I went to the dentist for a check up a few days ago (one of those big dental chains with lots of foreign dentists offering NHS treatments). There were no problems with my (few remaining) teeth but after taking several x-rays the dentist announce that two of my crowns had ‘insufficient margins’ and had to be replaced (for a lot of money of course).

When I queried why there was a fair bit of evasiveness so I offered the suggestion that perhaps they weren’t seated properly – ‘they’re not seated properly I was then told’ and they also offered the suggestion that they were opaque and the dentist couldn’t see what was going on inside (presumably opaque to x-rays).

Now the thing is, they crowns in question were fitted ages ago (12-15 years ago I suspect) and so have been in place all the years I’ve been with the current practice; they’ve been examined, poked and x-rayed before without comment and continue to give me sterling service and no problems at all (unlike a crown I had fitted at my current practice which went rotten internally resulting in an abscess and the loss of the tooth).

I wasn’t actually asked whether I wanted the crowns replaced, the paperwork was just filled out and I was told to pay in advance for the treatment; I think I caused a degree of upset by saying that I needed to think about it.

So, crowns that suddenly have ‘insufficient margins’ – something I need to worry about or are they just after my money?

They’re dentists, of course they’re after your money.

Current wife is a dental nurse and reciting this to me to type !!
Crowns don’t last forever. The internals of the crown are metal, to give strength and then porcelain on top, so the x rays will not show the whole tooth. The only way to see inside is to remove the crown. Her advice is, if you are unsure seek an alternate dentist for confirmation of work. If you feel you are pressurised into the dental work, there is a government help place ( she cant remember) to which you can complain.You can complain to the practice manager as well.
In the future you may get problems, as a crown will only last usually up to 15 years. A second opinion is where she thinks would be best to head.

Presumably this is an NHS practice? How much is the total estimate/bill they have quoted you? I know what it should be, and I bet it won’t be that.I’ dbe very interested to know.
Nothing we replace your damaged teeth with will last forever, but if you have been attending regularly, and these crowns have been fine until now, what do you reckon the chances are they they have both failed now at the same time? I’m betting these are two almost adjacent teeth.

To be fair though, if you’ve been to an NHS practice and had any x-rays done at all, you’ve done better than most! When did you last have any x-rays done? typically every 2-3 years ( based on several assumptions from what you’ve described)

I wasn’t actually asked whether I wanted the crowns replaced

That’s not a great start. Crowns don’t last forever, but if they’ve been there that long, it’s a brave clinician that starts messing about with them. If they’re not giving you any hassle then I’d be asking my dentists for justification; margins or not…

You’re free to refuse the treatment.

For what it’s worth, I recently had 2 crowns done privately at a local dentist (rather than the chain outfit similar to the one you mention), and it didn’t cost much more.
The service was very good, instead of feeling like I was on a conveyor belt. And the inner bit of the crown is made of some zirconia stuff called Lava, and should hold out better than old style metal ones.
Worth a call around for quotes IMO.

Change dentist.

My wife and I had no fillings until our late 20’s and my checkups consisted of a a good prod and scrape round with the spikey thing plus x rays. Then our dentist changed, the next checkup was basically a quick look and the xrays. First check with the new dentist, we both needed a filling.

This year, I asked about a tooth that had gone a bit grey, told me I needed another filling. So I went to another Dentist and she prodded about and said it was just a fissure in the top of the tooth and nothing to worry about.

I’ve got a mouth full of crowns c 15 years old and there’s bugger all wrong with any of them. I do have receding gums though.

Can any of you ‘experts’ explain what insufficient margins actually means?

Insufficient profit margins from you to date, perhaps?

Sounds like when I took my Passat to the dealer to get a small repair and the receptionist told me the discs were worn and needed replacing. At 35,000 miles? I told her I’d pass on that one. It will be interesting to see if they flag it up at the big service next week.

Cheers for the thoughts although I’m still not clear what ‘insufficient margins’ means. I can’t quite make out from the writing on the form whether it’s £214 or £274 but I’ve just spotted another charge for £49 to see the hygienist (this wasn’t mentioned at all the, and practice only has a private hygienist); I was told that the crowns would be £400 each paying privately. I don’t suppose that the dentists themselves are on commission; it does all feel a bit odd!

