I recommend a crown or an onlay to lots of my patients. It’s one of the most common procedures we do and we do it very well if I say so myself. A crown is created by a lab and cemented over top of a patient’s existing tooth structure to restore form and function and to reinforce that patient’s tooth. They’re very predictable and work really well.
“How much does this wonderful service cost?” you might ask.
The answer is going to vary by geography but it’s typical for a crown to cost around $1000. A little less in some place, a lot more in others.
“A thousand bucks? You’ve got to be kidding me! That’s a lot of money for one tooth! Who do you think I am, Bill Gates?”
I hear you. $1000 is a lot of money. Who wouldn’t want to spend it on something else. Something fun like a phone, some shoes, a trip or whatever. But let’s take a look at that $1000.
Our office charges slightly less than that $1000, but the math is easier with $1000.
Most dental benefits companies will replace a crown after it’s been in the mouth 5 years. That is not typical, though. My experience tells me that crowns typically last 15 years or more if the patient has good oral hygiene, good saliva flow and has risk factors like dry mouth and high decay rate under control. Lets take 15 years as a reasonable lifespan for a crown.
Now be honest…what other things do you own that have lasted for 15 years? Is your car 15 years old? How about your phone? Your shoes? Bottom line, there’s almost nothing that you spend money on (sometimes a LOT of money on) that lasts as long as dentistry does in a healthy mouth.
A $1000 crown costs you $1000 on the day that you pay for it (or less if you are using a dental benefit…your mileage may vary).
If that crown lasts for 15 years, you’ve amortized your investment in that crown to $66.66 per year. So for $67 you’ve got a beautiful and functional tooth that you probably don’t have to give another thought.
Is $67/year a little too abstract for you? How about this. You’re talking about $5.55/month over 15 years for that crown. One less latte from Starbucks will give you pain-free beauty and function.
OK…let’s get stupid here. 18 cents per day. That crown is three nickels and three pennies per day for 15 years of chewing, smiling and not thinking about it. I’d say it’s worth it in spades.
It actually gets better, though. I’ve seen crowns last longer than 15 years. If you’re really good about taking care of your teeth and watching your diet there is no reason a crown cannot last longer. I’m not going to pretend that ever crown is problem free. To be honest, if we’re trying to restore a particularly broken down tooth, it’s tougher to get that predictability and longevity. Furthermore, some teeth require root canal treatment (again…the more beat up the tooth, the more likely this is). So I don’t want to oversimplify.
The point is to look beyond the price tag that you see in the office and think of the cost over the life of the crown. These restorations feel expensive on the front end, but if you look at the long run they’re a pretty great bet!
Did this make you feel thrifty? Did it make you want to invest in a new crown? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Last week I found myself in a spot that I don’t like to be in. A couple of times. I found myself preparing a crown on a tooth that was in much worse shape than I would like. One case was a new patient that I had just started treating. The other patient was one that had waited on treating the tooth until it broke. We had diagnosed an “incomplete fracture” on the tooth some months (years?) before and recommended a crown, but for whatever reason the patient had decided to wait. As I’ve discussed in the past, most dental problems don’t hurt until they’re a big problem.
Crowns or onlays are “indirect restorations.” Which means they are made indirectly from the tooth, by a lab. Direct restorations are made right on the tooth…most people would call these “fillings.” By the time a tooth is in need of an indirect restoration there has probably been a lot of tooth structure lost. Most of these teeth have been worked on before, often having had direct restorations placed. How do we know when a tooth is ready for an indirect restoration? There are a few signs I look for:
cracks: the way teeth are designed is interesting. The outer enamel layer is very brittle and it’s stuck to a deeper dentin layer that is slightly softer which surrounds the pulp (nerve, blood vessel and connective tissue) which is soft and gooey. This is some amazing structural design, but as you age and your teeth are filled, heated, cooled and used for biting…they can develop cracks. Sometimes the cracks are superficial, sometimes they are deep. The good news is that at Mead Family Dental we’re pretty good at finding them. The microscopes that we use throughout the whole office are great at helping us see fractures in teeth…often before they become a big problem.
wear spots: as you age, you wear your teeth. Some people wear their teeth significantly more than others. Just like tires, once you’ve worn your teeth down, they don’t fix themselves!
existing restorations that are failing: What do you mean my filling broke? It’s only been in there for 15 years! I wish every restoration I placed would last forever, but that’s not how it works. Ask yourself this question: has it ever seemed like you justbought a new set of tires and then you see that you actually got them 50,000 miles ago? Yeah…restorations in teeth seem kind of like that, too.
decay under an existing restoration: Your mouth is full of bacteria and your teeth are covered in biofilm…even if you’re a terrific brusher! Those bacteria are tiny and all it takes is a small leak in a filling or crown for them to sneak underneath and start multiplying. It happens to the best of fillings and crowns. Luckily, we can usually fix that decay so long as we are able to catch it early.
