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Root Canal Treatment Negligence
No one who has suffered a root canal treatment has easily forgotten it. Whilst it is certainly true that today the process is considerably easier than it ever was, the fact remains the procedure is far from a breeze to sit through. For most people the first things that come to mind are the pain and the but does anyone really understand why and what these procedures are and achieve?
Root canal therapy, also known as endodontic therapy, is a dental treatment for removing infection from inside a tooth. It can also protect the tooth from future infections. It is carried out within the interior of the tooth where the pulpy substance sits that is neither tooth nor gum. which is the root canal.
A “root canal” is not a treatment at all, it is a anatomical component of the tooth. It is the hollow section of a tooth that contains the nerve tissue, blood vessels, and other cells, also known as the pulp. A tooth consists of a crown and roots. The crown is mainly above the gum, while the roots are below it. The roots attach the tooth to the jawbone. Inside the crown and the root, or the root canal, is the pulp. The pulp nourishes the tooth and provides moisture to the surrounding material. The nerves in the pulp sense hot and cold temperatures as pain.
Stages of Root Canal Treatments
In the UK the following stages are typical, however, the way that root canal treatments are approached, the methodology, the medicants and the stages of treatment differ from clinic to clinic. What we present here (as non dentists) is a typical or generalised view of the process.
1. Radiology – Opening the tooth and visualizing the roots
First, the dental surgeon, (we are assuming that a dental surgeon is doing this rather than a specialist endodontist) takes radiology (x-rays) and observes the anatomy of the roots and justifies the procedure. The issue of dental infection and abscess are beyond the scope of this page but assuming there is no option (other than extraction) the dentist will then remove everything that is obscuring the canals. This really means under local anesthesia, the dentist makes a small access hole on the surface of the tooth and removes the diseased and dead pulp tissue down to the level of the top of the roots. Depending on which tooth is being treated this could be up to four roots.
2. Excavating the Pulp and Filling the root canal
Next, the dentist cleans, shapes and decontaminates the roots using tiny finger driven files and irrigation solutions. Then, the tooth is typically treated with a antibacterial material to keep infection at bay. It is then filled with a rubber-like material, using an adhesive cement to seal the canals completely. After root canal therapy, the tooth is effectively now dead. The patient will no longer feel any pain in that tooth because the nerve tissue has been removed, and the infection that was previously present has no live material to feed on and / or it has been eliminated. Slowly over the next 48 hours the infection will die back.
3. Filling the Tooth and Crowning.
However, the tooth will be now more fragile than it was before. A tooth with no pulp must receive its nourishment from the ligament that attaches the tooth to the bone. This supply is adequate, but in time, the tooth will become more brittle, so a crown or filling offers protection. Until the crown or filling is complete, the patient should not chew or bite on the tooth. Once there is a crown or filling is done, the person can use the tooth as before. Treatment often takes only one appointment, but if there are curved canals, multi-canals, or large infections, this could take one or two additional appointments
How Do I Sue My Dentist for Negligent Dental Root Canal Treatment
Looking at the above then we can say that root canal treatments are undeniably an invasive form of dental treatment, so it is perhaps inevitable that complications will happen either during or after the procedure. These complications serve to frustrate the chances of the root canal being effective. Of course, there is always a risk that the treatment will not work and that is nobody’s fault. Sometimes the best possible root treatments just fail. Typically though patients will be able to make a claim if their dentist:
- Fractured an instrument inside the root canal and then did nothing to explain it to you or investigate the harm it may have done.
- Failed to hit the apex of the root leaving the infection untouched
- Perforated instruments through the side of the canal.
- Did not advise them of alternative, less costly treatments
How painful is it?
One of the exaggerations often told about this treatment is that it will be horrendously painful, but the treatment should be relatively painless. The pain from the dental infection is typically what is causing the discomfort and not the treatment. There is no doubt the procedure is hardly pleasant. After the treatment, some tenderness is normal. It is temporary, and over-the-counter medication may be enough to relieve it. If needed, prescription drugs, such as codeine, are available.
