Referal to endodentist after failed root canal on premolar

[GiddyG2001]

Basically my dentist can't complete a root canal on my premolar because of its difficult roots. He's said he can refer me to the hospital for a specialist endodentist but they may not take the case. My son sees a private dentist and at his surgery,they have a endodentist and I know they take NHS patients on referrals. Can I ask for them to refer me to that surgery instead of the hospital?

I'm on a tax credits exemption certificate in the UK so don't pay for my treatment. Currently awake with an abscess on the same tooth (I have antibiotics) and am very anxious about either getting the root canal or an extraction sorted soon as I'm aware abscesses can return if the procedure isn't done quickly after the infection clears.

 

[Busybee]

I don't understand why your dentist started the root treatment instead of referring you in the first place. You will have to pay for treatment if he refers you to the private sector. Did you discuss an extraction with the dentist?

 

[GiddyG2001]

I don't know either! He did the first session,then said he wouldn't be able to get it done as my roots had "vicious curves" and I'd need to come back.
Went back,took him 30mins to numb me,and even then,I wasn't completely numb so still couldn't finish.
Told me to rebook a 3rd appointment on a certain day so a more experienced colleague was there to consult.
I think what happened was,he's fairly young,he wanted to give it a go then realised he couldn't do it. So he should have admitted defeat. Which it seems he hasn't.
He did say extraction was an option if it failed (which it now has) but he also mentioned an endodentist at the hospital,which would be free on the NHS but would come with the caveat that I may not be accepted and would prob be on a long waiting list.
I'm quite surprised I'd have to pay as my son's dentist say they accept NHS referrals. And my status on the NHS is free treatment.

 

[Busybee]

You'd have to speak to your son's practice. You should complain to the NHS about the treatment. If the dentist cannot complete treatment then he should not have attempted it.

 

[MattKW]

You'd have to speak to your son's practice. You should complain to the NHS about the treatment. If the dentist cannot complete treatment then he should not have attempted it.

Unfortunately, it's not always possible to fully appreciate the difficulties of some treatment until you get into it. The important thing is to recognise when you are out of your depth and pass it on, rather than keep trying and possibly do irrreversible damage.

 

[Busybee]

Unfortunately, it's not always possible to fully appreciate the difficulties of some treatment until you get into it. The important thing is to recognise when you are out of your depth and pass it on, rather than keep trying and possibly do irrreversible damage.

MattKW the most sensible dentists I have met do not even attempt a root treatment, even the simplest canal. They always refer to a specialist. it must be awful to have a treatment half done and have to eat and live with the pain and a weakened tooth while you wait to have it retreated.

 

[MattKW]

I know a great many more dentists than you, and I tutor in the clinics at the Uni, so I know very well what is taught, and to what standard upon graduation, and what my many colleagues practise. You lack detailed knowledge of RCTs and the principles of pain control as properly applied in dentistry.
As a pertinent example, dentists are often presented with toothaches and to relieve the pain, they must extirpate the pulp. That is not " awful" or "half done"; that is standard first stage emergency pain relief for acute pulpitis and similarly for necrotic pulps. Done properly (and simply), there is prompt cessation of pain. If we didn't at least accomplish that step, then how would patients wait up to several weeks to get into a specialist (if that's who they need)?
Younger dentists may defer their more complex RCTs to senior dentists in the practice, and senior dentists will sometimes refer to endodontists. RCTs are very much bread-and-butter for many general dentists - I finished 2 molars today. It sounds like you haven't always met the right ones.

 

[Busybee]

We will have to agree to disagree on this. In my opinion MattKW general dentists should never attempt root treatment and I would like to see this as a legal requirement. Financial considerations should certainly not be part of any decision making in this respect. We see plenty of examples just on this forum of the disaster that follows and patients who end up with long term pain and tooth loss. It's best left to the specialists who have years of experience and the right equipment to save a tooth.

 

[MattKW]

In your very limited opinion. Should we also leave surgical extractions to oral surgeons, and crown and bridge to prosthodontists? General dentists are trained in many procedures and should refer more difficult cases wisely.

 

[Busybee]

General dentists should not be attempting root treatment and implants. If they want to do either then they should complete the same training as a specialist and be required to have the same equipment. Were this a legal requirement then there would be far more specialists than we have now.

 

[MattKW]

General dentists are trained to do RCTs and are qualified to do so immediately upon graduation. They also receive rudimentary lessons in implants, and can do it after post-grad training.
Why on earth would you want more specialists? The cost of specialists is well out of the reach of most people, and should receive referrals when the treatment is too difficult for the general dentist. Why can you not understand this simple concept? (and you avoided answering about oral surgeons and prosthodontists).
I infer that you work in some sort of health field, and I don't mind when you give general and supportive advice, but you really have no technical knowledge of dentistry, and some of your comments are dangerous and misleading.
You and your "legal requirement" nonsense, really. Do you not think that Dental Boards or Councils, specialist organisations, and Dental Associations are somehow less astute than you?

 

[Inneedofdentalhelp]

I agree with Matt here, but what if they adopted a system more similar to medicine? One in which you specialise in some field upon graduation. That way there can be a number of specialists in each dental practice and the overall level of care would improve for all patients. Also dental associations/boards/councils are never infallible and there is always room for improvement.

