Q.
Hello Andrew, I have just the one filling (UL6) which I have had for approx 15 years (I am 32). The filling was replaced approx ten years ago and was fairly large (covered back half of tooth). At some point during the early summer I somehow broke the filling in half (I grind my teeth in sleep, so this could have been the reason!) and stupidly did not go to my dentist straight away as the only symptom I had was pain when drinking iced drinks. Last weekend I developed severe pain, which felt similar to that I had with an abscess on my wisdom tooth in my teens, so I assumed that the cracked filling had led to an infection. I did not however expect to need RCT though for the following reasons: No sensitivity to percussion No pain on biting Not sensitive to heat Pain was only intermittent No discolouration However, after a sleepless night I went to Guys hospital as an emergency case to have the tooth looked at and some antibiotics prescribed while I awaited my dental appointment. The student agreed that it did not sound like I needed RCT after the exam but ordered x rays just to be sure. The x rays came back with very slight dark areas around the base of the roots of that tooth so he said that RCT would indeed be required. He said he would double check with his supervisor (who agreed but appeared to be newly qualified himself, so I was not confident). I expressed concern with having RCT as I am aware that it kills the tooth and so makes it brittle (I am a teeth grinder, so worried that it would not last long, in addition to the fact that I had orthodontic treatment as a child and so had already lost two upper molars!), However I was told that it was the only option and the first part of the surgery was carried out (they did not have all the tools so only removed some of the pulp and nerves and added sponge and a temp filling, but I am told the bulk of pulp was removed). I was advised that as I had lost quite a bit of tooth, a white crown would not fit properly, I would eventually need a gold crown as they are thinner. I visited a new dentist in London today, who told me that he can finish the job, but would advise me to choose private as he will then be able to fit a white crown (despite my previous advice) and will use tools not available as an NHS patient. I was the only person in the waiting room not on benefits, so I assume he was just making the most of actually seeing a patient that was able to afford private treatment but my questions are as follows: In light of my lack of symptoms, was RCT really necessary or would a course of antibiotics and a standard filling not have been suitable as a first course of action? If this is the case and some of my pulp and nerves are still intact, do I need to proceed with completing this or could the sponges be removed and a standard filling placed to retain the life of my tooth? Is a private RCT really more successful than an NHS treatment due to ‘better tools’? Or is it only the quality of the crown which differs? At the moment I am still suffering sensitivity to cold touch on the side of the tooth, a kind of dull throbbing as if it would hurt if I still had all my nerves and pain if I sneeze or bend down, so I assume the tooth is still alive at the moment! This dentist that I am supposed to go back to next week also did not advise on me taking antibiotics as he said that they would only kill the good bacteria as well as the bad. Have I been given an unnecessary RCT and am I being ripped off by being advised to switch to private treatment?
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