[OT] Question about dental crowns

I could use some dental advice. One of my molars has become very
sensitive to cold over the past several months. Heat also bothers it
somewhat, so I've been chewing mostly on the other side for most of
that time. It's gotten bad enough that I have to use warm water to
rinse my mouth out after brushing my teeth.

Anyway, I recently got dental insurance, and I went in last week to
get a checkup and cleaning. The dentist looked at that tooth and told
me I had a crack along outside edge, and that's what's causing the
sensitivity - from liquids seeping inside the tooth. She said that
there's very little tooth left, just the filling and a fragile bit of
tooth around the edges, and if she were just to replace the filling,
there would be nothing to hold it in place. So she says I need a
crown.

Since I've never had this done before, I wanted to ask if this sounds
reasonable. If I really need it, of course I'll have it done, but

William Hamblen...

It seems likely to me that you'd need a crown.

crowns are very expensive, and my insurance will pay only 50% of it.
So I don't want to get it unless it's really necessary.

EvelynVogtGamble(Divamanque)...

Sounds VERY reasonable to me - most of my teeth - especially
the molars - have for a long time been mostly filling
surrounded by a shell of tooth. As I've grown older, a
number of the teeth have cracked, leaving filling exposed
on one side. So far I've been lucky, and there was still
enough tooth left to provide a base for a crown, but once a
tooth breaks off, that is not always the case. The last
crown I had was precautionary - the filling was washing out
(after forty-odd years) and it seemed wise to have a crown
done while there was still enough of the original tooth
remaining to make it possible (not wait until it cracked and
one side broke off).

Monique Y. Mudama...

It sounds reasonable to me. I have, um, I think two crowns and a
half-crown (whatever that is). Only one of my crowns also involved a
root canal.

Dentists vary, obviously. Not just in quality but in philosophy. My
current dentist is very much "don't do anything unless it's absolutely
necessary," and explained his point of view to my satisfaction. My
previous dentist was all about crowning my teeth "just in case" ...
eventually I got tired of that. Was he padding his account or did he
just have a different philosophy? I don't really know.

It's pretty typical to do a crown when there's mostly filling left.
The description you gave sounds like a textbook case for getting a
crown (with the caveat that I'm not a dental professional; I've just
had a lot of dental work). If you're really not sure and don't like
the idea of a crown (I sure don't), I don't see anything wrong with
getting a second opinion. I found my current dentist looking for a
second opinion =)

I'd be interested in hearing some other experiences with this. Has
anyone else had the same symptom and ended up getting a crown? Should
I get a second opinion? Is it common for dentists to do unneccessary
work? I've always had really good teeth, so I mostly haven't had any
dental treatment beyond the usual cleanings and x-rays.

EvelynVogtGamble(Divamanque)...

If you don't trust the dentist, by all means get a second
opinion, but the diagnosis sounds reasonable. The only
"unnecessary" work I've heard of dentists promoting are the
ones who insist upon replacing all one's old-fashioned alloy
"silver" fillings with more modern materials. (Their excuse
is that the old ones contain mercury, but I figure if I've
lived with them for so many years, the "danger" is minimal,
so I'll wait until they need crowns.)

ladyjane...

Actually, my current dentist, (who I LOVE madly), did just that -
replaced all of my silver fillings with bonded ones. The only
silver filling I have left is the old one under the crown, and he
didn't want to disturb that when it was replaced.

Anyway...when I first went to him for a checkup, he showed me how
several of my silver fillings were starting to crack the teeth, so
we replaced all of those. Then he put in a couple of new ones, and
finally we replaced the final 2 silver fillings just in case.
Over a 2 years period, it cost me almost $2000 on top of insurance
coverage, but that also included the night guard and the replaced
crown. To me, it was well worth the expense. He said that yes, the
mercury was dangerous, but fillings have so little mercury that it's
hardly noticeable. However, they do expand and contract, and WILL
crack the teeth. So you might want to slowly get them replaced, just
to avoid the crowns. Bonded fillings will hold your teeth together
better.

Now that I've changed jobs, and apartments, I still travel an hour
one way to go back to him. He's wonderful. Anyone live near
Baltimore, MD? I have a dentist to recommend!

Jane
- owned and operated by Princess Rita

MaryL...

That sounds reasonable to me. I have several crowns, and the dentist first
made a temporary. The permanent crown was custom-made in a lab, and my
dentist is very particular (as yours should be!) about insisting that it
should fit exactly right. The fit and color are so good that I no longer
know which teeth have crowns -- I am completely unaware of them, and all
except one are several years old.

Monique Y. Mudama...

Oh, that reminds me -- the matching crowns are more expensive than the
gold ones, and tend not to be covered as well as the gold ones by
insurance. So it's more out of pocket. The gold ones also, I'm told,
are more durable because they don't chip the way the porcelain (?)
ones do. Anyway, I got gold for my rear molars, but a matched one for
the crown up front. I just wasn't ready to deal with having gold
flashing when I smile. But the gold ones all the way in the back
can't really be seen at all.

ladyjane...

Ah, I hadn't heard that. My initial thinking was "my teeth are naturally
yellow. I AM NOT going to pay $500 for a yellow-colored tooth!" So I got
gold. Besides, porcelin will crack, and gold won't. And gold is COOL-
looking. And, they were back teeth.

For what it's worth, one of those gold crowns, the first one actually,
is on a tooth that ached when I was 17. The decay had gotten down
below the nerve, and the current dentist had to dig by hand underneath
the nerve. AND, he couldn't numb the nerve because that would inhibit
the healing, yadda yadda....my whole face was numb, but he'd touch the
nerve and I'd jump across the room....over and over. But he saved the
tooth AND the nerve. The 'temporary' crown lasted a year. The gold
crown lasted almost 30 years, and it's just been replaced. Same live
nerve, different crown. I have never regretted it.

You can see a flash of gold on both sides if I smile widely enough.

Jane
- owned and operated by Princess Rita

Check your insurance carefully to be sure that the procedure will be
covered. Some dental insurance has a "waiting period" of one or even two
years for procedures such as crowns and root canals.

Monique Y. Mudama...

Ugh! You have got to be kidding! *spits on nasty insurance
companies*

I'm 51, and apparently I do grind my teeth in my sleep, so I guess
it's not that surprising that I would be starting to have problems
like this.

Experiences, suggestions, etc, are welcome!

CatNipped...

I had that exact same situation - but they told me I needed a root canal
first (to take out the nerve). That cost just a little less than the crown.
Didn't they tell you that it would be necessary first?

ladyjane...

All of my crowns are on LIVE teeth. One dentist told me, long ago, that
root canals are not necessary unless the root is actually infected.
Since then, I have fought tooth and nail (so to speak) to avoid any and
all root canals, believing that most of them are unnecessary, and so
far it's holding. I haven't lost a nerve yet.

Like my father used to say, 'Sometimes you really need the procedure,
and sometimes the dentist just needs to fund his latest vacation.'.

Oddly enough, the dentist that told me about the root canals was one
of the worst dentists I've ever had. But he did that one good thing.

Jane
- owned and operated by Princess Rita

sriddles...

I have six crowns. Some of them were the product of root canals, but
some are to protect teeth that are just too fragile; one is cracked and
one has an extremely large filling. I really don't think your dentist
is recommending work that isn't necessary--you can tell yourself by the
sensitivity there's a nerve exposed that shouldn't be. Crowns are
expensive, but you probably won't ever have to worry about that tooth
again. A couple of mine are over 30 years old and I've never had a
problem with them.