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  1. #26
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    I never took good care of my teeth and as a result had so many root canals that I lost count. Having fixed that dental nightmare, I'm a fan of root canals because they saved teeth. Get a second opinion if you wish, but I'd go ahead with it. I trust the opinions of professionals, and that's worked for me.
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  2. #27
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    Quote Originally Posted by Christine View Post
    For the second opinion, maybe I should go to an endodontist? Sucks when doctors retire.
    As a specialist I'm biased, but would say definitely. You wouldn't ask your family doctor to do your heart bypass surgery.

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  3. #28
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    Quote Originally Posted by DrSmile View Post
    As a specialist I'm biased, but would say definitely. You wouldn't ask your family doctor to do your heart bypass surgery.

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    While getting an endodontist opinion is obviously a great idea when the patient distrusts her GP, I think that is not a well-considered post. Unlike a GP MD who isn't trained in bypass surgery at all, GP dentists are well trained in performing competent endodontic treatment, and the vast majority of root canal therapy is done by GPs of course. They typically have to pick and choose the cases they tackle of course, as they usually do not have the skills to handle the more difficult cases (eg 5 highly calcified canals in a max molar, vs a pair of canals in a premolar in a 30 yr old). But by the board regulations they are obliged to provide all treatments at the same quality as that of a specialist, and they do so the world over. If they can't do that, GP dentists will punt it to the specialist. I'd guess that my wife refers about 1/2 the cases to specialists, and she'd even more delighted to refer 90% of them if the patients were willing to pay the higher fees the specialists rightfully command.
    Last edited by BCSaltchucker; 07-12-2017 at 01:30 PM.

  4. #29
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    Christine--I can recommend a great dentist in the city--just above Union Square, just off 5th.

    He was recommended to me by a former colleague of my lovely wife when we first moved to NYC--and I would still be going to him today, except he no longer accepted the insurance we were on. His name is Avo Samuelian @ Gotham Dental:
    Gotham Dental

    He did quite a bit of work on my mouth--filling replacements, cap replacement and prepped for 2 implants. I was just at a local dentist who complimented him on his work!
    "There are two novels that can change a bookish fourteen-year old’s life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs."
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  5. #30
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    Quote Originally Posted by BCSaltchucker View Post
    While getting an endodontist opinion is obviously a great idea when the patient distrusts her GP, I think that is not a well-considered post. Unlike a GP MD who isn't trained in bypass surgery at all, GP dentists are well trained in performing competent endodontic treatment, and the vast majority of root canal therapy is done by GPs of course. They typically have to pick and choose the cases they tackle of course, as they usually do not have the skills to handle the more difficult cases (eg 5 highly calcified canals in a max molar, vs a pair of canals in a premolar in a 30 yr old). But by the board regulations they are obliged to provide all treatments at the same quality as that of a specialist, and they do so the world over. If they can't do that, GP dentists will punt it to the specialist. I'd guess that my wife refers about 1/2 the cases to specialists, and she'd even more delighted to refer 90% of them if the patients were willing to pay the higher fees the specialists rightfully command.
    Also, being a specialist and expert in performing root canals does not make one an expert in determining when/if one is necessary. And the first issue here is determining if you need one not assuring it's done by the most competent person.

    I'd imagine there are plenty of Endodontists where this isn't the case but from what I've seen they just do what the dentist who referred you to them says to do and they don't have the experience in determining what is needed. They just do it. So while they may be the best option for actually doing the procedure that doesn't make them the best for determining if it's needed.

  6. #31
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    Quote Originally Posted by Jay Strongbow View Post
    Also, being a specialist and expert in performing root canals does not make one an expert in determining when/if one is necessary. And the first issue here is determining if you need one not assuring it's done by the most competent person.

    I'd imagine there are plenty of Endodontists where this isn't the case but from what I've seen they just do what the dentist who referred you to them says to do and they don't have the experience in determining what is needed. They just do it. So while they may be the best option for actually doing the procedure that doesn't make them the best for determining if it's needed.
    The day I do what a referring dentist tells me to do in my specialty is the day I retire. I have never seen what you describe occur, ever. And nowadays the person who determines what is needed is a bean counter at the insurance company, not the treating or referring dentist.

