. Now I'm wondering whether I should get an implant or not. From what I've read, I have about 6 months for the bone to grow.

 

[1lieutenant]

I had a root canal fail and the remnants extracted. Now I'm wondering whether I should get an implant or not. From what I've read, I have about 6 months for the bone to grow.

Can't diagnose without seeing the patient and x-rays but usually 3 month timeframe after extraction and grafting for bone maturation and implant placement. Sometimes longer depending on the extent of the defect. Do some research to assure yourself. Implants can be a highly successful way to replace missing tooth/teeth. I have been doing implants for over thirty years but only doing them when I can't save an existing tooth with a good prognosis.

 

[The motor guy]

My dentist ripped me off terribly. I'll fix a broken tooth with JB weld before I go back.

If possible, consider repairing a damaged tooth with filling material even if the result is not cosmetically perfect. Try it before ever getting an onlay, crown, root canal, or implant. Because that's the rapid progression. And my god is it expensive.

When all my permanent teeth came in my mom had all my teeth sealed. Looks like a few have worn off and need to be resealed at this point. Idk what's up with all this root canal business. I thought that was a last resort and you typically just fill cavities in. I've never had a cavity once in like 25 years until this past year.

 

[Cujet]

Not necessarily a good way to proceed. When I diagnose and treatment plan a case, I make sure my patients fully understand the issues and present all possible treatment plans (assuming there are more than one) with risks and benefits. It is my job to be sure they can make an informed decision. Not only must they understand the need for treatment and what's involved (number of appointments and overall timeframe), but they must understand the financial implications of each plan.

Sounds like you provide good advice. Mine did sloppy work, refused to fix the obvious problems. But at least he had $4000/month worth of car payments and $9000 mortgages to cover and 3 kids in Ivy League schools to pay for.

I would have been much better off with honesty, not greed.

 

[Pew]

At least 20 years ago (I'm peds), the approximate cost of a root canal + build up + crown is the same as an implant + abutment + crown. It only gets really expensive when you had a root canal + build up + crown that fails and now need an extraction + implant + abutment + crown, all to replace the same tooth.

And unfortunately insurance, or at least mine, doesn't cover implants. I have two I need to get extracted. With implants, $8k per tooth.

 

[SC Maintenance]

And unfortunately insurance, or at least mine, doesn't cover implants. I have two I need to get extracted. With implants, $8k per tooth.

At the end of the day $16K for your health is well worth it. Its also why medical tourism exists, most people don't have $16K.