Doubts On Root Canal Treatment

[Titus]

I have a question regarding a root canal treatment I'm going through.

The tooth affected is the third molar. I felt serious pain for a period of time until it gradually dissipated and I went to have it treated. Anyway, the dentist at first wasn't sure wheather to treat or extract it, but since I'm already missing the 1st molar she decided to treat it. A few days after the first appointment though I started feeling pain in the root again (though this time it doesn't hurt if pressure is applied on the tooth). I went back (a week later, as she only shows up once a week) as scheduled but she said that there was still too much infection to fill the roots. She decided then to apply what sounded like hydroxy-something, cover the tooth and leave it to heal for another two weeks. That was yesterday, today I'm already feeling pain again! Here's the catch, I told her from the start that I'll be leaving Thailand at the beginning of April, she told me that if in two weeks there's still infection she'll have to leave it as it is and I'll have to have the roots filled back home. That after I paid 9000bht, I'm serioulsy upset about this. What do you think my options are? I'd really rather keep the tooth but the disconfort is making me think twice...

By the way, don't all dentists know how to treat a root canal? Is it necessary to wait a week for a "specialist"?

I would really appreciate any advice on the matter. Thanks in advance!

[Ajarn]

I have a question regarding a root canal treatment I'm going through.

The tooth affected is the third molar. I felt serious pain for a period of time until it gradually dissipated and I went to have it treated. Anyway, the dentist at first wasn't sure wheather to treat or extract it, but since I'm already missing the 1st molar she decided to treat it. A few days after the first appointment though I started feeling pain in the root again (though this time it doesn't hurt if pressure is applied on the tooth). I went back (a week later, as she only shows up once a week) as scheduled but she said that there was still too much infection to fill the roots. She decided then to apply what sounded like hydroxy-something, cover the tooth and leave it to heal for another two weeks. That was yesterday, today I'm already feeling pain again! Here's the catch, I told her from the start that I'll be leaving Thailand at the beginning of April, she told me that if in two weeks there's still infection she'll have to leave it as it is and I'll have to have the roots filled back home. That after I paid 9000bht, I'm serioulsy upset about this. What do you think my options are? I'd really rather keep the tooth but the disconfort is making me think twice...

By the way, don't all dentists know how to treat a root canal? Is it necessary to wait a week for a "specialist"?

I would really appreciate any advice on the matter. Thanks in advance!

<{POST_SNAPBACK}>

In all fairness it seems, the infection is the root of your problem, and that can't necessarily be blamed on the dentist, but, of course, you're hurting, you're worried, you're maybe angry....

Maybe you can get some money back, but what about your current infection? It still needs treatment, of course. Your infection could easily spread to your nasal passage, which could life-threatening... Another dentist? What are your options for getting 'new' help? Once a week at this point sounds bad. Maybe you even need to have the infection treated daily...Call in some more help to at least get stable enough to finish the work at home if you want the tooth....

Do try to work with dentist, and hold your tongue. You need her help and support, right?

As to whether to keep your tooth at least until you get back home, or take it out here.... Well, pain will be your own guide, I suppose.

Sorry for your problems. Glad it ain't me this time.

Best of luck

[Wolfie]

I had root canal treatment on one of my teeth, 4 sessions over 5 days. I was in so much pain at the time i was forced to goto a hospital for the treatment (it was a sunday with no dentists open) the cause of the problem was an infection in the root of the tooth.

Sounds to me like the dentist in question doesnt know what to do.

The infection needs to be treated, but the root canal work can continue whilst you are taking the antibiotics for the infection. You will need additional pain releif at the same time (as in pain killers outside of the dentists chair)

Be warned though, if the infection is too bad the novacain (sp?) wont have any effect and having root canal treatment without and effective pain releif is an extreemly unpleasent expience, i know, i had to undergo it.

(were talking pain that can make you black out, send you into shock and bring a grown man to tears!)

I suggest getting a second opinion.

[phuketsiam]

get in done here, i've had 3 done here, good job each time, and yes they usually refer you to a specialist after the 'junior' doc has done the preperation

[lopburi3]

It is common to have waits of a week between RCT treatments and delay due to infections the cost of 9,000 baht paid up front seems very high. I do not remember paying more than 3,500 and it was always spread over the treatments but that is at a family type office rather than specialists. The specialist approach has an advantage in that they should be more skilled at doing the cleaning painlessly. I would hope for the best at this point.

[lopburi3]

I can echo Wolfie that you do not want to perform a root canal on an abscessed tooth in any hurry. I also had to suffer that pain and it is indeed enough to make you black out (and he had the nerve to say next visit would not be as bad). It was 30 years ago but can still feel the pain.