    As for a general dentist being trained well in a specialty, at least today in the charge-a-zillion-dollars-to-offer-education-by-computer era, I know of more than one dental school that will graduate a dentist without ever having done an actual root canal on a living person. So as long as you're trying to get a root canal for your second life character, you're all set.
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  7. #32
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    I've had two teeth that needed root canals. The first tooth was done by my regular dentist and had to be redone by an endodontist. For the second tooth, the same dentist prescribed antibiotics and referred me to the endodontist straight away.

    My wife has had one tooth that needed a root canal. She goes to a different dentist than I do. He did the root canal, and it also had to be redone by an endodontist.

    I don't know if we were just unlucky or if that's common.

    The second tooth barely bothered me at all and at first I thought maybe I was starting to get a sinus infection(the problem tooth was in the upper front), but after feeling like I was coming down with the flu, I decided I'd better get the tooth checked out. Yep, it was abscessed and causing a fever. You don't want that to happen. Get the root canal done.
    Last edited by Dresden; 07-12-2017 at 05:21 PM.

  8. #33
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    Remember, dental problems can cause illness elsewhere, particularly the heart.
    Waxahachie, Texas
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  9. #34
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    Thanks! There's an endodontist practice here in Queens, was thinking of checking them out. How does this work anyway? Do I make an app't at the endodontist first, or ask the current dentist to refer me.......?

    Union Square seems like a pricey location, and this might be pricey enough even with the insurance.

  10. #35
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    Quote Originally Posted by pmf View Post
    Dr. Quack took x-rays of me too. Unless you are trained to read them, it's hard to make heads or tails of one. Plus, they generate money. I bet he took a couple.
    My maternal grandmother died from jaw cancer, so I really really hate getting all the x-rays. Feels like I'm tempting fate. Just had some done last year, but our retired dentist didn't transfer his records over to anybody in particular as far as we know.

  11. #36
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    I think about jaw cancer and Roger Ebert every time I have that part of my jaw x-rayed. Now I'll also think about "Christine's grandmother" when I get dental x-rays.

    My dentist, of course, says dental x-rays are no more radiation than you get walking outside on a sunny day.

    But the heavy lead apron they put over my entire body and wrap around my neck, and the dental techs ducking for cover before the x-rays are released, make me think it's a bit more threatening than a lovely stroll on a sunny day.

  12. #37
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    The lead apron is overkill for intraoral dental xrays. In more sensible parts of the world (eg scandinavia) they have moved to eliminate the apron, just keep a collar covering the thyroid. The lawyers have made it so we still use the aprons here in north america, but not based on science. However we can't even cover the thyroid when taking panoramic or 3D xrays, though we still use an apron and use those images more sparingly.

    You are more likely to die from cancer in the head and neck if you don't get the recommended xrays - because they are part of the medical assessments used to detect such pathologies.

    I definitely do not understand anyone whom think the xray exposure of intraoral xrays is somehow dangerous, who then goes outside in the sun at all, or takes a flight on a jetliner (a flight from coast to coast will expose you to 20x-60x as much radiation as a dental xray, and to imagine there are people whose job is to fly in jetliners daily!). According to health canada the millsievert exposure safe limit of modern digital sensor dental xrays is approximately 5,000 xrays per year (times the number of years in a lifetime). This is not like a chest Xray or CT scan which is approx 2000x as much dosage as a set of dental xrays, though all medical people know to only take the minimum exposure necessary.
    Last edited by BCSaltchucker; 07-12-2017 at 11:03 PM.

  13. #38
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    Quote Originally Posted by David Loving View Post
    Remember, dental problems can cause illness elsewhere, particularly the heart.
    This 'oral-systemic link' between oral disease and heart disease is much hyped, and under-supported by science. Call it an emerging school of thought, but not accepted science in the mainstream at this time. A subset of dental people have embraced it a bit too hastily - perhaps to use it to scare people into brushing and flossing more, or spending more on their teeth. But I see that as more than a bit dishonest and perhaps manipulative.

    Periodontitis can’t be considered as a cause of atherosclerotic heart disease, stroke, diabetes or pre-term low birth weight
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644469/

  14. #39
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    Quote Originally Posted by Jay Strongbow View Post
    Also, being a specialist and expert in performing root canals does not make one an expert in determining when/if one is necessary. And the first issue here is determining if you need one not assuring it's done by the most competent person.

