Special care dentist and root canal treatment.

[rootcanaltreatment]

DS1 has additional needs and is seen by the special care community dental team. He was waiting for a filling at the hospital under GA or IV sedation. However, due to Covid delays x rays now show a root canal is needed. The dental service say this isn't done under sedation or GA, so it would be an extraction that is needed. I'm desperate to avoid this if necessary.

I'm wondering if it is possible to get a second opinion or root canal under sedation or GA privately?

Please don't judge, DS1 has medical conditions, one of which affects tooth development and another's treatments are harsh on teeth.

If I had known root canal treatment had a high failure rate meaning it would result in extraction anyway, I wouldn’t have let the dentist, then Liverpool dental hospital, have a total of 3 attempts at one tooth that ended up being removed anyway.
In your DS circumstances it might be less traumatic to go straight for extraction tbh.

If you can afford it, it’s worth going privately to an endodontist. I had mine done years ago and was definitely worth it, haven’t had any problems since, the alternative on the NHS was extraction :(

Thank you both for replying.

Distressingtimes I'm sorry your treatment failed. That's something to think about. I'm upset that he's so young to have an adult tooth extracted and concerned about the effect on the alignment of his other teeth.

Mrstwiddle did you have it done under sedation or GA? There's no way DS so of cope under local.

Which tooth is it?

It's a first molar.

I had root canal treatment and was dreading it. It wasn’t as bad as I thought. Wearing headphones, listening to something calming and zoning out helped.

Both my dc have had teeth out and ithasn’t affected their other teeth.

A root canal is going to take 30-60 minutes, the anaesthetist is not going to sign off on a long surgery on a baby tooth with a child who has other (complex) issues.

An extraction takes 10-15 minutes and still carries all the risks of a GA.

How old is your child? You have to remember that once root filled the tooth is dead and therefore if it continues to decay, will give no symptoms. Inevitably it will need extracting in the future leaving a big gap. If taken out in childhood the gap is more likely to close and will possibly allow more space for wisdom teeth which can be a whole different nightmare.

OP I can understand your concerns.
I am sure you would be able to get this work done privately under sedation or GA.
Root canal work is generally successful, google the stats yourself.
However the treatment ( speaking from personal experience) while not painful can be lengthy and invasive- involving a throat dam, bleach treatment.

You can definitely get a root canal done under sedation. I was told by three dentists I couldn't. Ended up having an extraction and an implant at great cost (and causing various other issues), and I then came across a private dentist that offered it. So ring around it's definitely possible. As others have said ideally get an endodontist.

Pinky it isn't a baby tooth, it is a permanent adult tooth - one of his first molars.

Angry DS1 is 11.

Standrewsschool the dentist told me DS' other teeth are likely to move due to the gap and he is still to lose some baby teeth/some adult teeth are yet to erupt. There would be a negative effect on chewing, potential increased risk of decay for neighbouring teeth and possible bone loss.

Due to DS1's additional needs there's no chance of him having a root canal under local anaesthetic.

Speakout Raving your posts give me hope sedation or GA may be possible.

I had a root canal under sedation about 30 years ago. It seemed to take 2 minutes and I was puzzled as the dentist had 4 eyes but I was happy and it didn't hurt. It was a strange, but basically pleasant, experience.

I think its shocking that not enough support is given to patients like your child who has additional needs meaning he is unable to tolerate a lengthy, invasive dental procedure. Why should he have to therefore have a lesser treatment that will impact on his for the rest of his life?
I would ask your dentist for a referral to your nearest dental hospital. I would say your child could have his tooth removed under sedation initially then have a bridge made, perhaps when he’s a bit older and perhaps better able to tolerate local anaesthesia.

Maybe pass this onto the dentist?
www.autismspeaks.org/sites/default/files/2018-08/Dental%20Professionals%20Tool%20Kit.pdf

Today I left messages with both DS' community dentist and the nearest dental hospital asking for them to contact me.

