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Post by heitara on Feb 18, 2005 9:00:19 GMT -5
All right, I know I'm a pain... but I can't overcome the uneasyness of wearing the rubber dam. My dentist is very gentle and sympathetic but he insists on having me wearing the dam during the root canal. I tried it once and I just couldn't cope with it. The fact that my jaw is blocked and that I'm unable to close my mouth if I want to, makes me panic. Control again...When I had my previous root canals without the dam (with my old dentist, before he retired), I had no problems at all and of course there are times during the procedure when you can't absolutely close your mouth, and I obeyed, but I knew that if I really want to do it, I could. Now, there's this problem that seems unavoidable. My dentist complains that without the dam the procedure won't be as sterile as it's required, compromising the result of the root canal in the future. Is it really like this? I hade two with my old dentist, over twenty years ago and never had a problem ever since. Is there a way out for me? I feel I'm trapped in a dead end street. Thanks for your help
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Post by letsconnect on Feb 18, 2005 15:55:22 GMT -5
Hi - I don't know if you've seen this thread: dentalphobia.proboards27.com/index.cgi?board=dentistry&action=display&thread=1107609844"My dentist complains that without the dam the procedure won't be as sterile as it's required, compromising the result of the root canal in the future. Is it really like this?" The situation is as follows: the currently accepted standard of care which dentists are supposed to abide by is that a rubber dam be used for root canal treatments. So, your dentist is right in saying that without the dam the procedure won't be as sterile as it's required (in terms of standard of care). While root treatment without the dam oftentimes works out just fine, there is a greater chance of it failing. There is a basic legal issue involved - if the root canal doesn't work out, you could take him to court and you'd probably win the case. It is not possible to sign away your right to proper treatment, so it's not possible for your dentist to have a waiver form where patients request no dam. So he's stuck. Now, some dentists will do a root treatment without the dam if they reckon that's the only way their patient will tolerate it - and if they reckon they're doing the right thing. Even if it means leaving themselves open for legal action. While it's not really something you can push, you could try and beg some more, he might give in. Or you could discuss other options such as sedation. Or you could shop around for someone who'll make an exception for you and do it without the dam (but you should avoid dentists who don't use it routinely - this would imply that they may be unconcerned about the standard of care in other areas as well). I'm sorry, there's no easy answer to this one
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Post by Guest on Feb 19, 2005 4:52:55 GMT -5
Hi Heitara,
just wanted to add that it IS possible to have root canal treatment without a rubber dam. It also DOES NOT mean that you are getting sub-standard care/treatment.
Your dentist will want to give you the best treatment. When I needed root canal treatment I coulcn't tolerate the rubber dam. And I can't cope with the idea of sedation either, so that wasn't an option. As I had an abcess on that tooth, it would have meant an extraction, i.e. losing the tooth. That would not have been "best" for me.
The other option was a root canal treatment without rubber dam. The dentist explained that this increased the risk of the treatment failing, because without the rubber dam there is a greater risk of bacteria getting into the tooth.
I wanted to save my tooth, and therefore was keen on the root canal treatment without the rubber dam. My treatment was successful. I had it 1 1/2 years ago, and subsequent x-ray showed it was successful.
Other factors to consider in the with/without rubber dam decision are:
- Which tooth it is that needs the treatment. Mine was a lower pre-molar and according to my dentist these are "easy" root canals. I guess if it's an upper back molar, it may be more difficult to do it successfully without a rubber dam.
- How experienced is the dentist. Someone fresh out of dental school who has only ever done root canals with rubebr dam may have difficulty doing it without a rubber dam.
My suggestion would be to discuss this a bit more with your dentist. And having the treatment without the rubber dam may be the best option and the best treatment in your case, or maybe you could tolerate the rubber dam with sedation.
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Post by letsconnect on Feb 19, 2005 9:31:50 GMT -5
The point I was trying to make is that RCT without the dam may well be the best option for you personally, but that your dentist is leaving himself open to legal action - so it's not him trying to be adversarial with you or telling tales, it's just how the system works. He may or may not be happy to take that risk. Of course root treatments without the rubber dam often work out just fine, but statistically, they are more likely to fail - hence your ability to sue your dentist if it fails and he didn't use a rubber dam.
You should talk to him again. Does he know what happened the last time you tried the rubber dam (or was it the same dentist)? You might be able to work out something which makes you feel more in control in other ways to compensate for the loss of control you feel from being unable to close your mouth. Or he might give in.
I certainly did not mean to imply that no rubber dam, where this is deemed to be in the best interest of the patient, equals sub-standard care/treatment. The point I was trying to make was that a dentist who doesn't offer rubber dams for any RC treatments to any of the patients, in all likelihood will take "shortcuts" elsewhere, and not comply with the currently accepted standard of care. This is an entirely different scenario from the dentist who usually uses a dam, but will make exceptions for certain patients (where it is deemed in their best interests). But not all dentists, including those who are sympathetic to your problem, will be happy to take the risk of potentially being sued and perhaps having their reputation damaged, and it would be unfair to blame them for their decision not to carry out treatment without the dam. It's a tough judgment call.
All I'm saying is that, from the dentist's perspective, he is leaving himself open to legal action, and if he feels too uncomfortable with this, there may be no point in pushing the matter. From your dentist's point of view, there is a legal (and an ethical) dilemma involved.