Your adult teeth have been functioning in your mouth since you were about 6 years old. They’ve been through a lot. Accidentally biting an olive pit, millions of hot—>cold and cold—>hot thermocyles (have you ever eaten ice cream while drinking coffee?) and hundreds of thousands of acid attacks. Frankly, teeth hold up amazingly well considering what we put them through. There’s no shame in having to reinforce what you were born with. In fact, I would suggest that it’s best to do this as soon as any of those signs start showing up.
Here’s the thing…the longer we let the problem go, the more difficult it is to fix. Ask any dentist and they’ll tell you. It’s much easier to save a tooth before it’s broken than after. Small cavities are much easier to deal with than big cavities. I’d much rather do an onlay on a tooth now than wait until it needs a root canal. I realize this sounds incredibly self serving for the guy who gets paid to fix your teeth to tell you that you should jump on things earlier than later. But remember, I’m a giant wuss when it comes to delivering bad news. I’d much rather place a really well fitting crown on a tooth with a healthy nerve and gums and solid bone to support it. The longer we wait on cracks, decay and failing restorations the worse the outcome is likely to be. No dentist wants to “make the save.” Teeth that have these problems are more difficult to clean up, more difficult to impression and more difficult for the lab to make an ideal restoration.
So, the moral of the story is…don’t wait! Often times I can make the save. But I’d much rather not have to!
Did this make you feel safe? Did it make you want to only eat soft and lukewarm things? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Contrary to what you hear from a LOT of dental marketing, heart disease isn’t caused by gum disease. It’s technically correct that gum disease and heart disease are correlated or “linked,” but there is currently no evidence that gum disease causes heart disease. Or stroke. Or other health problems.
Here’s the thing…a lot of these diseases have similar risk factors. For instance, if you are a smoker you are at greater risk for heart attack and stroke as well as gum disease (as well as countless other health problems). So the correlation between these maladies may have more to do with similar risk factors than the actual expression of the disease.
I’m not saying that treating gum disease is unimportant. It absolutely is important and worthwhile! Treating gum disease early and thoroughly (which includes teaching patients how to maintain their gums and teeth at home) could help patients avoid pain, infection, tooth loss and expensive dental work in the future. A few years ago I compared gum disease to one of my favorite comic book characters:
“So imagine this calculus on the surface of the roots of your tooth like a bunch of tiny slivers. Your innate immune system recognizes it as a bad guy, but cannot remove it. This makes the innate immune system mad. Kind of like when Bruce Banner gets mad. And the madder your innate immune system gets, the stronger the reaction it creates to try and remove this invader. It starts dumping the toxic chemicals it uses to kill bad bacteria and other bugs into the tissues supporting your teeth! These chemicals, along with toxins from the biofilm itself, start to break down the tissues that support your teeth. It’s kind of like you have an angry Hulk smashing around in your gum tissues, but he’s not able to get rid of the bad guys. And this makes him really angry! So instead, he starts attacking YOU!”
Essentially, gum disease is a combination of bacterial build up in your mouth and your immune system creating inflammation that breaks down the tissues supporting your teeth. Localized inflammation around the structures of the teeth causes the problem. Can this localized inflammation cause inflammation in the rest of your body?
The best answer at this point is, “maybe.” Ongoing research could indicate a more direct causative effect in the future. But for now, it’s not there. Even the American Heart Association agrees. The best way to prevent heart disease still continue to be:
quit smoking (and if you don’t smoke, don’t start!)
maintain a healthy weight
control your blood pressure
For the moment, treating gum disease isn’t on their list.
There are some dental professionals that try and use this “connection” between gum disease and “whole body health” as a scare tactic in order to promote treatment. Some even want to teach this technique to other dentists to help “fatten the bottom line” for dentists. Which is just perfect, right? As if dentists need something else to wreck our reputation as a profession.
Again, I want to stress to patients that treating gum disease is worthwhile in its own right. We’re interested in your overall health as well…that’s why we screen blood pressure and do a thorough medical history. But treating your dental needs is worthwhile without the baggage of unscientific claims and scare tactics.
Did this make you feel anxious? Do you feel holistic? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
It’s one of the most universal recommendations in all of public health: Floss daily to prevent gum disease and cavities.
Except there’s little proof that flossing works.
Apparently the federal government has been recommending flossing since 1979 in a Surgeon General’s report as well as the “Dieteary Guidelines for Americans.” However, anything that the federal government recommends is required to have an adequate evidence base to be considered.
It turns out that flossing hasn’t really been researched very much. In order for the federal government to recommend something it has to be able to point to a pretty serious body of research. Earlier this year the federal government removed it’s recommendation for flossing with little fanfare. After the AP requested the evidence the feds used to recommend flossing…they caved.
If you take a look at the research base, they’re right to have caved. The best studies on flossing that they have are not convincing. They kind of had to remove the recommendation to be consistent with their standards. I understand what they did and cannot fault them.
Here’s the thing…there will be no rush to research flossing. The research design would be difficult and expensive and I doubt that there is the will for it.
