NHS or private for specific dental treatment

Downthedrain

I have a molar that's been filled extensively - the last time was 18 months ago and the edges are already chipping away. My NHS dentist has proposed that the tooth should be crowned over the existing amalgam filling - no root canal treatment as there is no pain.

Would a composite restoration underneath the crown be covered under the NHS, or would I have to find a private dentist?

I had this type of work done previously on another tooth (different dentist - private at the time) and it failed after 4 years, resulting in leakage into the amalgam under the crown. I had an emergency root canal procedure through the crown as a result, which left a filled hole in the crown which is hardly satisfactory. Is fitting a crown over an amalgam filling normal practice? 

Toothsmith

It's really impossible to give you a definitive answer - as it depends on so many factors. These will be assessed by your dentist and would be different for each patient, and each tooth in the head of that patient.

Easy answer first, it's highly unlikely a dentist would put a composite filling in a molar - particularly if it's a big one. (Edit - on the NHS)

Should a tooth be re-filled before crowning - yes, if it needs it, no if it doesn't! That's only a judgement your dentist can make. Every time you take a drill to a tooth, though, you do do a bit more damage - and changing a big  filling could be the thing that just tips a tooth over the edge from a healthy, live tooth, to a dying tooth that gives problems. If not done though, some unknown, unseen problem might rear it's ugly head once the crown has been provided.

Radiographs and clinical judgement are needed to help assess a tooth, but at the end of the day, the dentist has to make a call. Sometimes it's right (mostly, hopefully), and sometimes it will be wrong.

A good dentist should be taking their time to explain the pros & cons of the decisions that have to be made, and let the patient weigh up the risks as well. 

It is virtually never a black & white decision though.

Downthedrain

Thanks for the reply. I've booked another appointment to discuss it with my dentist to get a better understanding. I want to get the best result I can because dental problems are really getting me down - I can't seem to get a clear run where there isn't something.