It’ll be £214 as a band 3 NHS treatment. Insufficient margins means there’s not enough material to make the thing secure.

Sounds like a dentist chasing his targets; welcome to the wonderful world of UDA delivery

I don’t suppose that the dentists themselves are on commission;

on the private treatment they almost certainly are, that is the norm.

As regards the “insufficient margins”, that specific term means nothing I’m afraid, and may be the result of a dentist for whom English is not their first language? ( though you would expect them to be proficient enough to discuss their area of expertise properly!)

“Deficient” margins though, would refer to the joint at the edge of the crown where it should seal against the tooth not being as well sealed as it should be, typically leaving a gap for bacteria to get into and potentially cause mayhem ( and not the Pat Adams kind!.
Alternatively it may be because the edges of the crowns stick out beyond the edge of the tooth, creating an overhang that cannot be cleaned properly, again leading to problems.
This may be for many reasons, either relating to the original provision/manufacture and or fitting, or due to decay or wear problems afterwards, or a combination of both. A deficient margin may increase your risk of, lead directly to, or be a result of, tooth decay under the crown causing damage to the core of tooth and or root that supports it. However, many teeth have crowns that are not just “deficient” but downright ruddy awful and survive for many many years with no issues despite this because the patient has maintained the teeth very well. By this i mean EXCELLENT cleaning, GOOD diet ( no snacking or other sources of regular carbs that cause decay, eg beer/lager/pop/energy drinks!). Conversely many excellent crowns are wrecked by patients in short order by poor oral hygiene and poor diet.

What you could do with knowing is exactly what type of “insufficiency” these crowns have: How long have they been like this, is it causing a problem now, or is it just less than ideal but free from active disease ( tooth or gum).

Sounds like you need a further chat with our dentist, as you are not really sure about the why and the how of treatment that they are suggesting to you. Are the crowns just less than ideal but in teh same cndiiton they were when they were fitted, or is there active disease?
What is the prognosis of these teeth if they have active disease for this further treatment? What preventve measures have they recomended to reduce improve the lifespan of the future crowns?
Without fully understanding both the nature of and the reasons for the treatment proposed you cannot give “informed consent”, and as such treatment should not go ahead. You should be able to see your dentist again….give them a call and say you want a chat. See how that goes but consider a second opinion.

Hope this helps,
let us know if you have any further questions.

You say a hygienist visit was also quoted, which you understand to be private. Was this made clear to you at the time, or on treatment estimate? Any course of care that mixes NHS and private care must be explicit in its clarity showing which is which.

Drillski +1

Sounds like you definitely need to go and have another chat with your dentist. I agree that what ur dentist is most likely trying to say is that the crown margins are deficient. However this does not necessarily mean they need replacing. Ask some questions as to why they need replacing? What effect is their deficient margins having? If you are able to maintain the crowns properly and have done so for a number of years then they may not need replacing at all. Also ask about ur private hygiene visit. If you need any periodontal (gum) treatment then this is also included in ur band 3 £214, as is any other treatment that you may require to make you dentally healthy.
Where are you based if you don’t mind me asking?

Ah… someone who knows what they are talking about. Thanks for the explanation Drillski.

Thanks for the information; I’m down in Somerset. My practice doesn’t have an NHS hygienist so there’s an extra charge on top of the £214 for the NHS treatment; I’m afraid that I’ve never visited their hygienist for this reason. I’m a bit annoyed that the hygienist wasn’t even mentioned and yet a charge was added to the charge for treatment I hadn’t agreed to!

The crowns themselves aren’t giving me any trouble but one of the teeth does have a receding gum problem due to the molar behind it having been removed, and can be a bit sensitive below the crown; I daresay I’ll have them changed at some point.

The sensitivity adjacent to a missing tooth is common, and a nuisance, but may well not be improved by replacing the crown. Treatment with topical fluorides and other desenitisers may also help. Avoid very abrasive toothpastes such as Colgate total Whitening, see the is article on relative abrasiveness of toothpastes (RDA) ie how much they wear your teeth while you are cleaning!
http://www.swissdent.com.au/press/dental-articles/comparing-different-toothpaste-brands-and-their-abrasion-levels/

regarding the hygienist – ask if your gum health means you need to see her/him, or whether it is purely cosmetic. If it purely cosmetic then its a private issue. If its clinically needed or preventativethen it MUST be provided under the NHS, as part of the same course.

