Questions about Dental crowns

welshdent

capomeister wrote: »

. Hoping this emergency NHS dentist is good and doesn't try and rip me off. I really thought gold crowns were still available on the NHS and the price wasnt so high (I was quoted about £50 for an NHS root filling 2 years ago). Thanks again for your helpful advice, Toothsmith

2 years ago was probably ish when the new contract came in ,,, why the assumption the NHS dentist would try and rip you off? No offence but you as an individual are worth peanuts to them. For an emergency appointment they are lucky to earn at most a tenner off you regardless of what they do. The fees and payments are not set by the dentist they are set centrally by the Dpt of Health or welsh assembly. The fees are so poor the earnings come not in ripping off an individual but by bulk treating as many as possible. What you THINK the dentist is ripping you off for rarely goes to the dentist. I would say of a gross fee ... which is NOT what you pay ,,, the dentist would see at most 30% of it

chickalittle

Just back from a visit to the dentist who advised me that one of my 2 front crowns really needs replacing as they are so old. She pointed out a “stickiness” at the top of one near the gum. Must confess I was a bit taken aback as it was only at my last visit ( about 7 months ago) I had specifically asked whether there was anything major coming up with my teeth as I was wanting to cancel my dental insurance and there was no mention of aging crowns then ....
Anyway, I’m not very happy at the idea of only having one replaced as I think the difference in colour will be very noticeable. I know I have had the crowns a long time but they fit really well, the colour is good and I am not aware of any problems so am hesitant whether I really need to go ahead with this at the moment.
Can someone who is the dental profession advise how critical this slight stickiness my dentist pointed out to me when she tapped against it with her instruments?
My other concern is that I am with a NHS practise and I have never been overly impressed with work carried out – but anything done has been to my back teeth so not really visible which is why I haven’t been too bothered. However, this would be a big concern to me to have my 2 front teeth done – so I guess it would be better to try and find a good private dentist?

welshdent

Difficult to say exactly whats going on in your case as we have not seen you however stickiness can be due to a few things. Over time the cement that holds a crown on can gradually disolve away from the interface between crown and tooth. This will leave a gap which can be termed "sticky" as the probe will get stuck in it. If this happens it is potentially unsightly but more of a concern is the large space for plaque to accumilate causing gum inflammation and possibly decay. Decay is an issue as you can not see what goes on under a crown so decay can sweep through underneath un noticed and may make a new crown impossible. Decay is also "sticky" because it softens the tooth up and breaks it down .. hence probes will stick in it. re concerns about colour - we can colour match them. to be something you are comfortable with. NHS or private doesnt matter too much because an NHS dentist can provide private crowns. NHS simpy refers to who is paying for you. The dentist is independent regardlessly. a GOOD dentist is what you want. If you go for the bog standard NHS bonded crown then it will probably not look as good as a high end private all ceramic crown. The bonded crowns have porcelain stuck to a metal base. They may look a bit lifeless and light can not pass through it and if it is NHS you are not likely to get a michaelangelo type tooth back i.e. there wont be much in the way of characterisation to them. A private crown you have more control over, for example you are more likely to get graduations of shades and incorporations of shading and even illusions of cracks if you want. If you have an all ceramic crown they can look extremely life like especially when compared to a bonded crown. It is a vast area of possibilities. The best person to speak to is your dentist who has seen you. If you arent happy with what they say then get a second opinion

brook2jack

Really can't say if it needs replacing as can't see it or the xrays. However a few points

1 if you don't trust your dentist and are not happy with their work why do you stay? Find another dentist you trust. That may be private but costs can be less than you think... Ask around.

2 yes it is difficult to match only one crown but on the Nhs cosmetics are not a reason to replace a crown you would only get what is clinically necessary ie the one crown.

3 if there is a gap between crown and tooth it can be a trap for plaque causing problems with gums and decay however this rarely happens quickly and most dentists would be giving you a warning that a crown would need replacing in the next year or so.

chickalittle

thanks for both replies - I think after reading what you both have to say I will try and get a 2nd opinion. I'm not in a position financially to deal with this at the moment so really need to know how urgent this "sticky" situation is. My dentist was recommending I have this done immediately which as I said, came as a surprise as I have been with her several years and there has never been any mention previously that my "aging" crowns may need replacing. If I can hold off for another 12-18 months then I maybe in a better position to afford the better crowns as you describe. I would in any case definitely want to find another dentist to carry this work out as it would be very visible and I am just not that confident in my current dentist giving me an end result that I would be happy with.
Thanks again for your comments.

MLSP

I just started seeing a new dentist on the NHS.

He's told me my teeth are in a bad state and need a raft of treatment.

First on the agenda is a crown to my first top right molar. He says it's necessary as the tooth has cracked, possibly due to a large filling.

He's offered me a silver NHS crown (not sure how much this will be) or a white one privately for about £475. This sounds a bit more than others have been quoted. maybe it's because it's to hold the tooth together?


It sounds like I also need remedial treatment to the upper front two incisors as they're almost down to the dentine (hard brushing? demineralisation?)

Also a filling needs re-doing, i need a splint to stop me grinding them, several trips to the hygenist to clean / teach me how to clean them.




