What's the "gold standard" (ha ha) for a chipped rear upper molar cusp repair?

[Deleted User]

Sorry to post twice but this is about myself (mid-40's) and I'm hoping to have brief advice on what type of treatment to seek (in general terms). I had a rear upper molar cusp smash into pieces while I was eating my porridge so I'm trying to research what I should have done. It's been 12 months since my last dentist visit and they didn't flag anything with it (which makes me slightly worried as to whether they are missing other things)...

I'm most concerned about longevity of my teeth, and cost is less of a factor. Appearance doesn't bother me.

So my questions are: (i) Is gold the "gold standard" for tooth repairs in this type of repair (most likely an inlay)? Porcelain apparently removes more of the damaged tooth and can cause scratches to the other tooth it touches, and is not as proven as gold? 

My teeth otherwise are generally average / OK - two fillings, both upper left molars next to each other (and the one that just chipped), one a gold inlay and one a white filling and both stemming from a childhood scratch to the tooth that slowly let decay in over the years, and somewhat receded gums.

I can go private if needed but NHS would also be fine (although my current dentist is private only so it would mean switching). Is NHS workmanship OK? Is not having access to my history a problem if I did switch?

Just looking for any general guidance. Thanks!!!

MalMonroe

Blimey, what on earth was in that porridge?!

Many of your questions can be answered by doing a quick google. viz : https://www.nhs.uk/nhs-services/dentists/how-to-find-an-nhs-dentist/

But you may struggle to find an NHS dentist at the moment - we have a shortage of dentists in the UK - so carrying on with your private dentist may be your best option. One of my friends who has just moved from London to the Midlands was told that there is a wait of three years for an NHS dentist. Another friend up north wanted to change dentists when hers retired recently but was told the same thing. If you were able to switch though, not having your records wouldn't be a problem at all because every new patient is (or should be) thoroughly checked out.

Most of the dentists who work in the NHS are the same dentists who work in private practice and in my experience, they're good at what they do. They only do cosmetic dentistry if it's essential though and of course, none of the treatment is free.

I'm not sure what you mean by "Porcelain apparently removes more of the damaged tooth and can cause scratches to the other tooth it touches" - that hasn't been my experience. The damaged tooth will have to be prepared properly, whatever repair it has.

Undervalued

MalMonroe said:

Blimey, what on earth was in that porridge?!

Many of your questions can be answered by doing a quick google. viz : https://www.nhs.uk/nhs-services/dentists/how-to-find-an-nhs-dentist/

But you may struggle to find an NHS dentist at the moment - we have a shortage of dentists in the UK - so carrying on with your private dentist may be your best option. One of my friends who has just moved from London to the Midlands was told that there is a wait of three years for an NHS dentist. Another friend up north wanted to change dentists when hers retired recently but was told the same thing. If you were able to switch though, not having your records wouldn't be a problem at all because every new patient is (or should be) thoroughly checked out.

Most of the dentists who work in the NHS are the same dentists who work in private practice and in my experience, they're good at what they do. They only do cosmetic dentistry if it's essential though and of course, none of the treatment is free.

I'm not sure what you mean by "Porcelain apparently removes more of the damaged tooth and can cause scratches to the other tooth it touches" - that hasn't been my experience. The damaged tooth will have to be prepared properly, whatever repair it has.

In some areas certainly. However in others, such as where I live, there are plenty of NHS dentists advertising for patients. 

brook2jack2

Gold standard depends on th hole, your dental and medical history , your bite , your diet, the position of your tooth etc etc , in other words there is no one gold standard for every person/every tooth. 

Gold is a good material, removes less tooth than porcelain but for a small hole will still be more destructive than white filling or even amalgam(silver filling). 

Your question can only be answered well by a dentist who can see you, your teeth , x rays and who preferably has seen you over a period of years so they can assess your oral status well.

pollypenny

I managed to lose a sizeable filling while eating ratatouille.  As brook said, it's as much your bite as the food. 

Toothsmith

As Brook said - the 'Gold standard' would vary depending on exactly how the tooth looks. You are right that porcelain/ceramic crowns can be more abrasive against natural teeth, but again, whilst that can be a big problem in certain individual mouths, it is often not an issue at all in others.

Also - all dentists will have different experiences and have done different post-graduate training. So if you see multiple dentists, you still may well be given a variety of different ways to go. There is very rarely one 'right' answer!

YellowCarBlueCar

I broke a tooth at the start of the first lockdown, and have recently had it repaired - a crown in my case.  The options I was given were:
-Metal (note gold isn't used so much now - more likely some kind of alloy)
-Ceramic over metal
-Ceramic

The first two were available on the NHS, the third private only.
Metal is the best medically, as it requires the least (equal with ceramic) of the remaining tooth to be removed to fit, as it's thinner then the ceramic over metal option.  The only down sides are the appearance, and that x-rays can't see through.
Ceramic over metal is the thickest so needs the greatest amount of tooth removal. Obviously better cosmetically, but also opaque to x-ray.
Ceramic is similar thickness to metal, but is more prone to cracking, and can cause more wear on the opposing tooth.  Better cosmetically, and x-rays can see through to what's going on underneath.

The service I've had with NHS dentists has been good on the whole.

brook2jack2

Sorry but there area few errors in the above.
Gold is still used , it has always been an alloy as pure gold is too soft to use in the mouth, but it is not used on the NHS except on inlays. A metal crown on the NHS will be a non precious metal alloy , privately gold.
X rays cannot see through ceramic , all crown materials are radio opaque ie they block out the tooth on X rays you cannot see the tooth through them.