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.
A couple of days ago a friend was complaining to me that he had gotten something stuck between his teeth. He’d had lunch at a barbecue joint and wouldn’t you know it he had some brisket jammed between his molars. He was looking for a toothpick or a straw to get it out because it was kind of uncomfortable.
If you’ve ever suffered the same fate you’ll know what I’m talking about. It isn’t necessarily painful, but it’s a kind of persistent pressure that doesn’t really let up until you get whatever is jammed in there out. There are a lot of nerve endings in the gums and the tissues that support the teeth that tell you brain, “hey, something funny is going on here.”
So I whipped out the floss that I carry in my pocket and rescued him. It took him about to seconds to snap the offending piece of brisket out and he was good to go.
“I’m lucky you’re a dentist,” he said as if it’s a given that dentists don’t go anywhere without floss, a toothbrush and maybe a spare dental mirror for good measure. The reality is my dirty little secret.
In a perfect world, the contacts between your teeth are tight enough that normal chewing doesn’t wedge food between them. Too tight makes it so flossing to remove plaque and food debris is difficult or impossible, but too loose means food can become impacted. Food impaction is an inconvenience to be sure, but it can become a problem. A spot where food impacts is more prone to decay simply due to the fact that you cannot remove the debris. The bugs (and by bugs, I mean bacteria) that sit there will metabolize the sugars in the impacted food into acid. When the pH of that part of the mouth reaches a critical level (5.5 to be exact) then the enamel of your teeth will start to dissolve. The longer impacted gunk sits there, the greater the chances that the pH can drop into dangerous levels and cause cavities.
Impacted food can also cause gum problems. I’ve spoken with periodontists (gum specialists) that have removed popcorn kernels from gum abscesses. People with gum disease are more prone to food impaction because their teeth are slightly more mobile than those without bone loss around their teeth. The bottom line is that places where food gets impacted are at greater risk for cavities and gum disease.
Why do we have spots where food gets stuck? Well, some people have naturally loose contacts between their teeth. As I mentioned, people with gum disease are definitely more likely to get stuff stuck in their teeth. If you have a broken or badly decayed tooth they will often be a spot that holds food debris. Finally, dental restorations like fillings or crowns can have inadequate contacts and be a risk factor on their own.
How do we fix it? Well, if you have naturally loose contacts between your teeth I’m not going to “fix” them if they don’t have disease. Those folks need to be extra careful in their brushing and flossing habits. Contacts that are particularly annoying to a patient can usually be “closed” in a minimally invasive fashion if the patient chooses. But if the loose contact in question is caused by decay or worse, the tooth is broken, we better fix it pretty fast!
Dentists probably floss more often than regular folks, but there is no law that requires dentists to carry floss. I carry floss because I have two very loose contacts. Both of them are caused by restorations that have opened up over time. I need to get them fixed and I’ve been procrastinating. That’s my dirty little secret. It may surprise you that dentists are like other human beings…some of us put off treatment that’s necessary, too. But that’s no excuse! Let’s unite in our commitment to close open contacts! No more food impaction!
Did this make you feel ashamed? Do you feel differently about dentists? 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.
Everyone knows that tooth decay is caused by bacteria in your mouth. The bad bacteria eat the sugar that you ingest and poop out acid onto your teeth. This acid eats holes in your teeth and those holes are the cavities that dentists fix. That’s what we’re good at. Fixing cavities. We do it all day long.
Does your dentist just find cavities and fix them? Or does your dentist punch tooth decay right in the face? I do!
“Take that, tooth decay!”
How do it do it? I destroy that bad bacteria and support the good bacteria. It’s almost like the bacteria are those aliens from “The Avengers” and I’m like the Hulk. Or maybe the Captain America. Yeah. Probably more like Captain America.
But instead of a gamma ray enhanced strength or a shield made of vibranium, I use chemical warfare. Specifically, I use the Carifree system. Carifree is different than any other toothpaste, mouth rinse or dental hygiene tool I’ve ever seen. Carifree kills bad bacteria with a strong antimicrobial. But the products also treat the pH of your mouth, remineralize tooth structure that’s started to break down and even provide a source of Xylitol. All these different things contribute to a healthier, less decay-prone environment in your mouth.
Removing decay and fixing cavities is called the “surgical model.” When you have a filling it’s actually a micro surgery on your tooth. Treating the bacteria and the biofilm on the surface of your teeth and gums is sometimes called the “medical model” of tooth decay treatment. When you use a system like Carifree, it’s actually medicine to treat the bacteria on the surface of your teeth that cause decay. Most dentists aren’t familiar with this “medical model” and limit their treatment to surgical interventions. By adding the the medical model to a high risk patient, we can effectively limit how much “surgery” we need to do in the future.
Do you have new cavities each time you have your teeth cleaned? Are you tired of having to have cavities treated? Let us help you fix your tooth decay problem. Come see us and we’ll team up to punch tooth decay in the face!
Did you find this post heroic? Spine tingiling? 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.
If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! Especially ones that want to punch tooth decay in the face! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at firstname.lastname@example.org. I always answer my own emails!
