Why good dentistry seems costly - How much should a crown cost?
Michael Radu, DDS, MS
Most patients don’t ask directly why dental fees are what they are. They usually express their perception of too high a fee by leaving the practice and not returning!
A couple of weeks ago, a young mother of two boys asked me a simple and straightforward question that most patients don't: “Doctor, why are crowns so expensive?”
Because I always try to be precise in my answers, I wanted to clarify if she was asking about crowns in general, or… my crowns. She smiled coyly and said she is just curious, in general. Understanding the underlying discussion, I told her that I would try to answer both implied questions.
What follows is my extrapolated, un-distilled answer.
First, why are crowns more expensive than fillings?
Fillings can be done when there is a cavity is relatively small in size and there is a lot of tooth structure left in place after removing soft caries (decayed tooth portion).
Fillings are done in one visit, usually in 15 to 30 minutes. There are no laboratory expenses; the dentist usually uses a composite soft material that is cured (hardened) with a blue light. Fillings wear and discolor in time, due to the properties of the composite material, so they may require replacement in time. The fees vary based on size, surfaces, and the position of the cavity, but are usually between $100-400.
Crowns are very different from fillings. A crown is indicated when the cavity destruction of the tooth is larger than 40-50%, or when a portion of the tooth is fractured off and there is not enough support for a filling. In other words, a filling fills a cavity, a crown restores a large missing portion of a tooth.
Crowns cover the whole tooth, making it stronger; crowns don’t wear and don’t discolor because the material is porcelain; crowns (usually) last much longer than fillings, 10 to 15 years, or even longer. Usually, it is the tooth itself that fails, and not the crown (hidden cavities below the crown margin on the root, infection of the nerve requiring a root canal treatment, fracture of the tooth at the gum level, or esthetic failure, because the gum has receded and the smile is unsightly).
Our crowns are fabricated with the CAD-CAM technique. This involves a crown designed with a computer from a digital model, then milled out of a block of porcelain, and then finished for esthetics by a technician. The result is a strong, precise fitting, and beautiful restoration for the patient.
Most crowns require two visits. One for preparation, impression, and fabrication of a temporary crown for the protection of the tooth while the permanent crown is created in the laboratory. The second appointment is needed to remove the temporary, fit, adjust, and cement the permanent crown.
The first appointment is 1-1.5 hours long, the second about half an hour long. The fees have to take in the account the multiple materials used (impression, provisionals, cements), the laboratory fee, and the considerable time involved – two visits totaling up to 2 hours and sometimes additional adjustments due to the bite changes that may occur.
Fees for crowns may vary between $1,000 – 1,500. Sometimes, when the tooth is heavily destroyed, an additional filling under the crown (called a build-up) is needed, which carries an additional fee.
In summary, crowns cost 3-5 times as much as fillings, because they require considerable more expense to the dentist, and they give the patient a stronger, longer lasting, more permanent and more esthetic restoration.
Second, let’s talk about my crowns. The concept starts with the diagnosis and goes on all the way to the warranty.
- Do you really need a crown, or can the tooth be restored with a filling?
- Is your bite right, or does it have to be adjusted before a good crown is doable?
- Is your gum healthy, to allow for a good impression and a strong foundation, or does it need a pretreatment before the crown is made?
- Do you need a build-up filling under the crown?
- Do you need a root canal treatment, or can the crown be fabricated without the cost and inconvenience of this additional treatment?
- Is the crown margin at the precise level on the tooth, or too shallow, or too deep under the gum?
- Are the contact points naturally designed so you don’t trap food?
- Is your crown made in China, or by master technicians using the latest technologies and materials?
- What guarantee or warranty do you have that if something isn’t right it will be taken care of?
And one more thing, a very personal aspect, do you hate the process and the team working on you, or do you have a pleasant (well, almost pleasant) experience and love the team?
Product vs. service…
The answers to the above questions are coming down to this: is a crown a product, or a service? Because, if it is a product, and a crown.. is a crown.. is a crown, then you can purchase it online, maybe on Amazon, or eBay, for the lowest price. If you think it is a service, then you try to find an office that delivers the service you want.
My team and I are trying to deliver the best service. Firstly, to you as a person, and secondly, for your tooth/teeth.
And yes, let’s face it, not all patients are the same, not all dentists are the same, not all crowns are the same…
At the end of my ‘sermon on crowns’, the young lady asked with a smile, “Michael, shall I pay you more than your normal fee?”
“No,” I said, “you should get a discount for allowing me to explain!”