What is a Crown and Why Do I Need a Crown?

A crown, or "cap" as it is commonly referred, is a cover that your dentist puts over a tooth.  The purpose of a crown is to make a tooth stronger by repairing it or to improve the way the tooth looks. A crown should look exactly like a natural tooth, it should be the same size and shape as your natural tooth.
A tooth may need a crown if:

• a tooth has a cavity that is too large for a filling
•  you need to cover a dental implant
•  you have a tooth that is cracked, worn down or weakened
•  a tooth has had a root canal
• you want to cover a discolored or badly shaped tooth thus improving your smile

Crowns are made from several different types of materials. Crowns can be made from metal alloys, ceramics, porcelain, composite resin or some combination of these materials.  Your dentist will make your crown so it fits comfortably in your mouth and looks like a natural tooth.  When determining the type of material to use to make your crown, you dentist will consider the location of the tooth, the position of the gum tissue and how much of the tooth shows when you smile.  You as the patient may also have a personal preference as to how you want your crown to look.

Once your dentist has determined that your tooth needs a crown, it usually takes two appointments to complete the treatment. At the first visit your dentist will prepare the tooth by removing a thin outer layer of the tooth.  This is done so when the new crown is cemented on your remaining tooth, it will fit and not be bigger than the natural tooth. After the tooth is prepared, an impression (exact mold) of the tooth is made to provide an exact model that a lab technician will use to  make your crown.  After the impression is taken, a temporary crown will be made and cemented on your tooth using a temporary cement.  You will wear this temporary crown for a week or two until the lab technician is finished making the permanent crown.  It is important to keep the temporary crown in your mouth, without it your teeth can shift then the new crown won't fit properly.  When the permanent crown is completed, the dentist will take off the temporary crown and try in your new permanent crown.  Sometimes it is necessary to make some minor adjustments to be sure that the bite is exactly correct. When you bite together the tooth with the new crown should feel comfortable and no different that your other teeth. After any adjustments have been made, then your dentist will cement the new crown on the tooth using a permanent cement.

It is important to remember that under the crown is your natural tooth and it is still possible to get a cavity on the natural tooth that is under a crown.   It is important to brush twice a day and floss daily to remove the plaque bacteria to keep the tooth under the crown and the gum tissue around the crown healthy.  As always, be sure to see your dentist regularly for professional cleanings and exams.

Why Doesn't My Insurance Pay for This?

     Dental insurance is a benefit offered by many employers.  It actually works more like a valuable "coupon" that can reduce the cost of your dental treatment.  It is important to remember that dental benefit plans do not cover all of the cost of dental treatment.  Hopefully this post will help to clarify how dental benefit plans work.
      It is important to remember that dental benefits offered by a plan should not be confused with dental treatment that is needed.  Dental benefit plans are a contract between your employer and an insurance company.  The dental treatment you need is determined by your dentist.  Your dental coverage is not based on what you need or what your dentist recommends.  Your dental coverage is based on how much your employer pays into the dental benefit plan. 
     At Clearwater Dental Associates, our main goal is to help you take good care of your teeth and provide excellent dental care for you and your family regardless of the stipulations of a dental benefit plan.  As a courtesy to our patients, we file dental claims with the insurance company.  We ask that the portion NOT covered by insurance be paid at the time of treatment. 
     Dental benefit plans use the term UCR (Usual, Customary & Reasonable) when they refer to the maximum charge for treatment that they allow.  The insurance company will make it seem that their UCR is the standard rate that most dentists charge for their procedures, but this is incorrect. 

• UCR charges usually do not reflect what dentists usually charge
• Insurance companies can set whatever UCR fees they want, they are not required to match actual fees charged by dentists in the area where you live
• An insurance company does not update their UCR amounts to keep with rising costs.  Often, they keep their UCR amounts the same for many years.
• Insurance companies are not required to say how they set their UCR rates. 

If your dental treatment costs more than what your insurance company has set for their UCR, it does not mean that your dentist has overcharged you. It means that your insurance company has not updated their UCR amounts, or the data the insurance company is using to set their UCR rates is not reflective of the state you live in.
    
     Another confusing issue with dental benefit plans are the terms PPO, DHMO, and Preferred Providers.  PPO and DHMO refer types of dental benefit plans companies offer.  A PPO type of plan gives patients the option of going to an "in-network" or "preferred" provider or they can go to an "out of network" provider.  An "in network or preferred provider"  means that the dentist has signed a contract with an insurance company and the fees charged are pre-determined and cannot be changed.  The benefit of a PPO type of plan is that if someone does not want to change dentists, they can go to an "out of network" provider and still use their dental benefits.  The out of pocket amount owed may be more, but that can be determined before dental treatment is rendered.
     DHMO dental plans do not give the patient the flexibility of going to an "out of network" dentist.  The dental benefits can only be used at an office with a dentist who is an "in network" DHMO provider.  If a patient goes to a dentist who is NOT a DHMO provider, the insurance will not pay anything.
     All dental benefit plans come with an annual maximum.  This is the largest dollar amount that the plan will pay out during a year.  The annual maximum is decided in the contract between your employer and the insurance company.  Annual maximums are not always updated to keep up with the costs of dental care.  In the 1980's the average annual maximum was about $1000 per year, and today the average annual maximum is only about $1500 per year.

At Clearwater Dental Associates, we have dentists who are contracted with some insurance companies, thus they are "in-network".  We have dentists who are contracted with Argus, Assurant, Cigna, Delta Dental Premiere, DeCare, Metlife, Prinicpal,  and United Concordia. 

Although you may be tempted to make decisions about your dental care based on what your insurance will pay, just remember that your dental needs are determined by your dentist and the least expensive option is not always the best.

What is Bruxism?

     Bruxism is a habit of grinding or clenching your teeth.  Clenching means that you hold your top and bottom teeth tightly together.  Grinding is when you slide your teeth back and forth over each other.  Bruxism can occur at any age, from children 3 or 4 years old up to adults.  Often, parents can hear their young children grinding their teeth while they are sleeping.  Many people with bruxism wake themselves up in the middle of the night from the sound of their teeth clinching or grinding.  Sometimes people are aware that they have a bruxing problem, but often times they are not.  They may have symptoms but be unaware that the cause is due to bruxism.
     People who suffer from bruxism may have the following symptoms:

• headache
• sore jaw
• frequent headaches
• facial pain
• worn or cracked teeth or fillings
• loose teeth
• earache
• insomnia

The exact causes of bruxism are unknown but most dentists agree that stress, sleep disorders or an abnormal bite are some of things that definitely play a role.  Your dentist can determine if your symptoms are from bruxism by looking for unusual wear spots on your teeth and assessing your related symptoms.  If you have any of the above symptoms on a regular basis, it is important that you have an examination by a dentist.
     There are several different ways for treating bruxism.  Some of these include:

• stress reduction
• a protective "night guard" worn over the teeth while sleeping
• medication for pain or muscle spasms
• fillings or other dental treatment to repair any damaged teeth

Frequently, wearing a night guard while you sleep will provide relief after only a few nights.  Night guards are custom made from an impression (mold) of your teeth.  They are made of a very hard plastic or acrylic.  The night guard fits snugly over either the upper or lower teeth and prevents the teeth from touching.  This keeps the jaw muscles relaxed thus eliminating headaches and soreness in the jaw muscles.  Wearing a night guard also protects your teeth from being worn down or possibly cracked due to intense bruxing.
     At  Clearwater Dental Associates we are able to examine and treat bruxism problems.  We make custom fit night guards and we have appointments available immediately!