What Can Complications Can Occur in a Root Canal Treatment
If complications occur, a specialist can try to correct the problem and complete the root canal. To avoid complications, patients should always follow the dentist’s instructions. If an antibiotic is needed, it is important to complete the prescription. It is essential to also ensure that a permanent restoration is in place such as a crown. If not the long term duration of the tooth is likely to be compromised and it will look unsightly very quickly.
- Sometimes the dentist misses a canal. If one canal remains untreated, the infection might continue cause further damage.
- The dentist must also make sure the dead pulp material is properly removed.
- The root of the tooth may crack, or the instruments can break in the canal or perforate the canal. This makes it hard to fill the tooth effectively.
The common causes of Negligent Dental Treatment with regard to Root canal treatments are usually on this list:
- Improper amount and type of irrigation.
- Improper use of the rubber dam and/or poor isolation. It is essential to keep the area as sterile as possible.
- Improper selection and use of obturation material and techniques.
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Should Root Canal Treatments Be Referred?
Due to the time constraints and complexities of root canal treatments, many general practitioners refer these treatment-planned procedures, as a matter of practice to their specialist colleagues or bring an in-house endodontist to their clinic as a “peripatetic” or traveling consultant. Many practices have a number of different professionals to whom regular referrals are an established practice. Smaller practices typically have a network of referral specialist clinics. There is no obligation for a General Dental Practitioner to refer these treatments out, however, they should give you the patient the option of a specialist referral as the procedures is always a little complex and stands the best chance of success with a specialist. If the procedure is particularly difficult then that referral becomes more pressing and not doing it or offering it is likely to be met with skepticism by the courts.
What is the best antibiotic for an infected dental root?
The typical first choice of antibiotics for dentists facing this issue is amoxicillin—that is, assuming that no contraindications exist, such as allergies. Because of its broad spectrum, it is effective against root canal-invading bacteria and other “polymicrobial” infections. In short its a shotgun approach. Metronidazole is either an alternative or is added to the regimen if amoxicillin is ineffective after 48–72 hours. This combination, is very efficient. In case of a penicillin allergy, the typical alternative is clindamycin.
What about pain relief?
Most dentists now indicate that over the counter NSAIDs, such as high-dose ibuprofen are the best if the patient can take them. The rationale is that after most root canal treatment there is a moderate amount of inflammation present around the tooth and in the supporting bone and periodontal tissues. This inflammation can be alleviated by blocking the production of inflammatory mediators and nothing beats Ibuprofen for that.
Should I have opted for extraction instead of Root canal?
The most obvious alternative to a root canal is simply extracting the tooth. Most dental professionals will tell you that it is always best practice to save the tooth whenever possible. In fact most dental surgeons will go as far as to say that if you want an extraction, you should at least consider the possibility of a referral to get the prospects of rct treatment accurately identified first.
- Extraction is a more traumatic procedure it also leaves you without a tooth and the consequences of tooth loss that can occur. Including drifting tipping and movement of other teeth
- Another alternative is known as pulp capping. Here, a sealant is used to close off the entrance to the pulp. This is not always successful, and you may eventually still be required to have the root canal treatment. It may just delay the inevitable.
- A bridge denture This would be if you elect to remove the tooth and replace it.
- A dental implant can provide a similar alternative.
- Extended infection management, some people can tolerate lengthy antibiotic treatments and the pain that comes with a prolonged dental infection. In some cases that infection may bypass and not return for some time – perhaps never. However, the risk of the infection becoming worse and developing into a dangerous abscess is probably not worth the risks. Only a dentist can guide you.
One Final Thing!
We would suggest that if you are contemplating instructing a Solicitor but you are a bit concerned about calling or emailing – for whatever reason, then write down every particular about what has happened to you. Put down dates and times and names of people involved. Then months from now when you change your mind and do contact a Solicitor – you will have the details. Many claims are never brought because the patients simply forget the details and are too embarrased to contact a lawyer to discuss. Get them on paper and if you never use them no harm done.