Expert: Mark Bornfeld DDS - 7/19/2005

Question
I have a gold crown on a back molar and my dentist says it has a hole on the top and must be replaced.  I would like a crown that will last the longest. this crown has lasted 25 years. He want to replace it with a gold and porcelain on top. Will that last very long or should I just get a gold one. It will cost $1078. is that a high price.  I live in Bergen county nj. thanks

Answer
Dear Ms. Robinson,

There are many factors that can contribute or detract from the life span of a crown, and the material of composition is but one. Gold is a wonderful material, and dentists and laboratory technicians have the most experience with this material. It is easy to work with, and has physical properties that make it an appropriate material where its appearance does not present a cosmetic liability. The one caveat is that gold is not the best material to use if the tooth against which it will chew has a crown or other restoration composed of porcelain. In this situation, the gold will abrade rapidly, because porcelain is significantly harder than gold. This may be a real consideration, given that your current crown has developed a perforation.

Porcelain fused to gold restorations are quite good, and assuming they are well made, will have a life span comparable to that of a full cast gold crown. Although porcelain does add a slight fragility factor, modern ceramics will bear up well against the rigors of most functional chewing.

As for price-- the fees for dental services vary significantly from place to place, and may be influenced by the general economic level in the vicinity. Bergen County NJ is one of those areas where there are both upscale and working class neighborhoods, and the fee you cite would be considered excessive in some areas and appropriate in others, assuming the quoted fee does not include any other services with the crown. I'm sure that you could easily find a lower fee, although I question the wisdom of shopping around using cost as the only criterion. Lower fees often reflect some cost-cutting measures, and some of them may negatively impact on the quality of service. For more relevant information, you might consider speaking with your neighbors, family, and acquaintances for a basis of comparison between your dentist and theirs; this can provide a more meaningful idea of where your dentist stands as far as quality and price in your community.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY