I recently had 2 root canal and crowns on teeth 7&10. 8&9 were replaced by implants, as the roots were cracked when I was intibated during surgery last year.

My insurance company denied the root canal claim saying that the root canal treatments appear short, and the canals are not filled to the apex. My insurance company is know for coming up for any reason possible to deny a claim. However, I'm worried I got inferior care. I'm not sure what to think or what I should do.

After reading here, I'm not sure I'd get more root canals as I already have 8 left (5 other teeth were extracted when the root canals failed), and i have lupus. However, these are currently in my mouth. I don't have any pain, discomfort, etc.

Also, are implants a safer concept for up infected teeth than root canals are? I'm 37 but my parents neglected my teeth so by the time I could afford dental work in my 20's I had to get root canals in lots of teeth. Those root canals are starting to fail, and retreating a root canal seems like a horrible idea in light of the fact the infection won't really go away.

Thought?

Hi socasusie,

My first thought is.... does your dentist know that you have Lupus? The reason I ask is because people with Lupus are more vulnerable to infection, compared to someone who is not afflicted by this condition. Mainly because Lupus (and often the treatments) compromises the immune system. So any ongoing infection is a risk to your overall health. Unfortunately, dentists often miss the boat when it comes to the systemic consequences of chronic dental infection. I know that sounds stupid.... but it's a sad fact, even amongst the profession itself.

The denial from your insurance company is quite amazing... but ironic at the same time. Their denial sends a message to the (uninformed) patient and the treating dentist that the root canal procedures are incomplete which makes a statement all in of itself. But at the same time, root canal therapy, even when done meticulously well, cannot cure the infection inside of the tooth. So they deny payment on the incompleteness in spite of the fact that it really doesn't matter.

Aside from the fact that the laterals will remain infected irrelevant of the treatment... to address the incomplete issue ..... Sometimes the root canal procedure looks incomplete, short of the apex, when in reality the large canals were calcified and access was unobtainable. So he stopped at the point where he could not go any further. OR the dentist purposely filled the canals short of the apex because he felt to push the procedure any further might cause a perforation through the end of the apex. So he filled it short rather than perforate. Either way, the treatment will look incomplete on the radiographs. It is important to know that re treating these teeth with root canal therapy or apicoectomies will not alter their current state.

It is disconcerting that you have so many root canaled teeth. Is your physician aware of your dental health? If not, it would be a good idea to let him know and have it in your medical records.

I'm sorry but there is no way to know if the dental implants are a healthy option for you considering your dental history and your medical diagnosis. Hopefully the implants will be okay!! I would urge you to give careful thought to the health risks of having any further root canal therapy and/or any re treatments in any teeth that are currently root canaled. The systemic risks associated with oral infections are very real and amplified in anyone who has a compromised immune system.

I wish I had better news for you. The treatment options are not that favorable and you would need to discuss them with your dentist. It is good thing at you have become better informed about your dental health. Always keep your dentist and doctor informed about your overall health.

I wish you well,
Bryanna

Thank you so much for your reply!

I disclosed I had lupus to my dentist. Having said that no dentist has ever even known what lupus is. Normally I educate but honestly, my health history is so complex I've given up on trying to help them understand. So while they know, I don't think they have a clue what that means.

My doctors know of the dental problems (my last 2 dentists advised me to ignore an absessed tooth because it didn't hurt, needless to say I moved on), however the medical community says lupus doesn't effect your teeth despite the fact every lupus patient I know has dental issues. I think my teeth likely contributed to my lupus. I developed it 2 years after finishing major dental work-3 root canals, 22 fillings, and other good stuff. Anytime I have dental problems my lupus inflammation goes through the roof. I honestly had been thinking that going forward I'd just pull the teeth. Truth be told I know that root canals only pro longs me losing them, as I know I'll lose most of them.

In the defense of the insurance company I only got the details of the denial through a friend who works there. It's funny many of my other teeth have had calcifications in the roots so that could explain it. I just had this moment of panic thinking I got bad care vs. there being a legitimate reason. As you know, insurance companies are always far behind on treatments-and claims processors are not trained doctors or dentists.

I've had 3 implants and they are doing well so far. I meant it as a general questions vs specific to me. I was thinking they don't have the same infections a root canalled tooth does so overall they would likely be better infection wise.

Thank you again for taking the time to answer me and share your knowledge, I really appreciate it!

Hi socasusie,

You are so right about dentists being basically clueless about lupus as well as the medical community being clueless about the systemic connection between our oral and overall health!! It is so disheartening to say the least. It is imperative to learn as much as you can and be a strong advocate for yourself... very hard, I know.

I agree with you in that your dental work may have exacerbated your lupus. Any time there is a chronic inflammation and or infection anywhere in the body, the lupus is going to flare. The big concern when this flare up occurs is that any lingering infection won't allow the immune system to calm down. So it would be typical for the person to then have more frequent or more intense flare ups. It becomes a vicious cycle.

My concern with anyone who has any root canaled teeth is that the mouth is never in a healthy state due to the chronic inflammation and infection. To complicated matters, the mouth is exceptionally vascular which means these issues are not by any means just confined to certain areas of the mouth. Dental implants or artificial joint replacements can become compromised due to the nature of any chronic infection/inflammation.

Your situation is complicated for many reasons. The fact that you recognize and understand the uncertainty of your root canaled teeth... makes you well informed for future dental work. Replacing them rather than retreating them may be in your best interest.

Please keep in touch with us... all the best to you!

Bryanna

I just wanted to follow-up. At my last appointment I asked the dental clinic about what insurance said, and we reviewed the X-rays with the specialist. The specialist said that one root canal was not short-that was the length of the root. The second canal had calcifications in it, and she couldn't get past them, which is why it was short. We took better X-rays for insurance. I have no idea if they'll pay or not, but at least I feel somewhat better about the care.

I have to be honest, in the back of my head I wanted to ask them to just pull them now and get it over with! Since I had another surgery coming up (last week) I decided to just sit tight for now and decide what to do later, in order to address one thing at a time. Long term I'd like to have all those root-canalled teeth replaced with implants.

Hi socasusie,

Just to clarify my previous replies to you.... it is irrelevant how the root canal was done or not done.... the teeth re infected which is a constant burden to your immune system.

I understand that you have other health concerns that have become the priority right now. I hope you heal well and have a complete recovery from your surgery.

My Best,
Bryanna

Hi Bryanna,

As always, thank you for taking the time to share you knowledge. Sorry, I'm on pain killer and am not as clear as I think I am! I completely understand on the root canals. In my mind I'm thinking of the bigger picture-if they can't do a root canal "right" by their own definition-meaning that they got the major canals and it's "all better" in their world, I was worried for my crowns, implants, etc that were done, and if they were done wrong and would have issues I needed to be concerned about.

Due to my surgery my surgeon would prefer no dental work for several for 3-6 months, which leaves me time for a game plan on my root canalled teeth, as well as my amalgam fillings. Really want implants due to my age, but overall health is most important.

Thanks for your kind thoughts, I'm healing well (even excited to go back to work soon!). Thank you again for sharing all your experience and knowledge, I appreciate it!