dental crowns

[Wahoo Redux]

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...

You need to clear this up with your dentist.  Again, sometimes you can wait on these things, sometimes they can be bad.

The root canal clears out the dead nerve and blood vessels from inside a dead tooth.  Usually I think this comes from a very deep cavity which intrudes into the inner part of the tooth.  Because the nerve tissue is dead, your dead tooth may not hurt at all.  Often the dentist has to shave the tooth down to the roots because teeth walls are not not strong once the tooth has been damaged like this. The dentist will then fit a fake tooth over the root. 

This stuff is explained lots of places.  https://www.aae.org/patients/root-canal-treatment/what-is-a-root-canal/

I would urge you to act on this, but as others have said, sometimes you can wait.  Talk to your dentist.

On edit: I think all crowns are ceramic these days; they will even match your particular tooth color to your particular crown.

[clean]

an issue with big cavities is that something has to be put in there to fill the hole. In the olden days that was a metal filling that could expand or contract (giving different forces on the tooth) , outgas mercury, or allow leaks to come in on the sides, which could allow another cavity or infection in the root. 
Today, if you add the filling into the hole, the rest of the tooth has to support the filling material. The filling material is a different density than the rest of the tooth and with less original tooth structure, the tooth is more likely to break/split/splinter. 

Take care of your teeth.  lots of problems pop up when you dont have them.  There are issues with bone loss, preventing implants, digestion problems from less effectively chewed food, ... 

Im not a dental expert. I have some crowns and filling.  I have chewed through one bite guard already (because I m a grinder, especially at night) and #2 is well broken in!  I visit the dentist regularly so I think I am informed about my choices, but it never hurts to get a second opinion!

Remember, "Dont as a barber if you need a haircut".  Similarly, if you are not sure, ask a second dentist if a particular treatment is best or if there are other options available (which my be outside Dentist #1's expertise or preferences).

[mythbuster]

The one thing about waiting- you do NOT want to wait to the point that you need an emergency root canal! Mr. Buster needed one after a night of agony such as I have never seen. His tooth had cracked and I think there was infection in the root involved.

The other info that I will give you- ERs have no clue what to do if you are having a tooth issue. They did not know how to give him a Novocain shot and instead tried oral opiates- which don't work the right way for this type of pain. Hence the night of agony.

So have a thorough conversation with your dentist about the window of time you realistically have to make a decision.

[Wahoo Redux]

The one thing about waiting- you do NOT want to wait to the point that you need an emergency root canal! Mr. Buster needed one after a night of agony such as I have never seen. His tooth had cracked and I think there was infection in the root involved.

The other info that I will give you- ERs have no clue what to do if you are having a tooth issue. They did not know how to give him a Novocain shot and instead tried oral opiates- which don't work the right way for this type of pain. Hence the night of agony.

So have a thorough conversation with your dentist about the window of time you realistically have to make a decision.

Amen and double amen.

Treat this like a potentially serious health issue.

[kaysixteen]

So I got the letter from the dental ins co today, regarding coverage for the (only one) crown the dentist wants to do.   Total charge dentist wants is just over $1600, of which exactly bupkis is covered by insurance.   The bottom of the letter also indicates that, BTW, I have less than $400 worth of benefit eligibility for 2023.  So I am cogitatin' about various things related to this, in no particular order of arrangement:

1) I pay just over 21 bucks a month in premiums for the insurance, which only seems to provide me with those two cleanings and one exam/ x-ray per year (the two fillings I got last week I am charged an $86 copay for, though I have not seen a bill to see what if anything the ins did pay for there).  I am thus wondering, as real work such as a crown is not apparently covered at all, what exactly am I getting for my c. 250 bucks a year dental ins premiums?  IOW, if I stopped the insurance, and paid out of pocket for those two cleanings and one exam, I wonder whether I might even come out somewhat ahead for the year, seeing as I would certainly have to pay for any additional work the dentists said I needed (come to think on it some, since my dental coverage is subsidized on the state's Obamacare plan, I do not even know, offhand, how much the total premium the ins co is getting)-- anyone try doing something like this?

2) I have occasionally seen tv ads for dental insurance schemes that are bought directly from a company that does not offer benefits through such avenues as the Obamacare exchanges, and the ads make very impressive claims-- does anyone have experience with buying dental insurance like this?

3) I have also seen ads for chain dental practices offering new and uninsured patients free exams and x-rays, which of course suggests that, unless the dentist offering such an exam finds some needed work he can convince said uninsured patient to get and therefore pay for, he will earn nothing from such labors.  This is different from the tv personal injury lawyer who offers free consultations and then, if he takes your case, does so on contingency, guaranteeing you will pay nothing if you do not win-- in the dentist case, there would seem to be a great incentive for the dentist to say you needed to get expensive work x done, in hopes that you would feel compelled to shell out the bucks to do so, esp if financing schemes were made available, as many such ads suggest they would be.  IOW, how do you avoid such mortician-style high pressure upselling efforts?  I have had the annual exam with my current dentist, for which the insurance paid, so there is no prospect of its paying for any second opinions-- I am tempted to go to one of those 'free exam'-offering dentists and seeing what he would say, and if he agreed with my current one's suggestion of a needed crown (I do know the number of the tooth she wants to do it for, too), without my telling the new dentist beforehand, then I would of course ask him what he would charge for it, and see what happens.   

