Advice needed rel quickly!

[jokingaside]

Hi,

The topic's a bit misleading, in that, my question is more about costs and covers a great deal of "topics"

I'm living in Korea atm, in need to treatment, and deciding between two clinics-
After radiological and photographical imaging, one quoted roughly $1500-1600 worth of work, encompassing 2 inlays (fillings, I assume), one implant, 2 crowns (pushing gold; $350-400 per crown), 3 scalings (smoker here), and 2 upper wisdom teeth extractions.

The other clinic, with only radiological imaging, didn't supply me with a full quote (didn't think to ask that day, arg), saying I needed 1 wisdom tooth extraction (the other, since impacted but attached or blocked by bone, would require breaking what I assume would be zygomatic bone), 2 crowns ($400-500 per crown (porcelain v. gold)+$100 so already $1000), mentioned possible work with inlays (fillings I assume), and mentioned no implants. This clinic also mentioned possible diseased regions up above the gum line which the first clinic didn't mention. This clinic also mentioned nothing about scaling nor implant

While I'd like to save some cash, I'd rather spend the money if it'll save me in the long run. Rather, from this description, which clinic would you trust?

Additionally, which material for a crown would you personally do (gold v. porcelain+metal) ?
The major work's for 6-7 if it helps (crowns are for the upper 6s; at least there'd be symmetry)

Thanks in advance sooo much. I know I've needed this for a while, but cost has been prohibitive until now.

[Jerome Tsang, DDS]

Well, I would definitely go with the clinic that you feel most comfortable with.  You don't have to accept the complete treatment plan as presented.  You can say you want the inlays and crowns done and say you'll think about the implant, etc.  

Most of the treatment do cross over in terms of what they recommend.  I would say if you're not completely sure, just do the treatment that both clinics recommend at this time.  That would mean removing one wisdom tooth, getting the crowns and inlays done and the cleaning.  It doesn't matter which side you start if you get it all done quickly.  

It does seem that the first clinic (A) did a better report and treatment plan presentation for you and you do seem less confused.

[jokingaside]

PS While there are a glut of negative reviews on dental work in Korea, there are also an equivalent number of positive reviews.

[jokingaside]

Thanks for the quick answer, Dr. Tsang.

One reason I seek advice is precisely because one place mentions an implant while another doesn't. There's a frightening glut of stories about A) botched procedures and B) clinics that advice treatment that others consider unnecessary. Additionally, the techs were the ones who quote me the price and necessary procedures.

Well, if  rough description would help (I saw both the X-ray and photo pictures)...using palmer notation, teeth 6 on the upper left and right definitely need a root canal and a crown. The central portion of my upper right has decayed to the point where I can touch the gum line (with a instrument) and my upper left has visibly decayed by roughly 30%.

Both recommended extraction for my upper wisdom tooth. Clinic A advised extraction for my upper right, while Clinic B advised against (until it became problem) since, on the x-ray, the root was contiguous with my zygomatic bone. The doc. from Clinic B said that it would require "breaking." The photo-picture shows some sign of decay (yellow, a few black spots). [upper left- not impacted; upper right- impacted]

Lower molars 6 (bilat.) showed cavities and Clinic A recommended inlays. The photo-picture I saw showed a slight recess with hairline pockets of decay (black matter). Clinic B mentioned some work, but was unspecific.

The photo-pictures for upper molars 7 and lower right 7 showed brown spots, the accompanying notation reads "Restu" which I assume means scaling. (The tech from clinic A mentioned scaling)

Clinic A recommended an implant for lower right 7 (This part confused me)

Clinic B also mentioned signs of disease in my upper left zygomatic area (indicated by dark spots on the X-ray) [This may be incidental/is guesswork, but my upper left sinus is often stuffy. Maybe there's a connection?]

The last bit is that Clinic A recommended I work on my left side first (with the visibly decayed tooth) to prevent further decay, while Clinic B recommended working on the right side, due to upper molar 7's (R) still functioning nerve (relief from/prevention of potential pain) [My upper left has lost function, it seems; I don't feel pain in that area]

While I understand that my limited knowledge of the terminology and the admittedly shoddy description of the imaging prevents accurate visualization and while I understand that this isn't medical advice in the stricter sense, I need your opinion on who I should trust with 1)the amount of work needed and 2)the actual work. (Basically, who would you trust? Considering price and quality)

Summary-

Clinic A: 2 crowns (upper 6,6); inlays (lower 6,6); "restu"[scaling?] (upper 7,7, lower right 7); bilat wisdom teeth extractions; implant (lower R 7). Left side first. Cost $1500-1700 (Crowns- $800-1000)

Clinic B: 2 crowns (upper 6,6); possible inlays (?); unilat. wisdom tooth extraction (upper left). Potentially other procedures (Crowns- $1000-1100)

[Jerome Tsang, DDS]

Sorry.  Kind of hard to tell because I can't see the teeth or the x-rays and so giving specific advice on treatment can be kind of hard.  I will say that a full gold crown is definitely the best restorative material.  It is proven to last the longest and has the best wear characteristics of any material we use in dentistry.  It polishes nice too.  The only problem with gold is that its expensive and that its not cosmetic because its gold, not white.  

Inlays are fine and are probably better than your typical filling.  

Not sure why one mentioned an implant and the other didn't.  An implant replaces a missing tooth.  How one can see it and how doesn't even mention a missing tooth confuses me a little.