Not a new technique, when I was in dental school(30 yrs ago) two visits was standard. First opened the tooth, drained if needed and placed formocreosol to kill any bacteria and remaining nerve. Second visit filled the canals with gutta percha. Turns out just cleaning and shaping the canals in one visit works just as well but without exposing folks to formo. Probably been like this 20-25 years.
Presumably OBE by now (haven’t read the whole thread) but I do concur that dentists will do anything they can to try to save the tooth - sometimes taking it to ridiculous lengths.
Tooth #3: regular dentist tried a crown. That didn’t work. He sent me for a root canal which a) was a nightmare of pain, and b) had obviously failed within weeks. I had it yanked a few months after that and had an implant done a year or two later. All in all, somewhat reasonable though I wish they’d diagnosed the tooth as cracked before wasting my money on that horrifying root canal (I’m very tough to numb, and this fellow did not even offer nitrous; the novocaine injection itself nearly had me in hysterics and it went downhill from there).
Then, I have (er, had) one tooth, #14, that had been bugging me for years. I had a crown, a root canal (endo # 2 - I did NOT go back to the one who was so horrifying), the beginnings of a repeat root canal with endo #3 (whom my dentist had STRONGLY urged me to go to when the first RC failed), and something where they went in from the side of the gum (also with endo #3). Endo #2, when I was till having pain, had actually flat out said that if someone tried to do that from-the-side thing, it would not be worth it - I wish I’d listened to him. Endo #3, when I insisted I was still in pain, told me everything looked great on the X-rays and it would settle down. I flat out told him “I do not trust you” and stalked out. Well, it did settle down for about 2 years, finally. When it started hurting again, my dentist STRONGLY pushed me to go back to Endo #3 for a consult. I refused. She urged me again - even knowing the history of the tooth, she could not get past the mindset of “Must Save Tooth”. I put my foot down and refused and insisted on a referral to an oral surgeon for an implant. Extraction / implant placement done in one procedure with IV sedation, woohoo.
So - my own opinion of root canals is not high, though I know numerous people who’ve saved teeth that way - and in an ideal world that would be the best option.
As I mentioned I’ve already made two trips to dentist and they haven’t started work yet. The root canal is scheduled to begin Saturday. It will take five visits for the root canal, crown and a “pin.”
One of my misgivings is: I’m afraid I’ve several bad teeth and this was just the first to produce severe pain. It might be better to just extract it and spend the root canalling on the more salvageable teeth.
But I think I’ll just follow dentist’s advice. Good news is: The dentist gets rave reviews. One European rates him/her (two-dentist shop) as best dentist he’s ever met. (When he had a crown, the dentist was dissatisfied and made a 2nd crown, with another 1 or 2 visits … for no additional charge. (Bad news: it’s 3-hour round-trip drive to dentist. Living in “middle of nowhere” has disadvantages.)
I have two adjacent teeth missing on one side of my mouth for different reasons.
Keep the tooth.
Unless you really have big bucks for an implant.
I’ll report on my dental visit and ask another question. I don’t understand how this three-visit root-canal treatment works, but perhaps others will. At the end of this first stage she showed me an X-ray with long thin white filaments(?) of some sort in each of two canals(?); getting the exact lengths seemed important. She also noted a large “infection” in the adjacent tooth, and agreed to fill it during one of my next visits when I said I could tolerate keeping my mouth open for more than an hour. The bad tooth’s nerves have been killed. (I did feel pain for a while after anesthetic wore off because she “touched my apex.”)
She impresses me as extremely competent, but she scheduled the 2nd visit for one month later!(*) :eek: (As one of the best dentists in the region she has a long queue — that was the earliest appointment available. As I mentioned I think she’s under some obligation that limits her time.) The idea that these holes in my tooth should be exposed for a month seems very wrong: won’t they fill with food particles? OTOH, if my tooth is sort of OK as is, why not just stop now? Stopping the pain was my goal, and that’s accomplished.
(* - I’d mentioned that I can’t drive at night, but when I said my wife would drive she did move up the appointment to an evening … but still two weeks away.)
She was using the files to get the length of the canals. Probably got most of the nerve out at the same time, hence relief of pain. I assume since she is doing three visits she will file it to the size and shape so she can fill the canals on the third visit. She should have placed a temporary filling in the access opening of the tooth. Temps cam last a while with no ill effect.
You said you could or couldn’t tolerate keeping your mouth open for a long time?
Anyway, consider asking your dentist to use a bite block. It’s a hard-ish rubber block they stick in your mouth, between your upper and lower teeth, to hold your mouth wide open. You can relax your jaw muscles and just let your teeth bite down on the block. It’s still kinda uncomfortable having your jaws jacked wide open like that, but at least it relieves you from having to use your own muscles to keep your mouth open.
I’ve rarely had dentists use one, or even suggest it, unless I asked. They tell me that most patients don’t like it. But I beg to differ. Having a bite block greatly helps it be more comfortable to keep my mouth open, and my jaw muscles aren’t sore for the rest of the week.
I can tolerate keeping my mouth open. Once I’m in the chair I’d prefer she do as much work as possible. I can tolerate mild pain; it’s the tedium of the many visits and long waits that turn me off.