All this said…#Istandwithfloss.
I can hear what you’re thinking: “Mead, you claim to be interested in evidence and science! How can you possibly recommend flossing to patients if the federal government retracted their recommendation! The science says it’s no better than brushing alone!”
Let me explain myself.
Everyone’s teeth are covered with a layer of gunk called biofilm. It doesn’t matter how well you brush them and floss them, they’ve got biofilm on them. When dentists and hygienists accuse you of not taking care of your teeth they call this biofilm “plaque” and they get all bent out of shape that you have lots of it on your teeth. We’ve been instructing patients to do their very best to remove this plaque from their teeth for as long as we’ve been in the profession.
The goal is to remove as much of the biofilm as you can.
So you brush. And that can remove a lot of the biofilm. But there are places your toothbrush can’t get to. What is a person to do? The research says flossing doesn’t work.
So I guess you should just leave that gunk sitting in between your teeth, right?
Do me a quick favor. Grab a long piece of floss and wrap it around your fingers. Slide that floss in between a few pairs of teeth, wrap it in a “c-shape” and gently stroke up and down. Then take that floss out and take a good hard look at it. Is it clean as a whistle or does it have a bunch of gunk on it?
If you’re like virtually every patient I’ve seen, it will have a little gunk on it.
So why do #Istandwithfloss?
The problem is the research, not the flossing. Maybe the design of the studies hasn’t been adequate. That’s a huge problem in medical research. Often times we think we’re measuring one thing when we’re not measuring that at all. You’ll notice that the evidence hasn’t recommended against flossing either. Flossing has been an accepted recommendation by dentists and hygienists for so long that it is no longer a hotbed of research inquiry.
Getting back to what a dentist or hygienist should recommend to patients: if our goal is to remove as much biofilm from our teeth and gums as possible, flossing does that. I don’t actually need peer reviewed research to observe that.
There is a word that I really like. That word is “plausible.” Plausible is defined as:
(of an argument or statement) seeming reasonable or probable.
The idea that flossing helps remove biofilm, which in turn helps reduce a person’s risk for cavities and gum disease is plausible. An idea that is plausible, even if it doesn’t have tons of great evidence, is worth keeping around.
Flossing is not expensive nor is it risky. It observably removes biofilm from in between the teeth that brushing cannot always get. And even though our current level of evidence does not allow the federal government to recommend flossing, it is still likely a worthwhile effort.
That’s why #Istandwithfloss.
Did this make you feel plausible? Do you feel like flossing? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
I remember when Bubble Yum bubble gum came out. Wikipedia says it was in 1975 and that feels about right. I remember commercials with a puppet that was trying to steal a kid’s Bubble Yum.
I also remember the gum itself. It was the first “soft chewing” gum in memory. Before Bubble Yum, it was either sticks like Trident or rock hard little nubs like Bazooka. Bubble Yum made chewing gum more fun. It also had a ton of sugar in it. So much you could feel the little grains of sugar as you bit into it. It was glorious, but it promoted tooth decay. The rare times we were allowed candy (yep, my dad was a dentist) I usually chose grape Bubble Yum. It was one of the flavors that defined my childhood!
Fast forward about 40 years. My diet includes things that cause tooth decay. The saliva in my mouth is a natural defense mechanism of my teeth. Healthy levels of saliva can keep the acid that causes cavities in check.
I’m not alone. I see lots of patients with decay problems. They have sugary diets, too. And many of them have a dry mouth as well. Any time a person takes more than one medication (which is very common) there is a high likelihood that their medications has induced dry mouth.
Dentistry has done a terrible job with dry mouth. We see it all the time. We can explain to our patients why they might experience it. But we don’t have much in the way of treatment for it. We can offer dry mouth rinses and toothpastes, but my patients that have tried them overwhelmingly feel like they don’t work very well. I don’t recommend that patients change their medications to treat blood pressure, depression or anything else. So mostly people just live with dry mouth.
I’ve found a solution that takes me back to my childhood. No, it’s not grape Bubble Yum. But it tastes and chews almost exactly the same. I’m here to tell you that Arctic Grape Ice Cubes gum is my suggestion for dry mouth. It’s as close to a perfect solution for dry mouth as I could invent.
It’s delicious. It tastes identical to the Bubble Yum I remember from the 70’s. Right down to the little grains of sugar. Except that it’s actually sugarless.
It really increases your saliva. Pop a couple of pieces in to chew and your mouth becomes flooded. It’s nothing short of amazing!
It’s sugarless. So even though it tastes really good, it won’t promote tooth decay. In fact, it’s flavored with xylitol which is known to inhibit acid production by the bacteria in your mouth in high doses. The amount of xylitol in this gum isn’t clinically proven to do that, but it’s still better than using sugar to sweeten the gum.
The best treatment I’ve found for dry mouth takes me back to my childhood. How cool is that?
Did this make you feel juicy? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.