Expert: Tony Appleton BDS DPDS - 11/25/2008

Question
QUESTION: I have a large back tooth with a filling in it, my old dentist said i should have it crowned, he is now retired and my new dentist isn't willing to do any root treatment or to crown it and says i should just have it pulled out, i am confused.  Also, at the top of my gum above this tooth I have what feels like abscesses, why would one dentist recommend crowning and root treatment and one not?  The new dentist says crowning back upper teeth isn't a very successful process can you help?

ANSWER: Hi Alison

If there is an abscess on this tooth, then that would need sorting out by root treatment (if feasible) before having a crown fitted.  If root treatment is not practical or unlikely to work then there is no point in having a crown as it will fail.

Crowning back teeth is very successful, provided the underlying tooth is healthy enough.

Regards

Tony Appleton

---------- FOLLOW-UP ----------

QUESTION: Thanks for your reply.  My tooth is the 2nd back tooth at the top left hand side.  is there any reason why dentist would think would be unsuccessful.  Can I also ask you...I went back to this dentist after initial visit (when he gave me antibiotics) and was given more antibiotics, however as i had nothing else done on the day I have been invoiced for £9.55.  This is for issuing the prescription and the 15 min of time with the dentist, this has never happened before with any other dentist is this correct procedure? is there a governing body I can check this with? thank you very much. Mrs A Wilkie

ANSWER: Hi Alison

As I said - if there is infection (under the tooth) then that would need sorting out first, probably with root canal treatment, if feasible.  It may be that the dentist feels the tooth is not savable which is quite possible and depends on the condition of the tooth.

I don't know whether you are being seen on the NHS or privately, but it is perfectly reasonable to charge you both for the issue of a prescription and for a consultation i.e. the dentist's time.  Bear in mind that it costs between £120 and £200 per hour to run a single surgery - so if you were being charged the full pro-rata amount you would pay between £30 and £50 for a 15 minute appointment.

If you are an NHS patient the local PCT can help you with the fee structure.  If you are private then it is entirely up to the dentist what he charges, although I'm sure he will show you his fee scale if you ask.

Regards

Tony Appleton

---------- FOLLOW-UP ----------

QUESTION: Thank you for your swift reply!  my first dentist said it was feasible to crown the tooth, however that was before I had the pain and the possible abscess.  I am with a different NHS dentist now and i wish i had stayed with the first one.  I just feel that I am being passed from pillar to post, being told different info.  I wasn't aware that dentists have so many different views on matters.  Can you recommend a good dentist in my area, Erskine, Renfrewshire, Scotland  thank you, Mrs Wilkie

Answer
I'm afraid you will find that NHS dentists are very reluctant to perform root canal treatment - basically because they are paid a pittance to do it!

Had you had the crown originally then you would probably still have ended up with the abscess so the second dentist is correct when he won't crown the tooth - the abscess must be sorted out first.

I'm sorry but I am in Stratford upon Avon so don't know any dentists in your area.

Regards

Tony Appleton