When is a crown necessary on NHS

Duggo

Hi, in the past month or two I’ve had two chunks of tooth fall off two different teeth. I know they both have very large fillings. (Think more filling than tooth) and I know a crown was mentioned briefly for one of them in the past. I suspect they both need crowns, but from a cost point of view I can’t see my dentist being prepared to do both on one course of band 3 treatment. Are they likely to refuse? How to I convince them there is a need to crown both teeth? 

brook2jack2

It is a clinical decision to crown a tooth . Unfortunately crowning a tooth has downsides, you have to remove a lot of tooth and 25% of teeth crowned need root filling afterwards . 

It may be that neither needs crowning, one or both but as it is a clinical decision a dentist cannot change a treatment plan if they don’t think it is the right thing to do , but you do . They have to abide by their professional opinion. 

Undervalued

Duggo said:

Hi, in the past month or two I’ve had two chunks of tooth fall off two different teeth. I know they both have very large fillings. (Think more filling than tooth) and I know a crown was mentioned briefly for one of them in the past. I suspect they both need crowns, but from a cost point of view I can’t see my dentist being prepared to do both on one course of band 3 treatment. Are they likely to refuse? How to I convince them there is a need to crown both teeth? 

brook2jack2 said:

It is a clinical decision to crown a tooth . Unfortunately crowning a tooth has downsides, you have to remove a lot of tooth and 25% of teeth crowned need root filling afterwards . 

It may be that neither needs crowning, one or both but as it is a clinical decision a dentist cannot change a treatment plan if they don’t think it is the right thing to do , but you do . They have to abide by their professional opinion. 

Variations on this have been discussed on here many times. Whilst the band fee collected from the patient is not what the dentist gets paid by the NHS for carrying out the treatment, there is no doubt that some (many?) NHS treatments represent a financial loss to the dentist.

Obviously that should not influence their clinical judgement about what is the correct course of treatment, however it always raises a question when an expensive or time consuming treatment is refused. In most cases that maybe unfair on the dentist, who may well be correct in opting for a simpler treatment. Sadly though on some occasions the financial motive may have prevailed.

It is difficult or impossible for the patient to challenge, even a second (or third!) opinion won't help in more borderline cases where they my be valid argument both way. Plus, would you really want somebody crowning your tooth if they have to be forced to do it?

Obviously, if you go private and pay the full commercial cost of the treatment you then have the concern that perhaps you are being "upsold" a more profitable treatment that wasn't really necessary!

Ultimately you are relying on a professional person's integrity. Hopefully that is genuinely there well over 90% of the time. Sadly though, not 100% in any profession or trade.

Edited to add.....

There is a related article in today's Guardian........

https://www.theguardian.com/society/2025/feb/13/england-dentists-nhs-exodus-fees

Duggo

Interesting article. Makes you wonder how much longer there will be NHS dental provision,