4) My current dentist takes my insurance, of course, but may not be in the insurance co's 'PPO Network', whatever exactly this means, but the claim denial letter helpfully offers the www site for the list of dentists who, being in this network, may charge less for the service.  I suppose I will look at this site, and see what develops (I have been with this dental practice for 7 years, with no complaints, but I would very much like a second opinion before shelling out big bucks I do not have, presumably only on a financing plan scheme). 

5) Again, I guess, I have to reiterate the plaintive wail-- why the hell is dental insurance like this, whereas regular health ins ain't?

[Kron3007]

One of my postdocs recently needed a bunch of dental work, but didn't have dental coverage yet.  It was cheaper for them to fly half way around the world to their Home country to get the work done there, so they did.

I also had a former supervisor who did a lot of work in Brazil.  They always had their dental work done there.  It was cheaper (and apparently good quality) even with their dental coverage.

Apparently dental work in N. America is a bit of a racket. 

Worth considering a trip!

[clean]

Definitely look to see if there is a nearby In Network dentist. 

As for foreign options, there is a Mexican town that specializes in dental work. It is just across the US border and many, many retirees will park their RVs on the US side and walk across to get extensive, inexpensive work done, and some of these dentists may even be US trained.  Im sure that a web search will find the city.

Dental and vision insurance are not really things that one should buy. For the insurance company to make money, they must collect more than they pay out (which is true of all businesses!).  However, these items are not generally items that will break one's budget.  Glasses can be paid for, and you get more choices of frames without the insurance!  Getting glasses wont cause major financial distress. 

Similarly, you are paying $21 a month.  A cleaning without insurance costs what?  Annual x-rays?  There isnt a lot of money left to apply toward paying for major treatment needs. 

You may very well be better off by self paying for your cleanings.  Consider going next year without it (If you have one, move the dental premium into your your health care savings account.  It wont pay any LESS than your current insurer is paying for the crown!!) 

[Parasaurolophus]

FWIW, here the checkup costs ~$300 (though it was $80 back east!), X-rays cost about $120, and a crown costs ~$1600. My insurance covers $1600 a year. Although they're being right dicks about the crown I got in March, which they haven't reimbursed yet for reasons I cannot fathom. They normally just accept the charge right up to the limit.

Incidentally, I just got new glasses. They cost $900, which is actually a fair sight cheaper than they have been in the past (usually ~$1200). But glasses are known to be a lot more expensive in Canada than the US. My insurance covered $750, which was nice, with no restrictions on frames, tinting, slimming, etc.

[Ruralguy]

Most basic dental plans ONLY cover 2 checkups (basically, a doctor examining your mouth) and annual x-rays, and that is it. They pay out a % on fillings, but you'll still be charged something (maybe $100 or so).
I honestly don't think any basic plans pay out ANYTHING else.

Dental surgery, I believe, is usually covered under medical, not basic dental, but that's ONLY the surgery, and not the crowns (for the case of a root canal).

Some employers or other providers will give you a premium dental option. The main feature is that it covers crowns, but of course it paid for by charging at least 100 more per month for the insurance, probably more in most areas.

[Kron3007]

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?

They are rolling out dental coverage for children and seniors with low income.  It is a far cry from any universal coverage, but it is a good start.  It is a shame that there are children across the country that dont have access to the dentist, although some of them may be happy about it....

[jimbogumbo]

See if Delta Dental is available in your state. Have had good luck with them, and in many states you can purchase directly from them.

[Wahoo Redux]

If you have a dental school within range, and you are willing to put yourself in the hands of a student, you might get the procedure greatly reduced or even free.

Aspen Dental also has a plan that covers cleanings and such and gives one reduced procedures.

https://aspendentalplan.com/

They lost money on me this year because of this plan. 

[simpleSimon]

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.

This is not the time to do your own research... or solicit advice from the internet.  Do as your dentist says.  If you do not have faith in your dentist then find another dentist.

[Wahoo Redux]

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.

No, no, do NOT go to Wikipedia for medical advice.  I think your questions have been answered here.  A bad tooth can be very painful and even dangerous. If you don't want to spend the money, you can opt to have the tooth pulled for probably a couple of hundred dollars, but don't ignore this like it is a skin blemish. 

[kaysixteen]

Random observations:

1) Err.... Delta Dental IS my dental ins co.

2) Lemme clarify a wee bit here-- I get that the dentist has *probably* not asked me to get a crown if she does not think it necessary that I do get it, but, like it or not, having ascertained that the ins will pay nothing towards it, the basic reality is that, well, I cannot afford this.   Not even in the ballpark of affordability pour moi.  Any financing schemes that the dental practice may offer me, moreover, would be also just unaffordable.   It is what it is.   A look-see around here in Rusty City, in any retail store or similar public place, further, will doubtless demonstrate that many adults here have not, ahem, seen a dentist in the 21st century, and that won't be changin' anytime soon.  It is sad to acknowledge that dental issues, those that apparently are real health issues, are apparently just not dealt with the way other health issues, covered by real medical insurance are, but it is what it is.