[Wolfie]

hehe took three assistants to hold me down in the chair, i was in shock and shaking so badly the dentist couldnt do his work. they ended up strapping my head down with a towel to keep it still and wrapping me up in a blanket to stop me shaking. I can joke about it now, but its the worst pain i have ever experienced in my entire life.

Get a second opinion if your not sure Titus, its cheap enough out here.

I also echo lopburi3 opinion on the cost, i think my bill came to 5k for the 4 sessions. Paid for each session as i left. 9k does seem high

[Ajarn]

It is common to have waits of a week between RCT treatments and delay due to infections the cost of 9,000 baht paid up front seems very high.  I do not remember paying more than 3,500 and it was always spread over the treatments but that is at a family type office rather than specialists.  The specialist approach has an advantage in that they should be more skilled at doing the cleaning painlessly.  I would hope for the best at this point.

<{POST_SNAPBACK}>

Last year I paid about 10,000 in CM, but it included a porcelin crown, too. Payments were spread out to per visit...

[Jai Dee]

It is common to have waits of a week between RCT treatments and delay due to infections the cost of 9,000 baht paid up front seems very high.  I do not remember paying more than 3,500 and it was always spread over the treatments but that is at a family type office rather than specialists.  The specialist approach has an advantage in that they should be more skilled at doing the cleaning painlessly.  I would hope for the best at this point.

Last year I paid about 10,000 in CM, but it included a porcelin crown, too. Payments were spread out to per visit...

Last year I had one done at Pattaya-Bangkok hospital, including porcelain crown.

Total about 15,000 baht.

I too had an infection, and it took 8 visits over 6 weeks to treat the infection and clean out the roots, install posts, take impressions, and cement the crown. Pain like you wouldn't believe.

The OP has had 3 visits and it's cost 9,000 baht already... it sounds like the dentist has already removed some of the roots, but not all, due to the obvious pain the patient is feeling. The nerves have to be completely dead if no pain is to be felt. This usually involves injecting the root canals with some kind of hydroxide, then packing them and waiting a week or so to allow the nerves to die some more... a little bit at a time until the whole length of the nerve down to the jaw is dead.

Brings back some horrible memories just thinking about it.

It sounds to me like the dentist is doing the right thing... it is a slow and sometimes painful process, and depending on how many nerves there are in the tooth (usually 3 or 4 in a molar), and how straight the canals are, and how bad the infection is, and how long it takes to clean out the nerves.... lots of variables that can complicate the operation.

Stick with it mate... and toss down heaps of pain killers with your whiskey.

Good luck.

[lopburi3]

It is common to have waits of a week between RCT treatments and delay due to infections the cost of 9,000 baht paid up front seems very high.  I do not remember paying more than 3,500 and it was always spread over the treatments but that is at a family type office rather than specialists.  The specialist approach has an advantage in that they should be more skilled at doing the cleaning painlessly.  I would hope for the best at this point.

<{POST_SNAPBACK}>

Last year I paid about 10,000 in CM, but it included a porcelin crown, too. Payments were spread out to per visit...

<{POST_SNAPBACK}>

That sounds right as I pay about 7,000 for high gold porcelain crown (normal is about 4,000) and about 1,500 for gold pin here in Bangkok if memory serves.

[slimdog]

Unfortunetely until a dentist has actually started work on the tooth it may not be possible to determine the full extent of damage even with an x-ray. I had the same at the Bangkok Dental Hospital last year, two teeth needed root canals, one was straight forward the second took two additional visits to ensure the tooth was 100% dry inside before finishing (No additional charge). From the x-rays both teeth looked in a similar condition. It is possible that the dentist is just being professional, ensuring that his or her work is good. I believe I paid about 7000B for each root canal.

[chingy_]

im not sure this would help or not, 6 month back i had a root canal, three of them on one tooth, it take about 2 week to finish it, doing the first week clean and clean and starting to take the nerve out, than fill it with tepmoray filling for the next visit, doing that time it start to hurt very much, the cause was the nerve produce gas with no place of excapt at the root and that cause it to hurt, once i return and took out the filling it doesn't hurt anymore, the best thing the dentist was leave the hole open and fill it with cotton ball so the gas can excapt, the dentist say that is the cause pain doing the remove of nerve, leave it open only fill with cotton ball, it won't get infect because you'll be back 1 or 2 day to restart the whole thing again.