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Post by Guest on Feb 27, 2005 4:31:40 GMT -5
The point I was trying to make is that, from the dentist's perspective, he is leaving himself open to legal action, and if he feels too uncomfortable with this, there may be no point in pushing the matter. From your dentist's point of view, there is a legal (and an ethical) dilemma involved. Hi Heitara, don't take everything that "letsconnect" writes as the gospel truth. She is neither a dentist nor a lawyer, and it's worth remembering that. On another thread, Gordon (who IS a dentist) wrote that it is possible to do RTC without rubber dam in the UK, but not in the US. And I have no idea what the rules are in Italy. I'm in the UK, and as I wrote before, in my case the RCT worked fine without the rubber dam (and that was the best treatment option for me). Discuss it some more with your dentist, and see what s/he says. I hope everything works out for you. Let us know how you get on. G. P.S. Here is the link to the other thread, so you can read what Gordon wrote: dentalphobia.proboards27.com/index.cgi?board=dentistry&action=display&thread=1107609844
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Post by letsconnect on Feb 27, 2005 6:28:36 GMT -5
Of course it's "possible" to do a root canal without a rubber dam, I never challenged that. You may have missed some of the points I was trying to make.
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Post by letsconnect on Feb 28, 2005 10:05:09 GMT -5
Point taken regarding me not being a lawyer or dentist. Also, I may have become a little confused between "standard of care" and "best practice". Bear with me - as the administrator of this board, I have to err on the side of caution . I do take your points seriously, and considering that dental law is different everywhere, I contacted a dental lawyer-cum-dentist, Dr. Chris Dean, and asked for the lowdown on the situation in England and Wales (which, apparently, can be different from the law in Scotland and Northern Ireland). Here is what he had to say: "Very happy to join the debate! Obviously the use of rubber dam in endodontics should be universal and personally speaking I wouldn't want RCT in my mouth or any of my patients without it. I would argue that rubber dam use is the appropriate standard clinical approach to tooth isolation, and should be mandatory in endo, but we all know that a number of practitioners continue to fail to use it. The legal standard of care in England and Wales is of course determined by the 'Bolam' test - the standard being that of the ordinary skilled practitioner. There has been a gloss added by later cases which indicate that the courts will exmaine the reasonableness of the treatment provided. In my experience in cases involving allegations of dental negligence in endo cases in England and Wales, it is accepted that the use of rubber dam is a good defence to allegations of breach in terms of a failure to isolate the tooth, or prevent canal disinfectants and endo instruments from damaging the oral cavity/trachea etc. It is much more difficult to defend a claim where endo instruments have been dropped into the mouth, or where canal medication has damaged oral structures when rubber dam has not been used, but it is possible to argue that the use of a parachute chain or floss, or isolation with cotton wool is sufficient. In terms of failed RCT, a failure to isolate the tooth effectively due to a failure to use rubber dam would form part of the overall picture of a failure to use reasonable skill and care but is unlikely to be definitive of negligent breach in the absence of other evidence of breach. So I agree with both your dentists and the patient! Kind regards Chris Dean"
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Post by Guest on Feb 28, 2005 11:53:37 GMT -5
There are two completely different scenarios getting mixed up here:
1. Patient comes to dentist needing RCT and dentist doesn't use a rubber dam, because he can't be bothered/doesn't feel like using one.
2. Patient comes to dentist needing RCT. Dentist wants to use rubber dam but patient cannot tolerate rubber dam. Dentists discusses options with patients:
(a) Get somehow used to rubber dam. (b) Have sedation which may make it possible for patient to tolerate rubber dam. (c) Have tooth extracted. (d) Have RCT without rubber dam (Dentist explains he will use cotton wool to isolate tooth and thread dental floss through tools to facilitate easy recovery in case he drops one. Dentist also explains risk that RCT without rubber dam means higher risk of RCT failing as higher risk of bacteria getting into the tooth from saliva.)
Patient knows that (a) they will not get used to rubber dam (b) they can't tolerate sedation either (c) they have already lost many teeth and really don't want to lose another one. Therefore: (d) patient chooses option (d) (Thinking that if the RTC is successful they have saved the tooth. If it's unsuccessful, they can still go back and choose option (c) tooth extraction.
In scenario No 1, it is easy to see that the patient would have a good case to sue the dentist for being negligent. That dentist is taking a short cut and not providing the accepted standard of care/follow "best practice".
But I really don't see how the patient in scenario No 2 could (or even would want to) accuse the dentist of negligence?! And as the dental nurse was in the room when patient and dentist had their discussion, there was a witness. In other words, the dentist doesn't have to worry that the patient turns nasty later and says "But you never explained any of that to me" if the RCT fails.
Obviously, if you run scenario No 1 past a medical lawyer they are going to scream "negligence", but I don't think they would do so with scenario No 2.
And it was scenario No 2 that MaryBeth, gdentalfear, and Heitara wrote about!
Sorry to ramble on and on about it. But I was so glad that my dentist tried his best to save my tooth (and succeed) and I really resent that letsconnect constantly makes out he is like the guy in scenario No 1 when that was so not the case.
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Post by letsconnect on Feb 28, 2005 12:42:44 GMT -5
Let me quote myself (see above): I certainly did not mean to imply that no rubber dam, where this is deemed to be in the best interest of the patient, equals sub-standard care/treatment. The point I was trying to make was that a dentist who doesn't offer rubber dams for any RC treatments to any of the patients, in all likelihood will take "shortcuts" elsewhere, and not comply with the currently accepted standard of care. This is an entirely different scenario from the dentist who usually uses a dam, but will make exceptions for certain patients (where it is deemed in their best interests). I fail to see how or where I "constantly make out he is like the guy in scenario No 1 when that was so not the case". I have to admit that, if we use the Bolam test to determine standard of care in England and Wales, it is entirely possible that not using a rubber dam could be defined as the current standard of care. But for various reasons, some of the people associated with this message board would like to promote best practice. Again, see my quote above for possible exceptions in relation to the use of the rubber dam.
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