ceramic onlay vs crown

[VIRGOASH]

I've just completed a root canal and two crowns. To make a long story short my dentist decided to re-evaluate my teeth and diagnose me with more work. And there's no doubt in my mind that I probably need more work done, or there is more decay. I have maybe 7 very old fillings and an old crown. On my last visit my dentist told me I two cracked fillings that need crowns asap. I have already spent $2580.00. I get an estimate (out of pocket) of $180.00 for each crown. So I was prepared to start the treatment and a payment plan. Then all of a sudden, yesterday my bill goes up  to over $9000.00. Now she is telling me the two teeth that originally needed crowns need onlays. They run $795 each. I told her I couldn't afford that. I explained I was told initially that I needed crowns, (they are less expensive). She said its not what she recommends. Said she only recommends an onlay on the tooth and refused to do a crown. She made an exception for the other tooth and agreed she would do a crown. I felt at that point she only wants to make more money off me. Won't a crown fix the problem either way, despite what her recommendations are? These two teeth are not in any pain, no infections. She says she found "some" decay and a cracked filling. Do I have a choice in this decision that the dentist is making? Do I have to have an onlay over a crown? Isn't it my choice? Please tell me. I am ready to report this office to the better business bureau. Please let me know. Thank you.

[RB1967]

My second molar (upper) was RTC 10 years ago and no crown was fitted. The dentist was very ood and had said he would save as much structure as possible. A year after the RTC another dentist had drilled and filled in between the first molar and second molar. Now this filling has come off. When I showed this to the dentist here in UK he said the RTC tooth has cracked. I explained that the filling between the first and second molar has come off. I have no pain and the RTC tooth original filling is fine. Dentist is saying we should go for crown for the second molar. Not sure if that is best choice given that only the filing between first and second has come off. When asked which crown he suggested metal cown. I asked about gold crown , he said it is not necessory, why you want gold? Is it better to ask for gold onlay? What is the best material. It is covered under NHS , I did offer to pay private if that is better,are there any?
Not sure what should happen to first molar since the filling has come off that was between first and second molar, which actually never allowed me to floss.

[EMJAY99]

Hi Virgoash. I am dentist and I have read your posts - your dentist sounds like she is trying to minimise natural tooth loss in this process . While there are many cases where a crown is indicated (say there is more tooth lost than tooth left), it is not always the best solution.  Every case is different depending on your history, your bite, the position of the tooth etc.  BUT once you get a crown (which covers your whole tooth) it is challenging to do certain tests and to visualise any issues should you have pain in the future.  A crown is best when all other options have been considered and are unsuitable.  It is easier to do a crown than an onlay.  I would always consider an onlay before jumping to a crown.
I agree that dentists depending on their experience and continuing education training will advise different things.  She may even feel the original dentist was being to aggressive and excessive in suggesting crowns (but she is avoiding bad-mouthing him).  
Without looking at your particular case, and without knowing the dentist, I cant tell you the ideal path.  She is saying all the things I would if I saw certain cases as I too, find many dentists are too quick to suggest crowns without seeking more conservative options (BTW I have 1st class honors, have worked for 15+ yrs,  go to education courses several times a year and to me, integrity is everything)
In the end, when you go to an educated and experienced practitioner, you never know as much as they do.  You need to at some point decide if you trust them to tell you all the options but to suggest what is best for you.  You could otherwise get 5 different thoughts, pay for half the crowns in consults.  Just choose someone and stick with them (and the best practitioner is not always the one who says do nothing or comes up with the cheapest option).  When I go to an expert, I want all the options and info but I always ask, what would you do and usually I do that.  Good luck.

[lynn117]

still sounds fishy. catching the decay is fine. any good dentist will do that. it has nothing to do with your onlay vs crown choice.  anyone that tells me its for my own good and is doing me a favor (for a lot more money) makes me very suspicious! make sure to come back and post what the second opinion has to say. ask friends, relatives, or coworkers to recommend a dentist. word of mouth is the best reference.

[VIRGOASH]

Thank you. Basically what my dentist kept saying was she was sorry its what she recommeds and this is what she would recommend for her sister or her mother. She said when a crown is done, more  drilling is required and I will lose more tooth structure. Therefore a onlay is required so I don't lose as much tooth structure. At this point, I already have severeal crowns and this was never an issue before. I have no problem with a crown obviously. Why all of a sudden its more important on this tooth to get an onlay I suppose I will never know because this is what she recommends.I mean as a patient and not a dentist I have to trust what she is saying is true. I kept asking why the other dentist that did my initial exam didn't indicate that I needed this kind of work and she told me this is for my own good, she is doing me a favor. She said all dentists are different and she is doing me a favor by catching the decay before they all turn into root canals. I think your absolutely right. I will get a second opinion. Thank you once again.

[scottma]

The choice of restoration depends on the practioner's subjective clinical judgement and experience, as well as patient's decision. I do'nt make desision for my patients. I only informs patients the advantages and disadvantages of  various restoration.The patient makes his or her decision. Occasionally, if the tooth is vital and severely decayed,after crown preparation, there may not be enough sound tooth structure  remained to support a crown, an onlay is indicated. If you are not comfortable with your current treating dentist, seeing a prosthodontist is advised.

[lynn117]

go to another dentist and get a second opinion. did she explain why the onlays were more appropriate that crowns to justify the extra charge? she should explain all your options and the pros and cons of each procedure so YOU can make an educated choice. if you feel uncomfortable with your dentist and suspect misconduct look around for a dentist you trust.