[taxexile]

the third molar is the wisdom tooth , and its the back tooth , these teeth often develop with irregular root patterns.

as you are already missing one molar , then the dentist is trying to save it so that you have two molars to use on that side of your mouth , two molars to chew against the molars in the upper jaw (i'm assuming its a lower molar , trying to root treat an upper wisdom tooth is something i've never heard of.)

the roots of wisdom teeth often develop in an atypical pattern , not always visible on an x-ray , the tooth is right at the back of your mouth and access can be very difficult .

the pain you were having initially was inflammation of the nerve , and untreated will eventually cause the nerve to die and the pain to subside as the nerve dies , the dead nerve tissue will (usually) get infected with bacteria and an abscess will develop around the base of the root , sometimes with facial swelling , sometimes without.

root canal treatment aims to remove all the dead nerve , pus , whatever , out of the canals ,and then these canals , (which can be curved,twisted,thinner than a hair,have branches to them,etc.) have to be widened and smoothed and filed so that a suitable filling material can be introduced into them to completely fill them up. no unfilled space should remain , and they have to be filled right down to within a millimetre of the apex (bottom) of the root.

its a tricky enough job on an incisor tooth with one straight wide open root canal at the front of the mouth , on a wisdom tooth with an uncertain root pattern at the back of the mouth , it becomes very very difficult indeed as you can hardly see what you are doing , unless you are working with magnifying optics.

some mild pain after a session of root canal is not unusual , but not the kind of pain that some of the gloaters here have been talking about , sometimes the instuments penetrate through the root apex and irritate the tissues there , this might cause some discomfort for a few days.

if the dentist has put some calcium hydroxide into the root canal and sealed the top of the tooth with a temporary filling , then i would wait until the pain has subsided before continuing , if the pain is anything more than mild discomfort then you might need some antibiotics or you might need to have the temporary filling adjusted so that when you bite down you are not touching that tooth first with your upper teeth. a premature bite will certainly cause pain , but usually when biting down and you say that biting down is painless.

simple root canal treatment should be done in one visit these days , if there is some infection there then a couple of visits should be enough.

occasionally , an infection will persist and then you must assume that the root canals have not been successfully cleaned and that a focus of infection remains.

root canal treatment should never be painful.

as to what you should do now , well its very difficult for me to give you advice.

if the pain dies down and it stays pain free then you should complete the treatment.

if you would rather get it done back home then you can leave it as it is for a month or so.

if the tooth is pain free , or the pain that you are having is getting less and less , and the canals have been filled with calcium hydroxide or some other palliative , and there is a good temporary filling that seals the tooth so that no bacteria from the mouth can get in , then you can probably leave it as it is for a month or so , at the first sign of the temporary filling breaking up , get it replaced.

if the pain does not reduce or it gets worse , then its possible that the infection in the roots is producing pus and you will need to go back and have the temp. filling removed to allow the pus to escape.

that is not uncommon , and is not a sign of poor diagnosis or treatment.

the human body and its reactions to infection and treatments are not always predictable.

if it remains pain free for a month or so then i think you can go ahead and have the root filling put in back home.

shortly afterwards you will need to have the tooth crowned. root treated teeth are seriously weakened , and tend to break , especially towards the back of the mouth , the forces of chewing back there are enormous.

if the dentist is a root canal specialist , then she will have assessed (from x-rays )

as much as possible about the root pattern , if you have already lost one molar , its possible that the wisdom tooth could have drifted forward into a relatively accessible position , treating with calcium hydroxide due to the possibility of some remaining infection makes sense too. calcium hydroxide is good stuff in these circumstances , the advice you have been given sounds ok.

root canal treatment is no guarantee that the tooth will never give trouble again though.

dental treatment in thailand is usually of a high standard ( in a hospital or good clinic) and 9000 is very cheap by european standards for molar root canal work.

hope all this has been of some help and not too long winded.

good luck

Edited March 25, 2005 by taxexile

[Bizz]

Also had same problem but can’t understand why wasn’t the infection treated with

Antibiotics at the start my dentist faxed the prescription to my pharmacist and I picked it up he would not treat tooth till after I finished the course of antibiotics

I wont tell you the final cost it shocked me at the time.

[taxexile]

if the infection is contained within the root canal then antibiotics will not work as there will be no blood supply to transport the antibiotic to the dead nerve tissue that is 'feeding' the bacteria .

the medication has to be applied direct into the root canal.

if the infection has spread to the tissues surrounding the root , ( mandible , maxilla , soft tissues etc.) then antibiotics will be effective as they will be tranported via the bloodstream to those sites.

antibiotics should really only be used when an infection is such that the body cannot deal with it by its own defense mechanisms.

a spreading swelling or a rise in body temperature of a couple of degrees will signify this point has been reached and antibiotics are needed.

however , these days doctors risk being sued and struck off if they dont give antibiotics at the earliest sign of infections.

hence the spread of antibiotic resistant infections which will cause real problems within the next decade.

we will be back to the dark days of 100 years ago when people were dying of simple infections that these days you dont think anything of.