    I'd imagine there are plenty of Endodontists where this isn't the case but from what I've seen they just do what the dentist who referred you to them says to do and they don't have the experience in determining what is needed. They just do it. So while they may be the best option for actually doing the procedure that doesn't make them the best for determining if it's needed.
    disagree with that. Endodontists are not merely technicians of root canal therapy. They are dentists who have a broader expertise in diagnosis and treatment planning of endodontic pathologies trained at a limited set of esteemed graduate schools - on average a much greater and focused and more experienced at it than GP dentists. Their opinion carries great weight and I think if I wanted a second opinion about a complicated root canal situation and I really didn't know who to consult, I would have the most confidence in seeing the closest endodontist in town.

    There is a lot of overlap with GPs though. GP dentists are for the most part doing plenty of root canal therapy, gaining expertise with time and continuing ed from endodontists. No reason that a person cannot get an accurate assessment and diagnosis from an experienced GP dentist. However some GPs are not enthusiastic about doing endo (like my wife) and will refer the bulk of the endo to the specialist. Since I know a lot of folks in the field, I would not hesitate to see certain GP dentists if I had an endo problem myself, nor would I hesitate to see an endodontist.

    If an endodontist seems to be 'just doing what the GP tells them' in reality it just means they have also done their own assessment and it agrees with the GP's diagnosis.
    Last edited by BCSaltchucker; 07-12-2017 at 11:24 PM.

  15. #40
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    Quote Originally Posted by DrSmile View Post
    The day I do what a referring dentist tells me to do in my specialty is the day I retire. I have never seen what you describe occur, ever. And nowadays the person who determines what is needed is a bean counter at the insurance company, not the treating or referring dentist.
    So are you saying a company like "Limited to Endodontics" doesn't get a lot of business from referrals and does what the referring dentist recommends?
    If so, your experience and knowledge is drastically different from mine.

  16. #41
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    Quote Originally Posted by Jay Strongbow View Post
    So are you saying a company like "Limited to Endodontics" doesn't get a lot of business from referrals and does what the referring dentist recommends?
    If so, your experience and knowledge is drastically different from mine.
    I'm not sure what experience you've had, but what you describe just doesn't happen. Yes of course they get referrals, but the referral is to have the endodontist figure out what to do with the tooth that the dentist doesn't want to deal with.

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  17. #42
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    Quote Originally Posted by DrSmile View Post
    I'm not sure what experience you've had, but what you describe just doesn't happen. Yes of course they get referrals, but the referral is to have the endodontist figure out what to do with the tooth that the dentist doesn't want to deal with.
    okay, so you're essentially calling me a liar. I know what my experience was and if you want to believe I posted to this thread just to lie about it then feel free to think that.

  18. #43
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    Quote Originally Posted by BCSaltchucker View Post
    The lead apron is overkill for intraoral dental xrays. In more sensible parts of the world (eg scandinavia) they have moved to eliminate the apron, just keep a collar covering the thyroid. The lawyers have made it so we still use the aprons here in north america, but not based on science. However we can't even cover the thyroid when taking panoramic or 3D xrays, though we still use an apron and use those images more sparingly.

    You are more likely to die from cancer in the head and neck if you don't get the recommended xrays - because they are part of the medical assessments used to detect such pathologies.

    I definitely do not understand anyone whom think the xray exposure of intraoral xrays is somehow dangerous, who then goes outside in the sun at all, or takes a flight on a jetliner (a flight from coast to coast will expose you to 20x-60x as much radiation as a dental xray, and to imagine there are people whose job is to fly in jetliners daily!). According to health canada the millsievert exposure safe limit of modern digital sensor dental xrays is approximately 5,000 xrays per year (times the number of years in a lifetime). This is not like a chest Xray or CT scan which is approx 2000x as much dosage as a set of dental xrays, though all medical people know to only take the minimum exposure necessary.
    Maybe because the x-rays are focused on a small point in the body, repeatedly over many years of getting dental x-rays.

    A walk in the park on a sunny day isn't putting focused energy into an area the size of a couple of molars.

  19. #44
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    Quote Originally Posted by SPlKE View Post
    Maybe because the x-rays are focused on a small point in the body, repeatedly over many years of getting dental x-rays.

    A walk in the park on a sunny day isn't putting focused energy into an area the size of a couple of molars.
    this is entirely a misunderstanding of radiation exposure. The xrays are collimated, not concentrated. This collimation is done to reduce overall exposure, and protect more vulnerable tissues.

