NHS Crowns

cdbe11

Hi, I pop on here every few years when something else goes wrong with my teeth. My 2016 "Groupon" implant is still going strong. 

My ongoing issue is that my molars have had it! I paid over £1,000 the other year for a specialist to root canal a 20 year old crown which seems ok so far. I have 6 others left with two being largely filling on filling - one was patched up last year and the other seems to have fallen off (feels like most of the "tooth" gone with just a concave section left).

I have very little confidence in my NHS practice, I usually get the newly qualified kids and hardly ever see the same dentist - after a patch up job a few years ago one of them told me the next time something breaks off I should have two crowns - sounded good to me but I don't believe this ever went into my notes and in subsequent visits, while drilling and filling what's left of the teeth, none of them will even discuss this option.

I want to know, is this them being cheapskate at my teeth's expense? They normally charge me I think band 2 for the fillings - I never have any pain with the teeth and think as a man in the street that they'd be far better being crowned and I should be able to ask for this as an NHS patient?

Toothsmith

With NHS Dentistry, what might have seemed a good idea in the last financial quarter could well be completely financially unviable to provide now - never mind what might have been said a few years ago.

brook2jack2

To be fair NHS or private crowns have both their drawbacks and their place. 

Crowns should not be placed on someone who has not made the changes to diet and cleaning that caused the damage in the first place. It is accepted good practice to try to stabilise the mouth before advanced treatment is started. In some people that change in diet and cleaning never happens. In most new versions of the NHS dental contract crowns cannot be placed unless or until good oral care is achieved. 

Crowns should ,normally , only be placed on teeth that are severely damaged but that still have enough of the original tooth left to hold the crown on. Many heavily filled teeth cannot be crowned because there is not enough underlying tooth structure to support a crown. 

A tooth that is crowned has a 25% chance of dying off and needing root treatment . That root treatment is not guaranteed to work , on a back tooth in a specialists hands success rate is up to 90% , in a general dentists hands the success rate is less , and complications like curved roots will decrease success rates in both specialist and general dentists hands. Even if the root treatment works the dentist will need to drill through the crown which will possibly then need replacing. 

In other words there are many clinical areas to be considered before a dentist makes the decision to crown a tooth and certainly NHS or private a dentist cannot be forced to crown teeth that, in their opinion , should not be crowned. That does not stop you seeking and paying for a second opinion because different dentists have different approaches to treatment planning. 

cdbe11

Sorry, I've been away.

Thanks for the replies, maybe April is a good time to go! 

I've never been advised of any issues with my oral hygiene. At 52 years I've only lost front tooth to a childhood accident and one molar to decay or stress?*. The rest of my missing teeth (I think 8 or 12) were removed as a child following orthodontics treatment.

*lots removed at the back hence I suppose the remaining molars had a lot to do.

I didn't realise that crowns were so risky - I think my concern is that I don't believe the junior staff who usually treat me (last one had to get the "real' dentist in 3 times to help her with a filling) are looking at the bigger picture - they seem harassed and under pressure to get patients in and out quickly. I now know that the one (I saw only once) who verbally recommended two crowns was one of  the partners.

As I mentioned earlier, I've already been through the shock of having to pay £1,000 plus for a specialist root canal with the microscope etc and £1500 for an front implant so (with a struggle as an NHS patient) I appreciate that there is a low standard of what is considered medically necessary and limit to what you will be offered on the NHS which in those cases was an extraction/a denture. I just think I'm entitled to an informative assessment/discussion of the longer term care of my teeth (including private options for me to consider if in my interests), I'm certainly no expert but wonder if for example, I should be considering some implants/private crowns now rather than throwing good money after bad on patch ups if the longer term prognosis for the teeth is poor rather than just another lump of filling and being told to try and eat with the other side.

I'm in on Wednesday so I'll see what happens.