My dentist just completed two full crowns of the last two right lower molars. X-rays, incluing a paronamic was completed after the crowning and pain began. No abcess noted. However I am having severe pain. I was placed on a medrol dose pack and antibiotics with no relief. Now he is suggesting I go see an endonist. The X-rays show no abcess. I have spent over $3000 and have no more dental benefits. What could be happening and how will I afford another $2000 if root canal is needed with no benefits. What should I do?

I always thought a root canal was done BEFORE a crown was placed.. that gave a post for the crown to set into.

Was there no root canal before this was done?

It's not uncommon for teeth to be crowned without a root canal having been done. Crowns are generally placed on teeth that have large restorations (fillings) and are at risk of breaking. The more often a tooth is worked on increases the risk of a root canal having to be done.

medwreck, I would have hoped the dentist took x-rays BEFORE he did the crowns. The possibility of a root canal needing to be done should be ruled out before going ahead with a crown. Has the dentist checked your bite on the crowns? To do that he'd have you bite either on a thin piece of wax and/or red or blue carbon paper. When you close your mouth and slowly bite, do you feel that your teeth touch where the crowns are before the rest of your teeth come together?

If the bite isn't a problem, then I'd suggest you go to the endodontist but take the x-rays your dentist just took. This will save you some $$ for the consult portion.

There is always a possibility that the root is cracked and this cannot normally be seen on an x-ray. The endodontist is your best bet to rule out all possibilities. If there is more than one endodontist in your town you may not want to go to the one your dentist recommends as I've heard some referring dentists get rewarded by the specialists (more so in the USA than Canada). Ask your friends and family if they have seen an endodontist and what they thought of him/her. The one with the best comments is the one I'd see.

And, finally, in answer to your question about paying for a root canal after a crown, I'm afraid you do have to pay UNLESS there was negligence on the part of the dentist and the x-ray before the crown shows infection at the root tip.

I work in dentistry and specialize in root canals... root canals should be done before a crown is placed because a crown usually irritates the pulp causing it to inflame and induce pain requiring you to need the root canal... If you have a crown on and require a root canal then we have to drill through your new crown ruining the beauty of it and put in a filling afterwards.. if u have the root canal done first then we do not have to ruin the beauty of the crown and risk the chance of breaking it or causing it to crack or if it is porcelain then u can risk chipping the porcelain off it.. so root canal before crown.. but always crown after root canal even if it was not in the plans because root canals weakin the tooth causing it to crack/fracture much easier and the only fix to that is to have the tooth extracted in most cases.

Unfortunately you are incorrect. Yes crowns are placed ~99% of the time due a tooth having large restorations. BUT due to the trauma to the nerve during a crown prep procedure in ~95% of cases a root canal is required because the nerve inflames or becomes necrotic. I am office manager and head assistant for a well known endo clinic I have people flying across seas and driving for days just to be seen by our office and about ~90% of my cases are due to crown prep, crown placement and large restorations, ~9% is due to physical trauma and ~1% is natural causes. Therefor it is recommended by majority of specialists root canal before crown so that the patient does not have to risk destruction of the crown like I stated previously and so that the patient does not have to be concerned about being in severe pain while waiting to be seen by a specialist since they decided to have the crown placed first. General dentists do not have as much knowledge and experience in this form of dentistry and do not tell their patients about this risk prior to placement of a crown and they also do not teach their staff proper knowledge in this area of dental health.

Also their does not have to be a visible abscess to require treatment and panoramic radiographs are not the type of x-ray that you should be having taken when you have a root canal issue. Periapicals are the best form of radiograph for this diagnosis. An inflamed pulp does not mean that there is going to be an abscess. Trust me you do not want to pull the teeth. Get the root canals done... by pulling the teeth you bone will have to fill back in but it will cause your facial features to alter due to tooth loss. There are replacements including implants but your natural tooth is much better then any form of replacement.. plus if u think about the money you have invested (3 grand) an additional 2 grand per tooth is well worth it causing your total to be ~7 grand. While if you pull the teeth your losing out on that money plus implant are about 5 grand per tooth then on top of that you have to get new crowns made to fit the implants so in the end that's almost an additional 14 grand just cause you did not want to pay for the root canal treatment, I'm unsure of where you are form and costs may be different but that gives your a rough idea cause that's the average for where I am in Ontario

JD, where are you located?? I have never heard of a crown costing "3 grand" or a root canal costing "2 grand"! I've worked in the dental field as a dental hygienist for over 30 years, those fees are preposterous! Implants here, cost less than $3,000 including the crown. Obviously there are no fee guides where you are and you can set your fees to whatever you want.

I did not say a crown post placement I said a crown and implant. (The 3 grand is what medwreck said he/she paid) and yes right now a 4 root rct is 1500$ without any additional treatment (ie- cal .hyd. perf repair, If it's a retx, if the patient wants a comp placed back in the access prep, etc) from a specialist.. a general dentist fee is probably about 800$ and if you are a hygienist I assume you have only seen the general dentist fee guide and not the endo fee

The implants are from an oral maxilofacial surgern fee guide that the oral surgeon that we deal with has inform us the cost that he charges so that we can give patients an idea of the cost. And yes I am actually in one of the larger cities in ontario

You are right, I have not seen the specialists fee guide. I just know there are many capable general dentists who can perform the services that the specialist does, some just choose not to do so because they can be time consuming.

Depends... you should always see a specialist though cause we have more knowledge and also we have a lot more equipment for the procedure in case there is a problem. A typical 4 canal molar should only take one appt. that is 2 hours long. So its actually not that long of an appt. most general dentist take more then 1 appt and keep the patient for a longer time per appt.

I guess I've been fortunate enough to work with general dentists who have taken the extra courses and bought the equipment needed to do root canals and save their clients the added expense of seeing a specialist. The guys I worked for did do their root canals in one appointment and spent about an hour and a half.

I am mid-crown, as it were, with molars on both sides of my lower jaw. Suddenly, I am experiencing way more debilitating pain than I was before the start of this procedure, so I am strongly considering root canals to go with my new crowns, prophylactically. I live in Alaska, and yes, 3 grand is not unusual for this procedure here, and that IS per tooth! Total will be around six plus, but my insurance covers half.

Sometimes prophylactic root canals are a good idea and can save you grief in the future. It is something I personally would definitely do if I was in your shoes.

I have a new crown, but the crown is sensitive to cold , do I need a root canal. Can it be done through a crown?

You heard wrong about referring specialist. We do not receive anything other than a thank you as a professional courtesy , from the doctors we referred to. This is hype. Medical and pharmaceutical companies may do so, but the dental field does not. There is more than enough business to go around and if you are good at what you do, there is no need to "deal" with anyone over patients. We want patients to feel comfortable and confident in the person working in their mouth. Insurance has more to do with this decision than any other factor. You should be more concerned about who your insurance company wants you to see than who your chosen dentist recommends. We, as dental professionals, want you to see the dentist of your choice.