If you have dental problems, it’s mostly your fault. And if you want to have less dental problems, it’s your responsibility. It’s not the fault of the dental insurance company. It’s not the government’s responsibility. It’s on you. What you eat and how well you take care of your teeth are decisions that you’re in charge of. And you’re in charge of these decisions for your kids. So, will you rise to the challenge?
“Wow, Doc. Kinda harsh.”
Maybe, but I recently saw a PBS Frontline special called “Dollars and Dentists.” Among other things, it accuses dentists of not doing enough to help poor kids with dental care. I’m hearing this more and more and it really irks me. Because 95% of all dental disease is completely preventable.
What I’m saying is that if you’ve never had a cavity, you can choose to keep that perfect record. If you have gingivitis, you can change that. If you’ve had dental troubles, you can stop the destruction and turn it around. And that goes for your children, too.
“Sure, doc. But, what’s the catch?”
There actually is a catch. If you get a lot of cavities or have gum disease it’s likely that your diet and lack of brushing/flossing have a lot to do with it. You see, tooth decay and gum disease are biofilm infections. Your teeth and anything else in your mouth (crowns, dentures, implants) are covered with a film of bacteria and bacterial products called a biofilm. How much of this biofilm (a.k.a: dental plaque) there is and how healthy it is has everything to do with how much decay and gum disease you experience.
“O.K. Doc, I get the “how much” part, but how can bacteria in my mouth be healthy?”
Once you become in charge of your own health, it’s time to step up. If you’ve been dealt the hand of tough mouth bugs, you’re responsible for changing them! Those who have already experienced dental troubles (cavities or gum disease) need to work even harder on their home care. The very fact that you’ve had dental problems lets us know that you have virulent (bad!) bugs. Brushing and flossing can reduce the number and location of these bugs on your teeth. But how do you change what kind of bugs you have?
Diet has a lot to do with the type of bugs that inhabit your mouth. If your mouth maintains a low pH (acid) for a long period of time, the kind of bugs that can tolerate that environment will become more numerous. What kinds of things keep a mouth acidy? Drinking pop. Specifically sipping pop slowly over a long period of time. Other habits like sucking on hard candies cause this, as well. Bathing teeth in a sugary, acidy environment will not only cause cavities but it creates an environment perfect for the nastier bugs. Changing your dietary habits can make a huge difference on the “environment” you create in your mouth. Reducing sweets, especially pop, as well as reducing how often a person snacks will go a long way to letting your natural defenses change the environment in your mouth. Chewing xylitol gum or mints can also change the kind of bugs you have in your mouth. Dentists can prescribe certain mouth rinses that can actually change the makeup of your biofilm over time as well.
Do it for him!
Your biofilm is your problem. Most people only see the dentist a few times per year. The choices you make on a day to day basis about diet and taking care of your teeth (or not) are the ones that really count. I can’t control what you or your kids eat. We can clean up your biofilm a couple times per year, but it will be back to the same the day after we clean your teeth. The choice is yours. So step up and take care of those teeth!
Did you find this post invigorating? Harsh? 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.
So there I sit, next to my patient. I’ve removed their temporary crown and am getting ready to place our beautiful new porcelain crown. It’s finely adjusted and exquisitely polished. We’re ready to rock and roll. Then…the question.
“Doc, how long is this crown going to last?”
“How long do you think it should last?” I ask.
“I don’t know. For as much as it costs, it should probably last forever!”
I’ve had some variation of this conversation many times before. I’m asking the patient to spend a bunch of time and money for the work I’m placing. Why shouldn’t it last forever? Or at least a really long time?
In a perfect world, the dentistry that I place will last forever. In this same perfect world, you wouldn’t have to change the oil in your car. Or replace your roof. Or change the filter in your furnace. Or mow your lawn.
Actually, that crown we just placed would love to switch places with your roof. The conditions that your roof has to put up with are a cake walk compared to your crown. A little snow, wind and rain and some gradual temperature changes? Pffffft. Nothing to it!
Let’s do the math.
Let’s say you chew each bite of food 10 times before you swallow it. (A very conservative estimate, but it makes the math easier) Then let’s say each meal you eat has about 20 bites.
You just used that crown 200 times while you ate lunch. Multiply that by 3 meals and you’re working on 600 times per day. If you don’t eat snacks. And don’t even get me started on chewing gum!
So yeah, you use your teeth for chewing a lot. But most restorations will handle everyday chewing pretty handily. Leaving out the unpopped popcorn and olive pits, chewing isn’t the real problem. The real problem is the environment that we’re placing this crown in.
Your new crown will have to tolerate temperatures ranging from 150-170 degrees F (hot coffee) to 20-30 degrees F (ice cream). Sometimes within seconds of each other.
Most crowns will have to tolerate acid attacks throughout the day.
Your crown will be almost constantly covered with bacterial biofilm that resists efforts at removal.
Many crowns will find that their owners grind their teeth throughout the night while they are sleeping.
Some crowns will need to resist bad habits of their owners like ice chewing and lemons sucking.
The bottom line is, the mouth is a pretty tough place for this beautiful new crown to have to survive!
