Wrong crown fitted - advice appreciated

Wheelchairmike

Hi all,

TLDR: NHS treatment plan doesn't include other areas of decay found under private consultancy. Previous Inlay (LL5) incorrectly fitted, needs replacing. Patient requesting advice.

Thanks to anyone reading this and for your time.

I’m 39 and am in the middle of a Dental treatment plan, having just had 2 teeth extracted (UL6 + UL7). I am with a local NHS dentist who also does private work of course. Having had a consultation and treatment plan issued by my NHS Dentist, due to the grand scale of work required I opted for a private consultation in order to understand the differences in service and costs.

Under my NHS dentist, the treatment plan includes:
• 2 x implants in replacement to the recent extractions (extractions complete, currently aching)
• 1 x Endo RCT referral for a failed RCT on UR6 completed by this dental practice 9 months ago
- the filling fell out after 3 months and I have been dealing with an empty shell ever since, awaiting a referral (which they forgot about)
• 2 x crowns LR6 + LL5 to replace recent large Amalgam fillings that have repeatedly fallen out. The current re-fills are already cracked within weeks.

Under the private consultancy, they found a little different:
• All of the above +
• The LL5 and LR6 crowns could be simply fillings (unknown until excavation and inspection)
• The UR6 Edo RCT is destined to fail as the tooth is on its last legs
• 2 x additional teeth showing signs of decay around existing dental work (not discovered by my NHS Dentist so not included in treatment plan)
.... And then…
• He spotted a inlay in my UR5 which is oversized and showing signs of decay underneath, asked what it was and where I got it. This was installed by my current NHS dentist 18 months ago. I confirmed that it would be porcelain before the lab request went out, but it was only after fitting a few weeks later (when I got back to my car after the appointment) when I discovered a shining silver inlay. I immediately went back to the dentist to demonstrate my dissatisfaction who simply told me that “what’s done is done, it can’t be removed”. This inlay is 100% pure metallic, no gold! It is also in a location where it can be easily seen but my biggest concern is that, after only 18 months of broken floss where it catches on the oversized underside of the inlay, it’s showing decay… and I’m very conscious of dental hygiene.

Following both consultations, I am booking in for the Endo consultation to see if a specialist can advise me on the possibility of saving my UR6. This is the most pressing matter. I have 2 months of healing to decide on an action plan for the implants.

What I’m unsure of is what I should do about the UR5 wrong inlay. It is clearly the wrong installation for this tooth, completed to an insufficient level. Is my NHS dentist responsible for this work? Should they be offering a re-fit? Why did they fit such a thing in the first place?

The costs of this work is going to absorb my entire life savings, the deposit for my house that I’ve been striving to save for over a decade. I want to assure the correct treatment with no corners cut, but I don’t want to anger my dentist halfway through a treatment plan.

For all those wondering how my teeth have got to this level:
I grind day and night
History of dental work where they do “only what’s urgent”

Any advice on how to proceed is appreciated.

With thanks,

brook2jack

I am a little confused , your "nhs" treatment plan includes implants , which are not available on the NHS.

The two treatment plans are very similar , all dentists will look at the same teeth and give several different treatment plans. Some will say a tooth might need filling , others will want to crown it.

You have a problem with decay , you need to take the steps about diet , medication etc to rectify this.

You have a problem with grinding, this will have to be addressed if you are thinking of implants as it is a major course of implant failure.

If you grind , fitting a porcelain inlay would be a bad idea as they will break with grinding. Besides which porcelain inlays are not done on theNHS . A metal inlay will remove less tooth and is much better in people who grind. This will be a non precious metal alloy which looks silver in colour. Alternatively are you talking about a crown? You can fit a porcelain bonded to metal crown or a metal crown on the NHS , however teeth towards the back will be metal. Again if there is decay , you cannot have the crown "refitted" it will need further treatment .

Without seeing x rays etc I cannot comment on the fit but would point out you have decay on several other teeth so your diet etc needs looking at and if there is decay around the inlay it cannot be "refitted" other treatment will be necessary.

It is worrying that you are contemplating spending a lot of money on dentistry without

A addressing the problems that caused the damage eg decay and grinding which could cause you to lose crowns and implants even faster than your own teeth.

B establishing a good relationship with a dentist you trust who can do the simple stuff , the things to improve your oral health and the advanced things well.

Get the simple things right first before you launch into expensive treatment which will not last if the grinding and decay are not sorted.

Wheelchairmike

Hi brook,

As mentioned, thanks for your response.

Apologies, let me clarify that no implants will be completed on the NHS. It's a hybrid plan.

As I'm sure you must understand, after several decades of dealing with this dental condition, I've gained a fair understanding of how my teeth last in relation to the work I've already had done. I don't have a lot of hope in the implants after a lot of study, but I need to address my dental issues with a long term solution.

The grinding is only a recent discovery. It's more clenching whist I'm awake rather than grinding. Nevertheless, I have a bite guard for the evening. My diet has been low sugar for nearly a decade but can improve further on the materials I eat, not just the content.

I've moved around a lot and have only ever been able to afford NHS treatment until recently. My experience in the majority of cases has been 'quick fix' treatment plans out together merely to solve the immediate issue.
Very much in this case, additional x-rays completed privately showed other signs of decay which would have been missed.

It's very difficult building a relationship with someone who doesn't have time for you.

The LL5 inlay I mentioned is a metallic inlay, not a crown. If this is indeed the correct procedure for this tooth, then you have answered my question. What would have been simpler is maybe my dentist being able to offer this advice, rather than the response I got. Building relationships is a two way process if I remember correctly.