Started root canal...lost insurance...can it just be filled?

My husband had a root canal started MONTHS ago and a temporary filling was put in. He lost his insurance and could not afford the remaining work that needed to be done. Can he just get the temporary filling removed and a permanent filling put in? OR does he have to either complete the root canal or pull the tooth since the drilling and cleaning has already been completed throughout the tooth and root?

Started root canal...lost insurance...can it just be filled?
In order to answer this frequently asked question, I have to cover all the bases. Here goes.





Pulp consists of the nerves and blood vessels within the tooth. Deep decay or other irritants can disturb the pulp beyond the point where it can recover itself. We dentists call this "irreversible pulpitis," meaning an irreversible inflamation (____-itis) of the pulp. The only solution is a root canal treatment - commonly (but improperly) abbreviated as a "root canal"





A root canal treatment consists of the following major steps:





1) access: open the top of the tooth, exposing the pulp tissue. This creates a hole (often) on top of the tooth, which must be sealed between visits to keep bacteria out.





2) caries removal: remove any remaining decay





3) coronal pulpotomy: remove all of the pulp tissue from the pulp chamber in the middle of the tooth





4) pulpectomy: remove most of the pulp tissue from the root canals





5) length determination: using x-rays and other tools to figure out how long your root canal is. Successful treatment requires the doctor to be correct within 1 mm.





6) shaping: using tiny metal files to remove the remaining tissue from the root canal, and to give the walls a smooth, tapered shape.





7) irrigation and drying: a final rinse of the tooth, followed by a thorough drying with tiny paper sticks that wick away moisture.





8) obturation: filling the tooth with cement and gutta percha, an orange colored rubber filling material.





9) temporization: cotton ball is stuff inside to protect the floor of pulp chamber, then temporary filling material (kind of like spackle) is placed over the access opening.





There's a *lot* of variation in endodontic (root canal) technique, but most dentists follow this general order. Root canal therapy can be stopped AT ANY POINT during this sequence and a temporary filling placed over the tooth. Stopping midway and "temping" is often done when the tooth cannot be completed in the alloted appointment time. The "temp" only seals out bacteria for one month. (Your mouth is literally an ocean of relentless bacteria.) After that, the tooth is considered recontaminated, and you may have to redo some or all of the root canal treatment.





I do not know the specifics of your case. The doctor could have put in a temp at any stage. If you stopped at:





1-3) then your husband would still be hurting, because the irritated pulp tissue remains. Not likely in your case.





4-6) then your husband would be out of pain. This seems like where your husband's dentist stopped, but I'm only guessing. Stopping here is also known as "open and med", because you open the tooth, remove the tissue, and place a medication (usually calcium hydroxide). It's a very common place to stop, especially if you didn't have enough money to finish the root canal. If you want to keep the tooth, you have to resume and/or restart the root canal. The root canals MUST be cleaned out and filled in, or else bacteria can reinfect the space. If it's been more than a month, they already have; resume treatment if you want to keep the tooth.





7-9) irrigation and drying: it's difficult to stop here, usually you made it this far, the doctor would fill out the root canals, sealing them from bacteria. The access opening would be filled with a temporary filling. That filling would seal out bacteria for about one month.





Within that month, you can safely get one of two permanent restorations for the access opening: a post and core, or a core buildup. (what out for dishonest offices that charge separately for both on the same tooth, I've seen it happen to a friend). That should hold you over a little while until you need a crown. Some offices insist on getting a core buildup/post and the crown on the same day. It's much more efficient (and profitable) to do both on the same day. But in many cases, you can do the core buildup/post to stabilize the tooth, then wait a while until you can afford a crown. Don't wait too long; the longer you wait, the greater chance of the tooth breaking. Root canal treated teeth, especially back teeth, usually need to have crowns because the access opening structurally weakens the tooth, and the removal of the pulp dries it out.





If it's been more than a month after the root canal was finished, (as in your husband's base) the tooth may be recontaminated. Your dentist will have to remove the temporary filling material and assess whether the root canal will have to be redone prior to a permanent filling or crown.





Finances are often an obstacle, and extraction of the tooth is often a lower cost alternative. Let me strongly discourage it. Adult teeth do not grow back after extraction. While the tooth is missing, adjacent teeth can tip over into the empty space, and the opposing tooth can erupt out of its socket. When you finally *DO* have the money to replace an extracted tooth, virtually every choice to replace the missing tooth is either more expensive (implants, bridges) or less satisfactory (partial dentures, bridges) than having the root canal, buildup and crown in the first place.





Whether or not an additional fee is justifiable depends on what was initially billed out to your insurance. If your dentist billed your insurance as an open and med (steps 1-4), then you will have to pay for the root canal treatment in addition to whatever you have paid. Sorry, but this is a standard and legal practice. If your dentist billed out as a root canal (as some other answerers have suggested), then the insurance has already paid him/her for the procedure. You are legally entitled (within a reasonable amount of time) to the completion of the procedure at no additional cost beyond your standard co-insurance payments and deductibles.





Regardless of the insurance situation, my specific advice to your husband is to bite the bullet and finish the root canal, and at the very least get a permanent filling (core buildup or post%26amp;core) in it while you save up for a crown. Take out a payment plan with your dentist, take out home equity, work some overtime, do whatever it takes to responsibly take care of his mouth. If your husband's life expectancy is 75+ years, then he's going to be stuck with (or without) that tooth for a long, long time.





Hang in there, things will get better, I promise.
Reply:It could absess if he doesn't finish the root canal hun. If you can't afford the bill try a dental college or a Univeristy hospital, usually they will do it at a reduced price or free of charge for learning purposes.





Or just tell him to get it pulled. You don't want it to absess and spread to his other teeth.
Reply:Unfortunately, it's finish or pull. There is insurance that you can purchase online that discounts dental work. If all he needs is the crown, then the discount plan can usually save you a good deal of money.
Reply:Most Dentists will charge the insurance company the full cost of a root canal in the beginning of the procedure. The Orthodontist did this too for my granddaughter for her braces.
Reply:I know that they can't just fill the tooth. And I don't know if a decent doctor out there would pull it. Mine won't. Just put it on your credit card. Than you don't have to worry. Just make payments for ever. Like I do. Good luck!
Reply:I work in a dental office. When you first went to the dentist, the company fully charged your insurance, you have the right to go back and finish the root canal, otherwise you will have an abscess. Don't buy cheap Insurance it is a waist of money. If you buy privately most wont cover in the first year, especially for root canals. Go back and tell them to finish it.
Reply:He, of course, can extract the tooth at any time regardless of the root canal treatment, but that would be a bad choice to extract a tooth that can actually be retained. But as for the permanent filling, he has to finish the root canal treatment first.