What’s a realistic estimate for a crown or filling to hold up? The unsatisfying answer: it really depends. In a person who avoids sweets and sodas, who takes exquisite care of their mouth (brushing and flossing), who doesn’t take any medications that might dry their mouth, who doesn’t grind their teeth at night and sees a dentist regularly in an effort to catch problems while they’re still small…you could easily see a restoration last for 15-20 years or longer. Regular wear and tear, even in the most “low risk” patients will probably do in any dental work placed if you live long enough.
How can you make your dental work last as long as possible?
Brush 2-3x a day with a soft bristled brush and floss once a day.
Avoid sugary foods and reduce between meal snacking.
Keep up with regular dental appointments. At least twice a year and more if you have risk factors like taking medications or having conditions that create a dry mouth.
If you have problems, get to the dentist for treatment right away!
So, back to my conversation with my patient.
“Doc, how long is this crown going to last?”
“How long do you think it should last?” I ask.
“I don’t know. For as much as it costs, it should probably last forever!”
“The only way I know how to make this crown last for that long is to store it in box. In a really safe place.”
“Um. O.K. Let’s just put it on the tooth and I’ll try to take care of it.”
Did you like this post? Would you like to share it with friends? You can click on the heart shaped icon next to the title of this post and automatically share it on Facebook, Twitter or Google+! Or you can leave a comment by clicking the “ballon” shaped button next to the title. Or send me an email at email@example.com. I’m happy to answer any questions and appreciate your input! If your looking for a dentist in Saginaw, MI I’d like to help out!
…stop eating this way. Donuts for breakfast, fast food at lunch and extra helpings at dinner are really catching up with me. The doctor has told me for years that my diet is the reason that my cholesterol is so high and that I’m looking at dealing with type II diabetes as I get older…
…exercise more often. I haven’t been active on a regular basis for a long time. It’s embarrassing, but sometimes the stairs make me a little winded! I used to be on the track team when I was in high school. It would be a lot easier to lose this weight if I just added 30-40 minutes of walking or picked tennis back up…
…quit smoking. It’s not like I don’t know it’s bad for me. You can’t turn on the TV or listen to the radio without hearing some new study describing the health effects of smoking. I would love to not worry about my breath or the smell on my clothes anymore, too…
…floss every day. Every time I see my dental hygienist she reminds me that my gums are bleeding for a reason. I don’t like to have to see the dentist for fillings and bleeding gums can’t be normal. Maybe my breath would be better if I took a little better care…
O.K. Be honest. Has the little voice in the back of your mind ever said any of these things to you? Mine has. Usually when I’m going through the drive thru at Long John Silver’s. Clearly all of these things are important and as a health care professional I recommend that you take each one seriously if it applies to you. As a person, I’d like to point out that one of those items is quite a bit easier to add to your lifestyle. If you aren’t sure which one, read them again. If you still aren’t sure, remember that I’m a dentist and this blog talks a lot about teeth and dental care.
Here’s the deal. Get yourself some floss* and put it in the shower. When you’ve got the shampoo in your hair, rinse those fingers and pull out a nice long piece. Take a minute or two and floss those pearly whites. We’ve already determined that flossing is gross, but necessary. Since you’re in the shower, you can rinse your mouth and your hands as soon as you’re done! It’s a perfect solution, if I do say so myself.
Then, the next time that little voice in your head bugs you about what you really should do, you can remind it that you’ve already taken some positive steps!
Now, put down that donut and get to work!
*you can get free floss at our office. Call to make an appointment at (989) 799-9133 or email me at firstname.lastname@example.org. We’d be happy to have you!
So which comes first, the chicken or the egg? I’ve heard arguments from knowledgeable people for one or the other. So which is it?
The main argument for “floss first, then brush” is that flossing is nasty. It’s very important, but kind of gross. Even in the cleanest mouth, the bacteria that you find under your gum line (known as “anaerobes“) is pretty smelly. You get stuff on your hands, you get stuff on the mirror and in general, it’s messy. So if you floss first, then you can brush the nastiness away.
With that said, I’m a strong proponent of “brush first, then floss.” When you brush with toothpaste, you’re removing the bulk of the plaque on the teeth as well as placing fluoride on the teeth. This fluoride helps to remineralize spots on the teeth where cavities have started. However, you can’t really get your brush in the spots between teeth. This is where the flossing comes in. When you floss after you brush, you can force the topical fluoride left behind after brushing into the “in-between” spots. In this way, you’re getting the most benefit of the fluoride from your toothpaste.
So what’s the solution for the nastiness of flossing? My new favorite dental health product: ACT Total Care Mouthwash. I can see the headlines now: “Saginaw Dentist Shills for Big Pharma.” What I like about this stuff is that it tastes really good, like a mouthwash, but also delivers an “over the counter” dose of fluoride as well. There are probably other brands that have both a fresh, minty finish as well as fluoride, but I haven’t seen them yet.
So try both out. See what you think and let me know at email@example.com Honestly, if you’re one of the few people who floss each and every day, I don’t really care when you do it…just keep doing it!