Looking for advice / answers about tooth pain turned into partial root canal, then... pull it? Cap it? Loads of visits ahead?

Joined
Apr 6, 2023
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I'm frustrated with what's going on with a tooth of mine and how complicated things seem to be. I am in NY metro area, if that matters to the way dentists work vs. elsewhere.

I had lower molar pain at same time as sinus congestion. sensitivity to cold, dull ache.
1 Week later with sinuses clear but still have pain, went to general dentist (new guy taking over practice from someone retiring / I've been with for a few years (I am 60).
He xray tooth - roots are good he said. Thought it was a bite issue and grinded down a high spot.
1 week later, pain was increasing and to more things - anything not room temp, pressure from chewing.
Not really responding / decreased from advil or motrin.
Went back to dentist. He said I should / need to go to endontist.

Endontist does 360 xray of tooth. Says root is dying. Sees some cracks in tooth, filling is intact. Does the first part of root canal as part of assessing situation.

Says he doesn't recommend a root canal / cap? because tooth is cracked - that will only get you 1 - 2 years max. Better to pull it, implant and crown.

He doesn't do any of that. Gotta go to periodontist.

it's been a week and no pain at all, so while I question doing the partial root canal to figure things out (and $700 cost), I guess it was needed to determine how to solve this long term?

Perio looks and says he can pull tooth, wait for healing, put in implant, wait for healing, go to dentist for crown.

My wife worked with this perio for similar work on her mouth. She likes him.

I am hesitant about the long process and feeling this is a good example of 'if you only have a hammer, everything is a nail'.

Endo only does root canal? He does the first part of it to do assessment.
Perio pulls teeth so that's his solution?

Tried to get appt with the older dentist I started with to discuss their involvement / his thoughts / etc. They rattle off the month long process. I push to set an appointment consultation and she said he'll call. No expectation of when though.

Some questions:

1) I am amazed with the multistep process, no one seems to have this written down. The perio and dentist are rattling off multi step / multi month process. I have ADD and OCD... but am I wrong? seems just good customer service to have a sheet detailing that?

2) perios work on gums? But they pull teeth? Endontists deal with pain? But not pull teeth? And dentist is a generalist? Doesn't do much of anything than look in mouth 2x a year?

3) I spent $700 with the endontist, when I pushed the office staff of perio for something in writing, they gave a $5000 proposal for pull and implant. I don't know cost for crown and any other costs. Should it need to be a cobbled together process with 3 different people?! And don't remember when I'll be eating soft food vs. regualr food, etc...

seems complicated and long. I like quick and simple things.
 
Solution
1. Sinus pain is unrelated to LOWER molar pain.
2. If endo finds a crack, then the tooth is unsalvageable. Yes, with consult fee and CBCT, initial access into tooth to find crack, $700 is not unusual. Endos don't pull teeth (except maybe absolute emergency?). They don't carry the instruments, and are well out of usual training.
3. Perios can advise on implant viability plus assess your general gum condition before you go for implants. They will also perform implant surgery. I co-ordinate with my perio for these reasons. Perios do not always pull teeth but may in implant cases, usu after asking referring general dentist.
4. General dentists can do lots of things, but need to know limitations. So I do 95% of my own endo, 30% of my own...

MattKW

Verified Dentist
Joined
Mar 18, 2018
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1. Sinus pain is unrelated to LOWER molar pain.
2. If endo finds a crack, then the tooth is unsalvageable. Yes, with consult fee and CBCT, initial access into tooth to find crack, $700 is not unusual. Endos don't pull teeth (except maybe absolute emergency?). They don't carry the instruments, and are well out of usual training.
3. Perios can advise on implant viability plus assess your general gum condition before you go for implants. They will also perform implant surgery. I co-ordinate with my perio for these reasons. Perios do not always pull teeth but may in implant cases, usu after asking referring general dentist.
4. General dentists can do lots of things, but need to know limitations. So I do 95% of my own endo, 30% of my own perio, and only the restorative side of the implants (altho I could do implant surgery). Difficult cases or unclear diagnoses get referred to specialists for opinion or treatment for specific issues.
After extraction, the bone has to heal and shrink (remodel) which takes 12 weeks; maybe a bone graft may be needed, thus longer. Only then can you place implant, and usually wait about 8 weeks for bone to heal again. Finally get to do crown.
 

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Solution
Joined
Apr 6, 2023
Messages
2
I love your avatar : ) Great movie!

And I really appreciate your comments!

1 other question if you don't mind?

I went to another perio after posting this and feel much better dealing with them.

Their office staff gave me a booklet for AVSDentalPlan saying that would save me money on the work they would do (the extraction / implant). If I am going to net save (after sign up fee) after these procedures, it seems a no brainer?

Any opinion on that or other discount plans?
 

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