[Miaow]

Semms rather expensive to me....Most i paid 4 a root canal was 1145 Baht...the less was 800 baht...Both of them well done...But the dentist didn't speak english at all....guess it explains the low cost....

[Titus]

A million thanks for all the replies.

The tooth in question is indeed a lower molar. I knew from the start that there was a lot of infection, I remember once squeezing the gum and a white nasty thing coming out (pretty much like poping a zit), also during my first visit a rather unpleasant smell came out of the tooth. I also saw the x-ray and one side of the root is shaped like a banana almost touching the other side, I'm guessing that makes it even more difficult to treat.

Yesterday though was probaly the worst night ever, I remember being awake till 4 in the morning, chewing aspirin like mad... Today I went to see one of the junior dentists, she said that looking at the gum there seemed to be a good deal of infection and that there was a bit of movement in the tooth. She told me to wait though, that the pain should go away soon. She then gave me some pills (Bufren) to take in case a feel pain again. So far they seem to be working as I haven't felt pain since. I'm hoping it's gonna stay this way...

Thanks again to everyone for sharing your knowledge on the matter!

[Trailblazer]

Could some of the posters give the name and location of where they went for dental work? I need to get some work done. I'm particulary interested in the less known/less expensive clinics around Bangkok...

[sbaker8688]

Please tell me what causes the need to have to have a root canal, so that I can try like hel1 to never be in that situation.

Also, what causes abcess and infection? I want to prevent all of these ailments. Please assist.

Thanks.

[Jai Dee]

Please tell me what causes the need to have to have a root canal, so that I can try like hel1 to never be in that situation.

Also, what causes abcess and infection?  I want to prevent all of these ailments.  Please assist.

Thanks.

I think that 99% of cases requiring root canal treatment are the result of decay getting in under an old filling, perhaps a cracked one or with a slight imperfection, and the patient not knowing about it. The decay spreads under the filling to the nerves etc... this is when infections can start along with the pain...

If you are filling-free, then you should have no problems.

[taxexile]

Please tell me what causes the need to have to have a root canal, so that I can try like hel1 to never be in that situation.

Also, what causes abcess and infection? I want to prevent all of these ailments. Please assist.

inside every tooth there is a canal , in that canal there are nerves and blood vessels.

if the tissues in that canal become inflamed (inflammation is the body's response to any kind of trauma) due to trauma (eg. a hard knock , infection entering from the bottom of the root , or infection entering from the top of the tooth due to decay , leaking fillings or crowns or poorly fitting crowns and other restorations ), then the tissues will try to swell as reparative cells infiltrate the traumatised area ,, that is part of the natural reaction to any trauma , (same as when a mossie bite swells , or the area around a cut swells a bit ) . however , the tissues in a tooth cannot swell because they are surrounded by the hard tooth , so there is a pressure build up inside the nerve canal which initially causes toothache and eventually , if left untreated the pressure will cut off the blood supply entering the canal and the tissues will die.

soon they will get infected , this is when bacteria enter the equation , they produce toxic by products and the inflammatory response is heightened , the swelling will increase and extend to outside the area of the root , i.e. the jawbone and soft tissues. that is an abscess.

root canal treatment involves removing the source of the infection by thoroughly cleaning the root canal and obturating it with an inert biocompatible material.

taking antibiotics will clear up the infection temporarily , but will do nothing for the infected material remaining in the root canal , antibiotics will not be able to reach that area as the blood supply has long ceased.

basically that is it.

there are other causes of dental infections.

sometimes they start for no apparent reason under teeth that have been heavily restored with large fillings or crownwork.

get vitality checks on all heavily restored teeth at check up time.

regular dental check ups , x rays every 2 or 3 years , regular scaling and polishing , good oral hygiene.... brushing at least twice a day and flossing and the use of fluoride toothpastes will help prevent decay.

if you already have a lot of dental work in the mouth then get it checked yearly.

[Titus]

I had a few fillings done during my last visit and a junior dentist at the place I went said something that confused me. After filling the tooth the said that the cavity was very deep and that I might feel pain and disconfort in the future ("long term" her words). Was she right then in filling the tooth anyway? Wouldnt it have been better to have a x-ray taken to make sure it was alright?

[taxexile]

a deep filling can leave a tooth sensitive to temperature changes (with hot or cold drinks) for a while. the sensitivity should not last for more than a minute after the hot or cold stimulus. might take a few days to settle.

if the act of drilling and filling has caused slight trauma and inflammation to the nerve it might be a bit sensitive / painful for a few days until it has settled.

lengthy periods of throbbing pain , often starting for no apparent reason , and powerful enough to wake you , is indicative of the need for root canal treatment.

[pluto_manibo]

Has anyone tried Silom Dental Clinic?