 

[Busybee]

Like I said MattKW we will have to agree to disagree on this one. There are plenty of examples on this forum of inexperienced general dentists leaving people in enormous pain and distress by attempting complex root treatment. The whole area of dentistry is insufficiently regulated. Considering the damage that results from poor shoddy work it needs massive reform and a big rethink as to who can do what and who should not be allowed to do risky procedures. To become a qualified doctor you are trained in all sorts of areas during a rotation but you do not have GPs attempting surgery even if they have done some training many years earlier. General dentists should stick to the basics just as GPs do and leave invasive high risk procedures to specialists who do them all the time. Passing patients around on a conveyor belt once it's too late is simply not acceptable.

 

[MattKW]

Again, just what is your field of expertise? What recognised qualifications do you have?
You also don't seem to understand that fora like this attract problems, not successes, and are skewed representations of the population.

 

[MattKW]

I agree with Matt here, but what if they adopted a system more similar to medicine? One in which you specialise in some field upon graduation. That way there can be a number of specialists in each dental practice and the overall level of care would improve for all patients. Also dental associations/boards/councils are never infallible and there is always room for improvement.

Lovely idea, but the extra training (time and money) to be a specialist won't make it cheaper. And specialists don't want to work in the same practice as GDP and vice versa. I prefer to send patients to independent specialists of whom I approve - not all specialists are good. There are 3 local dental specialists to whom I refuse to send my patients (an orthodontist, endodontist, and paedodontist).
Boards/councils aren't perfect, but Busybee hasn't proposed a better arrangement, just wishful thinking and no practical solution.

 

[Busybee]

MattKW I am not sure how much you know about NHS Dentistry but it has never had a good reputation. Most dentists here start their training in NHS practices straight out of university. These dentists may have studied root treatment at dental school but they are insufficiently experienced and should not be in a position to start complex work where there is no clear referral path and where they have no specialist backup. The NHS needs to address this because people are ending up with serious health problems as a result of a lack of expertise. There should be a specialist in every NHS practice but it's hard enough for them to try to find qualified dentists in the first place.

The majority of private practice general dentists here do not carry out root treatment themselves. Even though they may be very experienced most refer that to a specialist. That may be different in Australia but that's the case here. You've said yourself that you do not trust some of your specialist colleagues to carry out work so how can patients have confidence in dental professionals? Have you reported these specialists as incompetent? There appears to be knowledge of incompetence amongst professionals but how many are outed to their boards?

 

[MattKW]

Where do you get your information to make these assertions? You haven't answered any of my earlier questions, but just answer me this specific statement: "The majority of private practice general dentists here do not carry out root treatment themselves." I simply don't accept that phrase unless you can provide a reference. e.g. how many RCTs does a general dentist perform, and what percentage does he/she send to an endodontist?
So much of your talk is unsubstantiated nonsense, and misleading to other people needing expert opinion on this forum. You speak from personal anecdotes at best.

 

[Busybee]

MattKW my comments aren't anecdotal and you are taking this discussion too personally. Everyone who lives in the UK is acutely aware of the failings of the dental system and particularly NHS dentistry for decades now. There is a toxic environment and many dentists have retired with inexperienced new entrants or cynical sharks filling the gaps. Private practices do not want litigation so they refer to specialists. The NHS does not have the same easy referral routes. In fact private practices are able to refer back to NHS specialists with "too difficult" cases. The whole system needs reform here. Yes there are good experienced dentists around but they do not put themselves at risk to perform anything complex. They refer on because why would they expose themselves to potential litigation?

https://www.dentistry.co.uk/2015/09/04/i-am-a-dentist-get-me-outta-here/

https://www.nature.com/articles/sj.bdj.2018.359

https://onlinelibrary.wiley.com/doi/pdf/10.1002/j.1875-595X.1997.tb00793.x

 

[honestdoc]

MattKW I am not sure how much you know about NHS Dentistry but it has never had a good reputation. Most dentists here start their training in NHS practices straight out of university. These dentists may have studied root treatment at dental school but they are insufficiently experienced and should not be in a position to start complex work where there is no clear referral path and where they have no specialist backup. The NHS needs to address this because people are ending up with serious health problems as a result of a lack of expertise. There should be a specialist in every NHS practice but it's hard enough for them to try to find qualified dentists in the first place.

The majority of private practice general dentists here do not carry out root treatment themselves. Even though they may be very experienced most refer that to a specialist. That may be different in Australia but that's the case here. You've said yourself that you do not trust some of your specialist colleagues to carry out work so how can patients have confidence in dental professionals? Have you reported these specialists as incompetent? There appears to be knowledge of incompetence amongst professionals but how many are outed to their boards?

In the US, according to a source I read about 10 years ago, general dentists perform about 80% of all root canals while the specialists do about 20%. The general dentists are held to the same standards as specialists by the licensing authorities (state dental boards). I am a general dentist and was assigned to work full time on root canals at my large group practice since many dentists don't like to do them.

Incompetent dentists are quickly identified and shut down in my state. Just because we don't refer to specific individual specialists does not mean they are incompetent.

 

[MattKW]

In the US, according to a source I read about 10 years ago, general dentists perform about 80% of all root canals while the specialists do about 20%. The general dentists are held to the same standards as specialists by the licensing authorities (state dental boards). I am a general dentist and was assigned to work full time on root canals at my large group practice since many dentists don't like to do them.

Incompetent dentists are quickly identified and shut down in my state. Just because we don't refer to specific individual specialists does not mean they are incompetent.

Thank you. That would be my anecdotal feeling too, and I have read similar stats somewhere but can't be bothered to find details just to rebut Busybee when she goes off-topic and doesn't address the needs of the OP.