    You have to understand more about phsyiology though. The tissues which are vulnerable to rad exposure are the rapidly replicating ones. So tissues like nerves (eg the brain) and bone are pretty much unaffected, while tissues like the gonads and the thyroid are more affected. But those tissues are not protected at all when being in the sun, or flying in a jetliner - while we do cover them with lead when taking xays.

    The risk is essentially zero from dental IO xrays. ie it is so infinitessimal, they can't measure it in populations of millions.

    Now I have been to many a lecture by oral pathologists in my CE credits. Showing countless oral cancers, some of which have been undetected until they took dental xrays. Slide after slide of large sections of resorbed tissues caused by oral cancers which the person may not have felt any symptoms of yet. That is the actual life saving nature of xrays. Caveat is oral pathologists are serving populations of millions per OP - I have never seen an oral cancer on an xray in practice in 10 years of taking them, however I have seen many cysts which could be potentially cancerous.
    Last edited by BCSaltchucker; 07-13-2017 at 10:08 AM.

  20. #45
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    Quote Originally Posted by Jay Strongbow View Post
    okay, so you're essentially calling me a liar. I know what my experience was and if you want to believe I posted to this thread just to lie about it then feel free to think that.
    no you are not a liar, you are merely unaware and unqualified to know what happens in the practice of endodontics.
    Last edited by BCSaltchucker; 07-13-2017 at 10:20 AM.

  21. #46
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    Quote Originally Posted by BCSaltchucker View Post
    this is entirely a misunderstanding of radiation exposure. The xrays are collimated, not concentrated. This collimation is done to reduce overall exposure, and protect more vulnerable tissues.

    You have to understand more about phsyiology though. The tissues which are vulnerable to rad exposure are the rapidly replicating ones. So tissues like nerves (eg the brain) and bone are pretty much unaffected, while tissues like the gonads and the thyroid are more affected. But those tissues are not protected at all when being in the sun, or flying in a jetliner - while we do cover them with lead when taking xays.

    The risk is essentially zero from dental IO xrays. ie it is so infinitessimal, they can't measure it in populations of millions.

    Now I have been to many a lecture by oral pathologists in my CE credits. Showing countless oral cancers, some of which have been undetected until they took dental xrays. Slide after slide of large sections of resorbed tissues caused by oral cancers which the person may not have felt any symptoms of yet. That is the actual life saving nature of xrays.

    Good to know. Thanks for the info.

  22. #47
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    dental xrays have evolved a lot in the last 50 years. The exposure dosage has gone down to a fraction of what it was in the 50s. Back then they didn;t even collimate the xrays (I remember these non collimated xrays in the 70s when I was a kid, spraying higher dosages of radiation in all directions.) Then collimated xrays heads appeared in the 60s, and more recently there are even tighter collimation devices to further reduce dosage. Also they continually developed faster speed films, requiring less and less dosage into the 90s. Then digital xrays came out in the 90s and we now use even lower exposure time (= dosage) than we did just 15 years ago. In the mid 00s we were using D speed film and exposing for about .32 seconds. By 2010 I was using CCD xrays sensors at .1 to as little as 0.06 seconds.

  23. #48
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    Quote Originally Posted by BCSaltchucker View Post
    no you are not a liar, you are merely unaware and unqualified to know what happens in the practice of endodontics.
    And we all know that you're uniquely qualified to weigh in on pretty much anything

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    Quote Originally Posted by BCSaltchucker View Post
    no you are not a liar, you are merely unaware and unqualified to know what happens in the practice of endodontics.
    oh good, so if I'm not lying then being referred to an endodontists who just did the procedure without question or analysis was clearly just a product of my imagination.
    And my old college buddy who's a dentist now telling me what I said happens, does, is also a product of my imagination. Or maybe he was lying? Not sure what his motive could have been but sure, okay, got it.

  25. #50
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    Quote Originally Posted by Jay Strongbow View Post
    oh good, so if I'm not lying then being referred to an endodontists who just did the procedure without question or analysis was clearly just a product of my imagination.
    And my old college buddy who's a dentist now telling me what I said happens, does, is also a product of my imagination. Or maybe he was lying? Not sure what his motive could have been but sure, okay, got it.
    So the guy didn't look at an x-ray or anything and just did the procedure?

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