Sunday, I went to the "Man up" event hosted by the Durable Goods movement.
It got me thinking about the state of dentistry, and about value to the consumer.
In particular, I thought about the value of my service.
Many dentists follow established guidelines by insurance companies regarding how often they need to replace restorations or crowns. For instance, a crown can be replaced as often as every 5 years, and a filling every couple of years .
However, these insurance companies aren't dentists, and these standards are the minimum accepted. Additionally, one should look into the modes of failure:
1. Recurrent decay (most common):
If you don't brush and floss, all bets are off. Recurrent decay will set in, and undermine the area holding your restoration in place. Most failure is due to recurrent decay from bacteria that feed from stuff between your teeth. If you keep it clean, you should be good.
2. Crown Fracture (common for porcelain, amalgams)
If there was not enough material, or too much stress, or some sudden trauma, porcelain will fracture. Porcelain crowns look nice, and have a higher hardness than enamel or gold. However, porcelain fails by fracturing. Gold will deform into place.
3. Tooth Fracture ( Amalgams)
Amalgams are retained by mechanical retention. This means that they wedge against the teeth to stay in place. Amalgams tend to have a different thermal expansion than enamel, so will constantly wedge against the sides of teeth. That being said, they have self-sealing margins and can 10+ years if taken care of.
4. Shoddy work
I hate to admit this, but I've seen shoddy work. These include crowns with open margins, bad contours, and grossly plus or sub margins. Largely, this is from some non-American accredited provider. Often these are from patients that ask for a workup, go to China, Mexico or XYZ, and get cheap dentistry.
Frankly, I don't touch these unless a.) it's fixable and b.) my patient allows me to redo them.
I believe that you get what you pay for. Although, in my case you probably get more than you paid for. If I believe my work is sub-par...I'll make it right. Period.
That's my policy, and I'm sticking to it.