My wife was at the hairdresser last week and overheard a conversation in the next chair between a stylist and client who was lamenting her self-diagnosed ‘soft teeth.’ She stated how unfair it was that her husband did not have the same affliction and, even worse, that there was nothing she could do about it since it was genetic.
My wife may not have graduated from dental school, but she has been around me long enough to pick up a few things, and has evidently adopted my inability to remain silent in the face of ludicrous statements. She put down her magazine and explained to her neighbors how this was incorrect (she may have said “absolute rubbish”) because teeth are hard due to the shiny layer of enamel. If teeth were soft like mashed potatoes, no one could chew anything tougher than toast.
The other myth assumes that people are helpless victims of dental genetics. Teeth are not like height, you did not inherit them from your grandfather (although you could inherit his underbite), but if you sucked your thumb, consume a lot of sugar and brush infrequently, chances are these voluntary behaviors will result in cavities and buck teeth. Fortunately, all of these issues can be easily resolved with the intervention of a dentist. And yes, I’m proud of her, she’s like my own personal dental missionary.
So How Long Is A Piece of String?
My wife is smart enough to know when she’s been asked to jump down a rabbit hole, after her monologue prompted two other stylists to tug their mouths open and ask for quotes on fillings and crowns on certain teeth. The owner of the local salon walked over saying, “Do you realize you’re asking her how much a filling is the way people call here asking how much a haircut is?”
Here’s the thing, you can’t commodify a health service when it’s a diagnostic and therapeutic act that must be customized to the individual needs of that mouth.
So questions like, “How Much is a Crown on a Back Tooth?,” are simply impossible to answer. It depends. Your tooth might not even need a crown or it might need a root canal and a crown. A diagnosis has to precede treatment, which means you can’t (and really shouldn’t) quote a fee until you know exactly what’s going on.
Think about it; my monthly haircut does not take as much time, technique, equipment and product as my wife’s with her long hair, layers and other very specific and detailed requests of her endlessly-patient stylist.
As a trained dentist, I can’t even tell you what kind of restoration is needed on an individual tooth by you just opening wide and pointing when you run into me halfway down the cereal aisle at Hannaford.
This is what makes x-rays such an essential tool in dentistry. If there is decay, radiographs indicate exactly where and how deep, which determines how “big” (or how many of the five surfaces of your tooth) need to be filled. Without that information, dentists would just be aimlessly (and unnecessarily) drilling away at healthy tooth.
Another thing to keep in mind is that anterior (front) teeth are smaller than posterior (back) teeth. The other variable (I know, so many, right?) is that there may not actually be enough tooth structure to support a filling, and I have to take into consideration the function of the tooth (biting and tearing bear a different load than the forces required of your back teeth).
So You Actually Need a Crown …
“Well, what kind do I need and how much is it going to cost me?”
As a dentist, it always comes down to what is best for the function and aesthetics for the individual. You don’t necessarily want a crown to be made out of the hardest material, because some people with certain bites (overbite/underbite) or those that clench or grind can wind up breaking or chipping their opposing natural teeth if they mash down too hard with their new bionic tooth.
In dentistry we have a diagnostic decision tree that dictates which kind of materials are used based on the tooth and it’s function. Generally the materials used in a crown are either; all porcelain (ceramic), gold alloy, base metal alloy, or porcelain fused to metal (meaning it’s a metal crown with a tooth colored porcelain coating).
- Ceramic crowns are a porcelain based filling material, ideal for anterior teeth due to a better color match cosmetic. This material can be brittle under the pressure of heavy biting forces, but it is resistant to wear.
- PFMs (porcelain fused to metal) provides a stronger and more durable restoration than just porcelain alone. These crowns are a great option anywhere in the mouth.
- Gold alloy crowns are made from gold, copper and other metals to provide a strong material to adhere to the tooth structure. These use ‘high noble’ or precious metals. It means the composition is over 60% noble metal (gold, palladium, and/or platinum) of which more than 40% must be gold. It is very resistant to wear and fracture and more importantly doesn’t damage opposing teeth. This material is also highly biocompatible with gum tissue. And although I generally don’t get too many requests for a gold front tooth, most people don’t mind having it in the back of their mouth.
- Base metal alloys contain non-noble metals or base metals. Their noble content is less than 25% and they contain large percentages of nickel, cobalt, chromium and/or beryllium. The advantages of these types of crowns are that they provide strength and are highly resistant to corrosion. They also do not easily wear and are gentle to opposing teeth.
There are some services that are easy to quote over the phone (oil changes), or with very concrete information (carpet cleaning by square footage in your house); however, health-related and/or cosmetic procedures (like crowns and certain haircuts) are dependent upon a number of variables and should be customized to that individual.
No two mouths are the same, so if you are interested in a customized treatment plan specific to yours, call the office at (207) 782-5308 or contact us online to schedule an appointment. Our lighting in the operatories is also way better than at the grocery store so we can give you a much better idea of what your options actually are and what those exact costs are going to be so that you can make an informed decision.
And if you do get a crown, just insist everyone start calling you “your majesty,”
Peter Drews, DDS, MAGD