Sadly the wider NHS just doesn’t give a flying fig about all this though, so you’ve basically got bob hope of seeing a hygienist, or getting any gum treatment under the NHS. NHS dentistry has small pockets of excellence,( and they’re getting ever smaller!) but generally the basic level of care provided is poor, at best.

But because the publics main fear at a dentist is overtreatment[b], the MASSIVE, absolutely HUGE amount of undertreatment and supervised neglect going on in UK dentistry over the last 7 years is going unnoticed. After all, who ever argues because the dentist says you don’t need treatment? Unnoticed that is until you look at the number of teeth now being extracted and plastic partial dentures provided that is.
Ironically this is heralded by the governements Chief Dental officer as “an increase insimpler, less complex treatment that requires less maintainance”. Nice spin until you’re the one taking your teeth out at night.

Look after your teeth and oral health boys and girls, because the days of the state looking after you are behind you, I’m very sorry to say.

Whilst there are dentists around…

I had crowns added to my main top front teeth when I was 18 (I forgot to wheelie up a curb as a kid and snapped the ends off, it took that long before the tooth wallah would put crowns in after breaking some tile things).

Now 20 years later both the roots have died (got treated) and one of my gums is receding a bit leaving an slightly obvious black line, but everything appears to be working fine, no pain/looseness etc but I’m getting worried reading the above that my crowns are living on borrowed time – What’s the private cost of getting replacements?

I guess I should go get them checked out (not being to a dentist for 12+ years)…

hi Saccades

Ideally you should be getting an oral health check at least annually, if for no other reason than to check the lining of your mouth for unhealthy or abnormal pathology, which is largely a check for Oral Cancer and its cousins.

Gums recede with age naturally, this is so that humans “in the wild” would still have some tooth left sticking out to chew with when they had worn down what they started with, giving them a few years more before they starved to death. Most herbivores ( homo sapiens is most closely descended from herbivores than carnivores: though of course, with the notable exception of MTQGraham, we are now omnivores) lifespans are largely dictated by the lifespan of their dentition, foremost amongst other things.
If you don’t have alot of wear, and as a result vertical loss of tooth length, this gum recession occurs anyway, making you literally “long in the tooth”.
You won’t normally notice this that much as its so gradual, ( like the gradual expansion of that bald spot on the back of your head until it suddenly crests the horizon of your crown when you look in the mirror one day and…….but enough about…… errr….. my friend), unless that is there is a visible fixed reference point, like the point where a crown finishes and the rest/root of the tooth begins. If it has “died” and been “root filled” , quite often the root would go quite dark, and almost black with some of the older style root filling materials/techniques, making the contrast between the crown and root very striking and unaesthetic. On occasions this can be improved by using a white filling at the joint to improve the appearance, but the improvement will usually be very limited at best and not worth it. Alternately you can replace the crown, extending the joint point to where the tooth emerges from the gum, the gingival crevice……. hang on a mo………YOU AT THE BACK…….YES YOU…….YES, I used the word “CREVICE” …….now calm down and stop sniggering…….

sorry about that…. where were we…. yes you can replace the crown.

But basically, dark borders beyond the edge of a crown, whilst unaesthetic, don’t necessarily mean your crowns are on the way out. Get yourself a check up though. Could save you alot of grief long term, and it sounds like you’ve already had your fair share in the past. Perhaps best to keep ahead of probs while you’re still having a good run?

This certainly doesn’t mean that you are looking at problems with your crowned teeth, but you should really get them checked at least annually, assuming the rest of your oral health is tickety boo, which of course if you haven’t had it check, you kinda don’t know.

For those folks searching for a new dentist by the way, I’m often asked if I can recommend an NHS dentist, sadly not in my area, and there are precious few private ones fo rthat matter that I’d happily see a friend attend, but a good tip is to look at teh reviews recieved on NHS Choices for any practice you are looking at attending. Though the mumbers of reviews is often quite low, for the practices in my area they seem to be a pretty accurate refelection of the type of experience you might expect. See NHS Choices and use teh postcode search for practices near you. Also tells you who is accepting NHS patients

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