Is this the normal procedure for a new cap replacement?

Oral and dental care
1

Went to the dentist last December 2015, was meant to re book to have a broken cap seen to on lower back tooth, the dentist at that time said i could choose from two options,have a complete new one put on or the area that was exsposed just filled in with white filling. 

Went back yesterday for a checkup and to ask again about this tooth but undecided so the young lady dentist not the same one i saw last time asked another dentist for his opinion, this one says need a proper replacement cap to ensure long lasting adaquet  cover up. xrays were taken to ensure no undelying decay, showed none. Next thing she is putting these what i can only described as a mould /plate into the bottom of my mouth with this blue stuff put in, she then put the whole thing in my mouth, pressed. waited for abiut 3 mins then removed, no problem, when she did the same thing in my top of mouth i couldnt help but gag to the point i couldnt stop and was near enough being sick  so she had to put me forward and remove it before it was set to the plate. So im sitting there, she asked am i ok, i say yes, She gave me a mirror so i could wipe my my lips and my chin free from what now was a blue crumbly powder drying on my face. I could still feel like a had a mouth full of something and presumed the rest was still left inside my mouth for a reason, i start to pick at blue bots on my teeth, its only then i realised that all the blue putty like stuff was setting in my mouth, then she says i can pull it out, by now starting to stick to my teeth as i felt a pulling sensation as i pulled it all out. 

She said i have to book in for January for a 1 1/2 hr session to prepare my tooth for the removal of old  broken cap, the tooth is already a root canal,  why is this needed and what will be done?  She also said ill have to go through the whole proccedure again of trying to get a moulding of the top of my mouth and gums, teeth?  I cant see why this is needed to just to place a new cap on the broken one, anyone have any answers please.  Also dont think i can go through the gagging thing again, its not going to be any easier second time round is, i was wondering why she said deep breaths and wriggle your toes now i know but all the deep breaths and  wriggling my toes wont take away the urge to throw up will it. 

Also i have to pay for most of this, £150,  get some help towards this but it said on their chart a white crown or cap, does cap or crown mean the same thing i dont know was £550!  The receptionist said our H1?  still covers us till 2020, i hjope she is right!  

Im going to be anxous now till January approaches, shoulsd i go back and hve another chat with the dentist do you think about my concerns, and what put me off was the other dentist was telling her how to do this, im worried she hasnt done this before 

Sue 

2

Hi Susan, Your dentist was taking a mould in order to prepare a porcelain crown. This is perfectly normal procedure when preparing a crown, so you don't need to be anxious about it.

You might, however, want to be a tiny bit angry with your dentist for insisting on the more expensive option of a full crown, when the tooth could have been just as easily (and durably) repaired with a simple white resin cap at less than half the cost.

I have the same problem - the last lower molar before my wisdom tooth broke off 20 years ago. Same story - no decay. First time round, the dentist glued on a mercury amalgam cap. This lasted 10 years before it came off, taking most of the remaining above-gum tooth with it. Second time round a different dentist did the same thing, but this time using white resin filling. This one lasted about seven years before it fell off.

Three years ago, went through the same thing again with yet another dentist. Still no decay in the tooth so he said it was safe to make another ad hoc resin cap, but advised fixing it with titanium screws as well as acrylic adhesive this time, which I agreed to. The insurance covered 85% of the costs of the procedure, as before, but not the titanium screws, for which I had to fork out €55 myself - equivalent to around 40 quid in those happy days. He was so confident it would hold he even gave me a written 10-year guarantee! He had me do something none of the others had. He's a big guy with a loud voice, and as soon as he'd put the resin in place he said to bite. I obediently bit once, but he kept shouting "Bite bite bite!" making me bite rapidly non-stop for a full minute. I only realised when looking in a mirror afterwards that this had formed the resin cap into the perfect replica of a real tooth.

I didn't have to have moulds taken on any of these occasions.

I haven't had the slightest problem with any of the three, apart from the fact two of them eventually fell off, but then no form of crown or cap lasts for ever anyway. Interestingly, a friend's niece was recently on a visit from the US. She's a dental technician. When I told her about this she was scandalised, said I should absolutely have had a porcelain crown, though she agreed that 7-10 years is good going for any kind of repair on a lower molar. (But then she's from a country where dentists habitually go for the most expensive option!) She asked to look at the tooth, and absolutely insisted it was a porcelain crown and I must have forgotten I'd had moulds taken etc. I assured her it wasn't. She kept looking at it, and finally agreed it was resin, said she'd never seen such perfect work done with resin!

I suspect you're tied in financially to having a porcelain crown, having had the moulds taken, but I'd advise trying to get out of it. See if you can find a dentist who's prepared to put on another acrylic cap, preferably with titanium screws to hold it in place. It'll cost a fraction of the price of a crown, won't require any moulds and should last a long time. Not for ever, of course, but neither will a pricey porcelain crown.

Good luck!

3

Hi Lily

Thanks for all that info, i must admit i think im to blame hear, it was me who said idealy id like a full white crown, think i thought crown and cap were the same thing but different wording,   Silly me. So if i opt for the cap then wont need any more moulds taken of my mouth, this correct, and cheaper! Just the dentist asked what would you like to have it it were down to you? i said if i could afford it a white crown, maybe i should have said a white cap then! THink i need to go back and sort this one out dont you. And they only managed to take the bottom mould anyway, not the top. 

Thanks

Sue 

4

Ah, that's good. Even though it's for a bottom tooth they still have to take moulds of both jaws to make a proper porcelain crown, so they haven't really started the procedure anyway.

I'm afraid some (though not all) UK dentists are quick to take advantage of semantics when it comes to nudging their patients into more expensive solutions. When you go back, I'd advise avoiding all mention of caps or crowns. Just say you'd like them to build it up with white resin and you don't want a mould taken. White resin is all they use these days anyway, since mercury amalgam has been discontinued. I can't say yet whether it's worth paying the extra for the titanium screws as it's only been three years, but the fact that my dentist was prepared to give me a guarantee of free replacement if the thing fell off in under 10 years suggests that they're a good idea.

Totally sympathise about the mould, btw. I lost a top front tooth 60 years ago and have had a denture ever since, which needs to be replaced or adjusted periodically. This always involves full moulds, of course, so I know how unpleasant it is!

5

Thanks Lily, think then i should get in touch and say i dont want the cap or crown but can they build it up with white resin instead,  Why wernt these alternatives given to me in first place.  I can put up with the discomfort of the moulds, its the gagging, dont see how its going to be any different next time, it wont, so we arnt going to get anywhere are we.  I never had to have moulds taken when i had the gold cap put on years ago.  Yes im in the UK. are you?

6

No, Belgium. Just about the best dental system in the world, but things can still go wrong. I've had a couple of bad experiences, albeit not associated with building up broken teeth or being less than honest about cheaper options.

Yes, I think it would be safest just to say "build up" and tell them you don't want any more moulds. I don't see how they could get round that one. As to why the alternatives weren't explained in the first place, as already mentioned, some British (and most American!) dentists are disinclined to offer the cheaper options unless the patient specifically asks for them. It always pays to do your research before you start.

Don't know how things work with gold teeth, but I'm guessing this was an incisor. Also a guess, but as most people's incisors overlap rather than meeting and therefore aren't involved in chewing (as opposed to biting) maybe it's less important to get the interface right.

7

Thank you again

Ill ring them on Monday and ask to speak to the dentist about alternative options which dont involve another moulding,