Oh dear.

Any advice about the crown?
Or the two top front incisors? I have no idea what's planned for those.
He suggested sedating me for the crown work too as he said I appear very nervous (true).

Many thanks in advance

Toothsmith

Sounds like you have someone who explains things well, and gives you options.

He's the one you need to be asking the questions to, as he's the one who can see what's going on - but it sounds like it is someone who will take time to answer your questions. (That's probably why things are a bit dearer there!)

Write your questions down before you go next time, as important things tend to fly out of your head if you find the situation stressful. They also sometimes fly out of your head if you don't!! The dentist won't mind you turning up with a list!

mybad

Hello, fascinating thread, thanks for all the information on the various treatments available.

For a long time I've been very confused about the difference between NHS and private dental treatment. When I was out of work I would visit my dentist and receive standard NHS treatment. When I was working I would visit the same dentist - he would offer me the same standard of treatment while explaining that I now had to pay for it because I was working. He never mentioned anything about going 'private' nor did he mention anything about better quality materials, nor white fillings etc (for which I would gladly have paid a little extra). There was no discernable difference between paying and not paying at the end of the drill. Finally I stopped going because I was paying him to fill my mouth with poor quality metal fillings and crowns. I don't blame the dentist wholly - I really should have spoken up, but I am very shy about these things and didn't want to make a fuss.

I have now saved a little money and am hoping to visit a genuine private practice to have some of the above treatment replaced. One front crown in particular is many shades lighter than my other teeth (I'm a smoker) and is so badly fitted that I have developed a bit of a lisp. And I am now missing my upper left incisor due to a protracted abcess (ten years - don't ask!). I'm not even sure that the gap can be filled as the tooth next to it is a little loose, so they may not be able to fit a bridge. I did have a partial denture but found it almost impossible to talk while wearing it. All of this was NHS work and, to be honest, I found it to be temporary, serviceable and not at all acceptable in the long term.

I was wanting to ask whether going private will give me more of a voice in the treatment process. Will I be offered choices, alternatives, opinions, etc, in a way I never received at the NHS dentist? Will the treatment be a substantial improvement over the free and, indeed, the paid NHS treatment? Do private dentists offer deals, say?

One thing all this has taught me is just to look after the teeth I have left - I brush and use mouthwash several times daily, and I floss after every meal. I have stopped eating sweets of any kind and take no soft drinks. But, unfortunately, all a little too late.

Thanks for any advice.

Toothsmith

mybad wrote: »

I was wanting to ask whether going private will give me more of a voice in the treatment process. Will I be offered choices, alternatives, opinions, etc, in a way I never received at the NHS dentist? Will the treatment be a substantial improvement over the free and, indeed, the paid NHS treatment? Do private dentists offer deals, say?

There are good and bad private dentists just as there are good and bad NHS dentists. (And, indeed good and bad patients!)

Private dentistry certainly should be all the things you expect, but look carefully. Get recommendations, make a short list and VISIT!

Don't just look for the flashiest ad in yellow pages or the swishest web site and ring up. Cost is obviously important, but don't make it your No.1 priority.

mybad wrote: »

One thing all this has taught me is just to look after the teeth I have left - I brush and use mouthwash several times daily, and I floss after every meal. I have stopped eating sweets of any kind and take no soft drinks. But, unfortunately, all a little too late.

Thanks for any advice.

But what about the 'elephant in the room'?

The worst thing you're doing, and the thing you're not mentioning stopping, is the smoking.

Unless that goes, whatever money you spend will probably be wasted. That may well be why your original dentist didn't bother to tell you about the 'better stuff'. Yes, it's probably wrong not to at least let you know it's available, but none of it was probably suitable for you given the smoking habit.

If you do give up, and it's not too late for your teeth, then you'll have so much more money to spend on them.

Good luck.

mybad

Toothsmith wrote: »

But what about the 'elephant in the room'?

The worst thing you're doing, and the thing you're not mentioning stopping, is the smoking.

Unless that goes, whatever money you spend will probably be wasted. That may well be why your original dentist didn't bother to tell you about the 'better stuff'. Yes, it's probably wrong not to at least let you know it's available, but none of it was probably suitable for you given the smoking habit.

If you do give up, and it's not too late for your teeth, then you'll have so much more money to spend on them.

Good luck.

Hi Toothsmith, yes, you're absolutely right. Giving up smoking is something I keep deferring to another day, probably to be never. I wonder if I can use the state of my dental health as an incentive; the problem is that I know many other smokers whose teeth are fine and therefore I haven't really linked smoking to tooth decay in my mind. But, of course, the link exists, regardless of my ignorance.

I think the dentist was being a little unfair because he never explained to me the effects of smoking on tooth decay - sometimes a good talking to by a professional can work wonders for resolve and morale. However, I will not be visiting that dentist again because, regardless of whether I smoke or not, if he was going to fit a crown and I was going to pay for it, he might as well have given me the option of a better quality one, or at least tried to seat the one I have correctly.

But thanks for your advice - I think a major effort on my part to give up the ciggies is essential before visiting a private dentist. But, in a way, now, the whole thing becomes rather daunting as one has to make a major change in one's personal life.