I have also spoken to 3 private dental practices that offer IV sedation. Two don't offer it to children and one won't because of DS' additional needs. Next week I will phone more.

Molar root canal treatment is a long procedure, an extraction is much quicker so root canal treatment is rarely offered as a General Anaesthetic as the risks of the anaesthetic increase the longer the operation time.
Likewise sedation although really useful, it is not always easy to treat a sedated patient so carrying out a molar root treatment on a sedated patient who would need the sedation topping up multiple times and using a rubber dam is likely to mean treatment may be compromised. Root canal treatment has a failure rate, this increases in molar teeth and treatment that is difficult to carry out will have an increased risk of this. The tooth will also probably need a crown, which would mean an additional two treatments and with the risk of failure possibly a later extraction.
I absoluely agree that your DS1 has a right to the best possible care, but be prepared that you may be told that the risks versus the benefits mean that extraction is the best choice for him.

Is there a dental hospital near you? I really cant imagine any private dentist being happy to offer a GA to an 11 year old. At least in hospital there will be a whole team on hand and resus facilities if needed.

Youngest DS had one done under hospital special care dentist as he REFUSED to let anyone in his mouth even with sedation. [ADHD+ASD]
It was a first molar. The work failed and it abscessed.

He then had to be sat down and have a in-depth scientific talk with medical slides with one of the specialist dentists about bacteria and the risks they could cause to his adult teeth underneath.

He finally agreed to have said tooth extracted.

TBH if I could have got him to agree to have said tooth removed in the first place I would have. So would the specialist dental team!

In honesty take the advice from the specialist dental team. They have a lot of experience in providing dental care to children with extra needs including more complex ones. If they feel a root canal is in his best interests they can arrange the appropriate sedation/GA that your son will need. The same applies for a GA for an extraction.

Son was very groggy after both sedations and needed to be carried from the hospital to the car park. Drugs took about 24 hours to fully wear off when he was back to his usual bouncing off the walls self.

Hi I have the same situation as you, my son needs root canal on upper molar 6 and community dentist is saying extraction, he is now age 11. I can only get gas and air from a private dentist who have offered to root canal and fill the tooth for £800 with gas and air, but no crown that would be extra.

I have asked for a second referral as not satisfied with response that it would be too traumatic by NHS community team. It also seems a lot linked to costs as it’s a molar.

can I ask what you decided to do in the end? Did you find a dentist and go ahead with root canal and what sedation did they offer was it gas and air? Of did you get it extracted. My son has autism but he attends mainstream secondary school he gets anxious and doesn’t like xray or drill etc I’m so unsure what to do. I would pay private if needs be as nhs seems not an option with wales community service.

if you went private who did you go to? Was it a success?

@Passenger42 in the end DS had the tooth extracted. We couldn’t find someone who would give IV sedation or a GA for a root canal with DS’s medical needs. Entonox would not have been anywhere near enough sedation for DS.

Thank you for your reply,

I feel this will be the outcome for my son also, and despite all the words about treating people equally if you have special needs you seem low on the list of priorities in terms of dental care and the only places for treatment such as tooth fairy in London as ridiculously expensive and not an option for normal folk. Thanks for updating.

DD has had root canal under sedation with our local dentist, slightly older, I think she was 16yo. She has dental phobia and he'll organise his friend to come down to do the sedation, so she's comfortable. He's a real gem!

@MargaretThursday IV sedation? Root canal of a molar (which is harder than a root canal of an incisor)?

Yes, she's had IV sedation several times and root canal of a molar (and an incisor another time)

The dentist has really worked hard with her, and we've gone from her hardly able to get into the dentist, to being able to have small amounts of treatment without sedation.
But part of that is she knows that if she puts her hand up and says she can't cope any more the dentist will down tools and phone his friend and organise it to be done under sedation. It costs us about £200 for an hour sedation, and then I think it's £75 per hour after that, which is money well spent.

Our dentist is absolutely amazing.