Sorry for the long post, but I think the details are important. I recently had some dental work done due to some serious pain I was experiencing in my upper left jaw. It started as a dull ache that quickly ramped up to extremely painful searing pain in my upper and lower teeth, the jaw joint, temple and sinuses. This pain would come and go, but was unbearable about 5 minutes after eating anything. I went to my dentist who I have been using for over 10 years and he recommended a gold crown and root-canal ($3K) that DID NOT ultimately solve the problem and now he has recommended some more costly work (another $3K on a different tooth). In looking carefully how he approached this I think he made a major mistake in his original diagnosis and I could use some advice on how to approach this. I really hate to get into it with the dentist, but he has not come forward to admit any culpability in this case...and this make me angry . If you have some constructive ideas...especially if you are a dentist or legal expert in this area....please give me your thoughts. Here are the details...
After I reported the initial pain, the dentist did a cursory examination of the teeth on the left side of my mouth. He did a quick squirt of some cold air some water on lower teeth with no response. He did a quick bite test using some rolled up rubber sheeting...with no response. No cracking on any tooth was evident. He took five x-rays of my upper and lower teeth on the left side...still nothing evident. Upon physical manipulation he says that my back upper molar needed a crown and that, based on his anecdotal experience as a child, was probably causing all my pain. He recommended a gold crown. I said OK...if you are sure that is the problem...go ahead. He started the crowning process and put in a temp crown.
The pain never fully subsides and the dentist puts in the gold crown (one week later) with temporary cement in case I needed a root canal. After about one week the pain was still there and very serious. I went in to see him with my wife and he did a panoramic x-ray and suggests he thinks he sees an area of infection below the tooth he targeted. After inspecting my jaw he said that TMJ may also be the problem. This time he did a localized hot test on each tooth on my left side as well as a bite stick test on each tooth. No tooth exhibited instant pain, BUT after 5 minutes the pain did return. Of course, we still have no idea exactly which tooth is the culprit. He schedules a root canal for the next day on the crowned tooth.
The root canal was performed and a temporary crown was applied again. After about a week the pain was still there and has gotten worse.
This time the dentist did an Electric Pulp Test on each suspect tooth after calling me back in saying that is the definitive test. All my teeth were fine EXPECT for the tooth IN FRONT of the one he originally said was bad and he did the root canal and crown on. Needless to say I was pissed. If the Electric Pulp Test is THE definitive test to determine which tooth has a bad nerve and causing my pain...WHY DIDNT HE USE THIS TEST DURING MY FIRST VISIT??? The dentist offered to handle my pain right there (i.e. start a new root canal...which I immediately saw as a hard sell tactic), but I said no thank you and expressed my dissatisfaction with his testing procedure realizing he did the wrong tooth and left. (FYI, the tooth he actually did was never on any treatment plan so I am even suspicious if it ever needed a crown.) I am very sure that he believes that he did nothing wrong in how he targeted the first tooth. Now that I realize what should have been done, I vehemently disagree.
Now I need another $3K procedure on the correct tooth. The new tooth he tested was shown to have a dying nerve and became very pressure sensitive, but has actually stopped hurting over the last week because the nerve is toast...but... there still is the danger it may abscess...requiring removal of the tooth....which the worst possible outcome. I really think my dentist blew it on this one and I should not have to pay for the crown and root canal on the original tooth, but he has not even followed up with me to see what I want to do. I think, he thinks that he has me over a barrel because of this potential for losing the second tooth (another reason for me to be to be upset). If he is ready to play hard-ball on this one...well, so am I. He has made no effort to address this problem since and I can use some advice on how to approach this...especially if you have dental or legal experience. I really think I have a case, but I want to be sure I approach him on this in the correct way.
Was my dentist's initial testing procedures in fact correct and adequate for finding the actual tooth causing my pain? Shouldn't he have employed ALL the tests he ultimately used (tooth-specific cold, hot and pulp tests) BEFORE he targeted the problem tooth?
Is my assumption that not performing the root canal and crown on the actual correct problem tooth can lead to serious complications? Or, now that the pain has subsided can I just let the nerve die without problem?
Do you think my dentist should charge me for work on the original tooth, which was not tested correctly and did not ultimately solve my pain problem? If not, how do you think I should approach him about this?
Thank you in advance to anyone who will offer constructive advice on my problem.
Note to Self: Don't post such a long thread...if you really want people to read it and respond.
Although the details are important in this particular situation, I did try to come back and edit my post down, as well as "tone it down a bit", but found no "edit" option as in other forums. I think a resolution would be helpful to others facing a similar situation. Again, any informed responses would be greatly appreciated. Thanks.
Well teeth are a funny subject. As you can see, from experience. First off, generally after someone has had a root canal performed on a tooth, it feels a little better the first day or two but then for some reason it 'flares' back up. This 'dull achy pain' can actually last anywhere from a week to 6 months down the road. Yikes! He did do the proper thing as far as crowning the tooth, and then waiting to see how it responded to that procedure. Now, having said that, obviously problems still were persistent with the tooth, which led to it needing a RCT. The reason why your radiograph in the first place was WNL (with in normal limits) is that what dentists generally look for in an X-ray is either sever decay, or something called a periapical radio graphic lucencey, or a PARL. sometimes PARLs don't show up until the tooth has abscesse, or is about to. Which in your case was after the tooth was prepared for a crown.
Now having said that, the Dr was not your poor tooth's demise. Teeth are very interesting in that, any sort or trauma from a punch in the face, to a small chip from something hard (or soft), to even a filling being placed can cause a tooth to die. Also, the reason why lower teeth, or teeth on the other side of your mouth are starting to feel painful too is because your mouth has sympathy pains for its self. Aka referred pain. So when a tooth starts to flare up, try to always remember where about it started.
As far as advice with the second root canal, if you have doubts in your dentist (everyone always second guesses) do not hesitate to request your X-ray, a copy of your notes, and bring it to another dentist and ask for a second opinion. I've had patients walk into my office, and we were their third or fourth opinion. If you don't want to let the Dr know what you're doing, you can always just set up a consult with another office and they can do their own X-ray (generally insurances will cover this, but you might want to call first)
Well, I hope this help shed some light on your questions. Best of luck to you!
Nic27...thank you for the response. I am still concerned as to whether my dentist correctly diagnosed the first tooth as being bad and being the cause of all my pain. My post is detailed to show the inconsistency in his testing approach from one tooth to the next. After the root canal on the original tooth was done the pain remained and this is my concern. Then after what I believe was finally the correct testing approach (direct hot, cold, bite AND electric pulp testing on each tooth)...which he didn't choose to do on the original tooth... he identified the second tooth as the cause of the pain. Why didn't he use the same comprehensive analysis on the first tooth...which would have identified it as not being the source of the pain and not needing a root canal? It's too late to get a second opinion on the first tooth, but the inconsistency in his approach is obvious and I believe improper. What is the standard for testing a suspect tooth to find the source of pain? Shouldn't he have used all of the tests I listed above? Thanks.