dental crowns

[kaysixteen]

I have dental insurance, but like (apparently) most such plans, it really isn't very good, with it only covering routine (2x/yr) cleanings and exams (1x/yr).  Copays for any work that actually needs to be done are rather high, certainly much higher than corresponding copays for medical coverage in my health insurance (why the US continues to separate the two is rather, ahem, mystifying).  I have been on the coverage for 7 years, and the local dentist practice I use is fine (local site of a regional chain dental practice).   I did have one cavity c. 2018 which was filled competently.  On my most recent annual exam, three weeks ago, dentist told me I had two more cavities which needed to be filled, and which we did yesterday (seems to be fine, no problems).  But she also told me I need, or at least should get, a crown, and the practice is going to contact my insurance co to see what I would end up having to pay for it (as a comparison, it cost $86 copay for the two fillings).  I am certainly not going to authorize any crowns for which I cannot pay (but doc also mentioned yesterday that the cavities in the teeth she filled were very deep, she was going to do her best, but I might end up losing the teeth).  I confess I did not ask her on which tooth the crown is supposed to be put (though I can myself see some clear degradation of some of the surfaces of my teeth, I guess-- this has been there for several years and never has been mentioned as problematic by her before).   Question would thus be twofold: 1) anyone ever get one of these crowns, and 2) how would I know if it is essential, and what would happen if I declined?  I confess the wikipedia article does not make me clamour for this treatment.

[Parasaurolophus]

I've had two, due to nighttime grinding. I could tell they needed more than the usual work, but didn't have major pain or sensitivity.

[kaysixteen]

You are of course in Canada-- how is dental expense covered there?

[Wahoo Redux]

Be very careful with dead or cracked teeth.  I had a dental emergency while traveling once.  At first it hurt, but then that died down, and decided I would wait until we got home to have it fixed.  We were driving across perhaps 60% of the continent, so we had a way to go.  I looked in the rearview mirror and noticed that one side of my face was puffy.  My wife looked it up on her phone, which said "If you have an infected tooth and your face starts to swell, get to an ER immediately."  Apparently, the infection can easily travel through your sinuses and into the brain.  Fortunately we found a dentist which could see me the next morning and prescribe some antibiotics----but he had to numb me and cut open some of the soft tissue in the mouth to clean out the infection.  Not pleasant.  If you have a ruptured tooth the pain can be excruciating.  Get the crown if you can.

[clean]

1. You can wait.  The worst cases are a.  the tooth breaks, which may or may not hurt depending on the break, or you get an infection/the tooth dies.  (IF you notice that you are feeling pain with HEAT, that is a bad sign... lots are sensitive to cold, but with heat, the tooth is dying.)

You can also wait for the next year and add money to a medical savings account. The money will come from your paycheck and reduce your taxable income.  You can use that money to pay for the crown.  You do not need to wait, you can use the money as soon as your plan starts.  (It will start at the beginning of your year.  We are on a fiscal year, so ours restart in September, but if you are on a calendar year, you may start as soon as January).  You should contact HR to see if you have time to make that change. 

2.  I have a few crowns (at least 4).  One was probably not necessary. I had a cracked tooth and was warned that it could break.  However they never know how deep the cracks are.  After they reduced the tooth to make room for the crown, I asked, and the damage was less serious than thought but too late!.   The others included a tooth that had a major filling from my teens/20s that needed replaced and it was a large part of the tooth structure, and another 2 became sensitive to heat or gave major pain. 

Dental insurance never covers much.  I have a plan where IF I use a 'contract dentist' (who is part of the plan), then cleanings are free and there are significant savings on the other work.  My dentist was part of the plan, but reimbursements were so low, it wasnt worth their time.  There may be one dentist in town that takes the plan.   They do pay part of the cost of cleanings and other services.   I keep it because it does cover the annual cost of cleanings, and IF there is an issue, there is some offset.

However, as I mentioned, you can use the health care savings account, and I have used that to pay for most of it.  In fact I had a tooth die and got a root canal in May or so, but did the tooth prep and crown in September once the health care account became active. 

Sorry that you are having these problems.  Hopefully it will all work out quickly and inexpensively.

[Parasaurolophus]

You are of course in Canada-- how is dental expense covered there?

It isn't. It's shameful. The government did recently pass $500 of coverage for low-income families, which is a start.

I have some insurance through my employer. A crown costs more than my yearly coverage, however. And checkups alone are hella expensive here (four times what they were back east!).

[Morden]

I have multiple crowns (and yes, they are expensive, but they saved the teeth). My husband waited too long to get a crown; they couldn't save the tooth; the tooth pull didn't go well, and he wound up with a nasty abscess.

[Ruralguy]

The main reason for crowns being denied is that the policy explicitly states "no crowns."  This is very common for low level US policies. This is true even if a root canal is approved for taking care of the dying tooth.

They can also be denied if the dentist doesn't really state an explicit reason for them.

The medical savings accounts idea will of course only work if you have that as work place benefit.

I have one crown, put on after a root canal, and it wasn't covered.

[jimbogumbo]

Your employer may offer an HSA or an FSA. HSA's are more useful imo as the money can carry over forever. FSA's have to be spent in the calendar year or you lose the money. Either (if offered) may have an employer contribution as well as whatever you designate from your pay. As clean noted, they both are pretax contributions, and in my experience always well worth it. My dental never covered crowns at all, so I always made sure I did the max contribuTion in a year I needed one.

[Hegemony]

You could get a second opinion on whether you needed the crowns. My dentist was very convincing about mine, and much of the tooth had cracked off anyway. They are not painful to get, but it does take a while.

[kaysixteen]

Hmmm....

1) I have no visibly cracked teeth, and no inordinate pain.

2) I take it that crowns may become necessary when a cavity is deep enough that the dentist does not think a regular filling would work?

3) What exactly is the diff between the need for a crown and the need for a 'root canal', a procedure the dentist mentioned briefly the first time I saw her last month, at the regular annual exam?

4) I confess that my preference, for aesthetic/ personal reasons would to *not* get a metal crown, but rather a ceramic one, since the metal teeth looks downright thuggish...

[kaysixteen]

One more thing, wrt Canada and dental coverage, considering Canadians' general attitude towards national health insurance programs, etc, why has not dental coverage been added thereto?

[nebo113]

If you live in an area with a dental school, you might check with them.

[Morden]

One more thing, wrt Canada and dental coverage, considering Canadians' general attitude towards national health insurance programs, etc, why has not dental coverage been added thereto?

I suspect dental was seen as not essential--like eyeglasses, hearing aids, physical therapy, prescriptions (of course, many of these items are indeed essential). Many Canadians do have health insurance either with an employer or separately to help pay for these things, often on a co-pay basis. SO and I paid around $300C a month for 80% coverage.

[Parasaurolophus]

One more thing, wrt Canada and dental coverage, considering Canadians' general attitude towards national health insurance programs, etc, why has not dental coverage been added thereto?

I suspect dental was seen as not essential--like eyeglasses, hearing aids, physical therapy, prescriptions (of course, many of these items are indeed essential). Many Canadians do have health insurance either with an employer or separately to help pay for these things, often on a co-pay basis. SO and I paid around $300C a month for 80% coverage.

That, plus the same historical reasons that have seen dental (and eye) care separated from "medical" care and training in the US.

But also, the federal and provincial governments have been dropping the ball on healthcare funding for decades, and things are getting pretty worryingly bad now. There's been lots of outsourcing to the private sector, and it's only made things worse.