I’d never heard of this, but it was almost the first thing she put in my mouth! 
The long white filaments were actually something radio-opaque, specifically to show up on x-rays. Maybe pure metal.
I’d be very, very surprised if there were not SOME sort of temporary filling; call and ask if you’re not sure. I’ve never had a root canal go over multiple visits as you’re describing, then again I’ve never been in the middle of a severely infected tooth as you were.
I guess it was silly of me to imagine there would NOT be a temporary filling. As I say, she seems very competent.
The fact that U.S. root canals take one visit while three visits seem standard in Thailand is a slight mystery. Is the U.S. root canal completed in one hour? (The 3-visit root canal costs $165 compared with $18 for a filling. It seems unlikely they’d use extra visits just to inflate the price. Are there costly materials involved? The 2-visit crown costs slightly more than the 3-visit root canal.)
The tooth pain is (almost) completely gone now, so the remaining four visits seem low priority to me. 
I want to tell her to give me some simple cap instead of a crown and use the extra visits to start fixing my other teeth! (She did say the deterioration of that tooth makes crown mandatory, but would a simple cap be adequate? I had a root canal 25 years ago with no crown, and that tooth has never been a problem since.)
I complete most root canals in under an hour but there is a lot of variation depending on the patient and the tooth. Materials are fairly inexpensive. I use rotary files, usually 4 or 5 per tooth. Good for a couple visits. Not sure what they cost, probably around $10 per file. The obturators(filling material) is about $7 per canal. Hand files which are used prior to the rotary files are a buck or two apiece and can be used many times usually.
Root canal teeth don’t require crowns after treatment, they are used to restore the tooth structure and function.
:dubious: you don’t say?
In my experience, root canals aren’t terribly painful, though they are kind of boring. Yeah, an hour, maybe 2. Personally, my most hated part are the X-rays. I can’t do bite blocks.
I had thought that the US numbering system also started with the incisors, but I guess I’m wrong and misread before? There is also the FDI system, which is even weirder.
I’m bumping this thread to report that the root canalled tooth has fractured. :mad:
It’s been 19 days since the Visit #1. I did Visit #2 and was waiting for Visit #3 to finish root canal and get a “pin” (and then #4-#5 for the crown). The dentist told me not to do heavy work with the tooth until the root canal was finished. I tried to obey, but the tooth fractured while I was eating corn chips. :smack: (Earlier I used a toothpick near the gum; maybe that was the problem.) Was it improper for the dentist to prolong the root canal procedure over several weeks like this? Visit #3 was scheduled for October 1st.
I can feel that a largish piece of the tooth is loose now, though it hasn’t fallen out.
What do I do now? Is it possible to glue the tooth back together with some sort of superglue? :eek: Should I hurry to a dentist ASAP?
Really depends on how much tooth broke off and how far (if any) in goes below the gum. If the tooth split it is not saveable. If just a chunk off may still be able to crown it. As for seeing the dentist, that would be best. They can evaluate the fracture. Superglue doesn’t work well but I’ve had lots of patients try it. Improper for the length of time during treatment? Not really but I usually try to prep the crown about two weeks after the root canal. Way too many variables to really answer that well.
Call the dentist and run there tomarrow…don’t ask …say; I am on my way , my tooth has broken!
Update: The broken piece of tooth came out just now as I was brushing my teeth. I estimate, very roughly, that that piece is about 15% or 20% of the total tooth in bulk. It came off the inside; with my tongue I can feel a sharp edge that will presumably cause trouble eventually.
The breakage seems to be above the gum line.
Is extraction the only option now? BTW, the clinic which did the work was closed today (Thursday) and is a 90-minute drive away from me. There are nearer dentists but they’ve disappointed me for various reasons. (Quick access to competent medical care is a concern where I live. There is a pretty good hospital 90 minutes away — though without a dentist and a very good ENT specialist 50 minutes away — good for me with chronic E and N problems.)
Read 2 posts up. Crowning is an option; I don’t think you should automatically assume extraction. Only a dentist who actually sees your tooth can say for sure.
actually a piece coming out on its own in a fairly good sign that there may be enough left to crown. Take an emery board to smooth the sharp edge and see what the dentist says when you get there.
FINAL UPDATE. Thanks to everyone who responded, especially rsat3acr, but I don’t have that tooth to worry about anymore! The rest (except for roots) just came out in two small fragments. (I see now that my optimistic “15% to 20%” above was a huge underestimate. Had the tooth become a hollow shell?) I had only soft foods today; the (rest of the) tooth came out while chewing on fried rice just now.
Sorry for making such a big deal out of one little tooth. But with so many molars missing already, the remaining bicuspids seem increasingly dear. Dentures, here I come! ??
I’m left with the question whether to consult this dentist “who seemed so competent” for future problems. (And remember she’s 3 hours distant round-trip.) My daughter lives in Chiang Mai; perhaps I should visit her more often and find a dentist there.
Do you have insurance at all…You could go to an oral/maxf. Surgeon, Go to operating room, take a nice nap and get everything fixed at once. Maybe in the bigger town where your daughter lives, good luck!