Questions about Dental crowns

danba

Hi. I work in an NHS dental practice in Northern Ireland and we do tooth coloured crowns on the NHS. Never have seen anyone get a metal coloured crown, ever.

There's porcelain crowns which are just that, a porcelain shell which fits over the tooth prep or the post, and then there's bonded porcelain crowns which are cast in metal (precious or non-precious metal) with the porcelain then bonded onto the metal so that the front of the crown is tooth coloured. These are a stronger job but slightly less natural looking as the metal underneath makes it a little less translucent. But it's not a big difference between the two. (I have 4 bonded and 2 porcelain and it's not noticeable).

And, yes, he may choose to re-do the root filling to make sure the crown has a sound base to fit on.

Now, here's the crunch. We are on a different NHS contract over here, and still charge and get paid on each item of treatment. The contract differs with you in that it's within bands. And I do think it has a big effect on what a dentist will treat. And I'm not sure either if the Dental Practice Board (your equivalent of our Dental Central Services Agency) would have differing ideas on whats allowed to be fitted on a premolar.

You could try checking with your Primary Care Trust? They would have a dental department, maybe could tell you if white crowns can be used on premolars.

www .dh.gov.uk/en/Aboutus/Chiefprofessionalofficers/Chiefdentalofficer/DH_4138821

Good luck. I hope you get it sorted

I had to edit my link as it wouldn't let me paste it fully, because I'm a newbie I added a space after the www

Toothsmith

I'd pretty much agree with brook2jack.

The dentist could put whatever crown on he feels is justifiable clinically. Personally I think it would be a bit tight putting a metal crown on a premolar, but it is allowable, and dentists offering NHS stuff NEED another source of income, so the have to charge private fees whenever they LEGALLY can.

If a root filling is exposed by the tooth breaking, then it's always possible that the tooth could get re-infected. That might be the reason he wants to do another root filling before the crown. Sensible really.

coldstreamalways

What he said. There are lots of threads about this subject btw.

welshdent

I was at a course recently where they said if a root filling is exposed for up to 30 days then the whole tooth is reinfected and would thus need to be re done.

I am not saying yes always do this ... but there could easily be justification for it

coldstreamalways

The research says it takes minutes to get infected. I remember doing a presentation about it because they used some really cute monkeys!! Cynomolgus monkeys if I remember correctly.

I would give it a bit longer but if it is slightly infected, sometimes sealing it up would help, sometimes it wouldn't.

KPR11

Thanks everyone!

The response have been very helpful!

I am not too sure about it being exposed because he put a temp filling on it and said will keep me going a couple of weeks.

I would have preferred to get it done for £198 but seems like I will be going with the private option. I guess the best way to think of it is that the extra £200 is over an extra 10 years or so (or am I being too optimistic?)

Thanks for your reponses!

iWarrior

Hey,

I have a few questions in regards to crowns on the NHS that I can't seem to find decent answers for via Google. A few Google search results lead to this forums, so I've registered, and /hopefully/ will be able to get a little assistance.

First of, The tooth in question is on the right side of the mouth, second from back (Par wisdom tooth, which would make it third from back).

A few years ago this tooth got root canaled by a /bad dentist/ (She was just out of Dental school), the result of this was the tooth ended up having a large hole after she finished the treatment, as expected, that resulted in a rather large filling(The silver ones). About a year later that filling broke, as did part of the remainder of the tooth(On the front), after visiting her again, she prompt me to just have it removed, after a second opinion by another dentist there, she was told to fill it instead.

Being this was a large filling in the first place, after she drilled it away, and refilled it, the second was even larger, I'd say a pretty large percent of the tooth was a filling, She claimed it was the largest filling she had done (Doesn't say much as she was new...), None of the less, about 3-4 months ago the same tooths having issues again, while eating corn, part of the front of the tooth(White part) chipped off, leaving a sharp edge, being my dentist done a poor job twice, and they is a 4 week waiting queue to get an appointment, I put of visiting again, until recently I've decided it'l be best to sort it out now, than just let it get worse.

The tooth itself in pretty bad shape now, the filling looks some what decent and secure, however the "white part" of whats left is sharp and edgey. With her wanting to pull it last time I'm wanting to know if it's possible to get a crown on it instead, I've been told that I should be allowed to get a crown on NHS rather than it being pulled as it's "chewing tooth", although I've also been told I may not as crowns can be considered "Cosmetic"

So; To sum up, On the NHS
1. Crown - Yes/No?
2. Cost (Free? (I'm unemployed right now), If I find a job between now+treatment, projected costs?)
3. Does NHS dentist have the right to refuse a crown and give only option of pulling it?


Regards
iWarrior

Toothsmith

Hello iWarrior, welcome aboard!

If the filling really is that big, then it probably wasn't a 'bad job' at filling it, it probably was that the dentist's first instinct to remove it was the right one. We can't fix everything, NHS or private.

If the dentist thinks it's the wrong treatment, then of course they have the right to apply their clinical judgement. You, of course, have the right to go and see if you can find a dentist who feels it IS possible to save it, but from what you've written, I suspect it might have had it.

If you begin treatment whilst unemployed, there will be no cost, even if you find work in the middle of treatment - but provided treatment is completed within a reasonable time frame.

If you weren't unemployed, the cost of a crown would be £198 (assuming you're in England) and extraction would be £45.60.

iWarrior

Hey Toothsmith,

Thanks for the fast response, I have a further question about your response though, Assuming you're a dentist, you'll be perfect to answer it.

You, of course, have the right to go and see if you can find a dentist who feels it IS possible to save it, but from what you've written, I suspect it might have had it.

Do you mean [save it] by a crown, or the filling itself? I've always been under the assumption that if a tooth has had root canal work before, then it's easier to put a crown on it because the roots are already filled, making putting a "stump?" in easier, and after the stumps in, the task is easier and cheaper(Time wise) for the dentist him/herself to attach the crown (Assuming the root canal work is in a good state?).

regards
iWarrior

welshdent

It isnt easier to put a crown but there is a strong school of thought (which I normally subscribe to) that crowning or at least "occlusal coverage" is deemed highly desirable. That said ... I have seen MANY that have had root fillings in for years and massive great big fillings that are still going strong with no crowns. We normally recommend it because a tooth needing a root filling is often very broken down ... doing a root filling requires even more removal of tooth substance to further weaken it. Also crowns often help to prevent leakage in to the newly disinfected root canal system more so than a simple filling. You are getting the filing inverted however. To do a root filling we "file" within the body of the tooth and to do a crown we file the outside. cheapness ... nope cos we have to stump up the lab fee which can sometimes be quite high, time wise ... takes me personally an hour to prepare the tooth and then 10 minutes for fitting after approx 2 weeks. compare that to seeing 4 patients each of whom need 1 simple filling which may allow me to see 5 in the equivalent time frame required for a crown. I would then actually get an extra 3 UDAs on making the crown and no lab fee... so it isnt always cheaper. That said I dont think your original dentist sounds bad. Have you had pain in the tooth since? That would be a better indicator of the quality of the work than if a very big filling breaks ... happens to us all. also if the second dentist advised it then it sounds like they may have been what we call a vocational trainee so are often led to treatments by their boss more than being allowed to do it for themself ... and I think they wanted to take it out? Which is also an acceptable option for a tooth in such a condition