Will Dental Insurance Cover Crown Replacement?

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Do you have a dental crown that’s been cracked, chipped or broken?  Do you have insurance coverage but aren’t sure if your crown repair or replacement will be covered? Now you’re stressing about how you’re going to pay for it.

Dental plans may cover a wide range of dental care procedures, especially those that are absolutely necessary for helping you maintain optimal oral health. If you request a crown for cosmetic purposes, this is when dental plans may not cover the procedure. It’s always best to ask your dentist and your insurance company before proceeding with anything just to ensure you aren’t surprised by unexpected costs at the end of your appointment. 

So, how do you tell your crown replacement will be covered? Are dental crowns really necessary? What if you don’t even have insurance? We’ll explain everything clearly below for you.

What Is A Dental Crown?

A crown, also referred to as a “cap”, is just that – it fits over your existing tooth like a cap and can improve major cracks, chips, a badly broken or misshapen tooth, a weakened tooth after decay, or to hold a dental bridge in place. They can also be used after a root canal or to top a dental implant. Therefore, it can completely restore the strength, appearance, shape, and size of your tooth.

They can be made from a variety of different materials – porcelain, ceramic, resin, or porcelain fused to metal or gold. Many dental offices now have modern technology called CEREC, that can create (or repair) customized porcelain or ceramic crowns, veneers, and bridges while you’re there for your appointment instead of waiting for a couple of weeks until it comes back from a lab. 

Porcelain and ceramics are very popular dental materials and have widely been used since the late 1880s because they’re so durable and can mimic the appearance of natural teeth. A porcelain dental crown can also last upwards of 15 years, following the proper oral hygiene routine. Porcelain or ceramic crowns can be used for front and back teeth and are great for people who may have metal allergies.

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The Dental Crown Procedure

The dental procedure is actually quite simple, depending on the severity of your case. After being administered local anesthesia, your dentist will file down the outer layer of the tooth so the crown can comfortably fit over top, and because of this, receiving a dental crown is permanent. 

Once that layer is gone, there’s no going back. But that means a lifetime of an improved smile! Next, an impression will be made of your mouth so a customized crown can be made. If they don’t have CEREC technology, you’ll have to wait a couple of weeks to receive the permanent crown, so in the meantime, you’ll be supplied with a temporary crown.

After receiving a temporary crown, your dentist will supply you with aftercare instructions since it will be quite a bit different than having a permanent one. Temporary crowns are temporarily cemented in place for easy removal during your next appointment, so they can easily come out of place if you don’t follow the aftercare instructions properly, such as:

  • Avoid chewing directly on that tooth, especially the same day you received it
  • Avoid foods that are chewy, hard and sticky
  • Continue to brush and floss as usual, but gently around that area (don’t pull upwards with your floss as it can dislodge the crown)

If it does become loose or falls out, you should contact your dentist as soon as possible. Another purpose of a dental crown is to keep the gap prepared for your permanent crown, so it’s best not to just let the tooth sit without protection.

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Are Crowns & Bridges The Same?

If you have multiple missing teeth, your dentist may suggest a bridge instead. Though they’re made from similar materials, crowns and bridges aren’t the same. In fact, a dental bridge is just that – a bridge! 

But made from false teeth that look and feel completely natural and are bonded to existing healthy teeth or surrounding crowns. Just like a crown, bridges can last upwards of 15 years before needing a touch-up and they can drastically help improve one’s bite, digestion, speech, and appearance of their smile. 

How Much Can A Single Crown Cost?

It’s not just the crown you’re paying for. There are a few things that go into the total cost, like material expenses, lab fees, and professional fees. Each dentist will charge a certain fee per service based on the guidelines set out by the Ontario Dental Association so the total cost could range anywhere from (approximately) $1,000 to $1,500. 

You can ask your dentist ahead of time for an approximate cost, as well as request a coverage amount from your insurance company to see if, and how much, they’d cover and what you’d have to pay out-of-pocket. 

How Much Do Crowns Cost With Insurance Coverage?

A dental crown should be covered under dental plans if it’s absolutely necessary in order to improve the function of the tooth and your overall health, especially if your tooth has been chipped or broken or you’ve undergone a root canal. 

But there are times when patients may request a crown to improve the appearance of their teeth and this is when insurance coverage may not kick in since it isn’t deemed as “necessary”. If you’d still like to proceed with enhancing your smile with crowns, there are plenty of options for patients to receive cheaper dental care, but with the same high-quality materials. Let’s talk more about this below.

Cheap Dental Care Options in Ontario

Unfortunately, not everyone is able to have their dental procedures covered by insurance plans and they’re left having to pay high out of pocket costs. Luckily, there are cheaper options for people wanting to improve their oral health. Though the services are cheaper, that doesn’t mean quality care is lacking. And one of the best places to receive this care?

The various dental schools all across Ontario. Colleges and universities have highly-trained dentists overlooking their students practicing their studies on patients requiring a wide range of services, including:

  • General cleanings and exams
  • Root canal therapy
  • Fillings
  • Dental crowns, veneers and bridges
  • Orthodontic care
  • Periodontics
  • Emergency services
  • And more

Each dental school will list their services on their website along with the price for each procedure.

There are also government-funded programs for certain age groups, such as the Ontario Seniors Dental Care Program for low-income seniors 65 and over. Though the dental coverage won’t include receiving a crown for cosmetic purposes, it will cover a portion of the cost in order to improve your oral health (such as a broken tooth).  

Healthy Smiles Ontario is another government-funded program meant to help children in low-income situations who require dental care coverage who are 17 years and younger. It provides free preventive care (like general cleaning services, fillings, etc.) and emergency procedures. Again, cosmetic services won’t be included in the dental plan as well as orthodontic care.

Eligibility requirements for these programs can easily be found online.

Patients also have the Ontario Health Insurance Plan (OHIP) to rely on, especially if the service is urgent and performed in a hospital. Typical dental procedures (or cosmetic dentistry) is not covered

Most dentist offices are very flexible when it comes to payment plans their patients feel most comfortable with, so don’t be afraid to ask about it.

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How Do You Know When A Crown Needs To Be Replaced?

There’s no doubt that dental crowns last a long time (upwards of 15 years or more), but accidents can happen and you may need to have it replaced. If you, at any point, notice the following signs, it’s time you contact your dentist as soon as possible to have your crown replaced:

  • It's cracked or chipped
  • Gums are receding accompanied by brown spots
  • Pain or sensitivity when pressure is applied
  • It feels loose

It could have been cracked or loosened from a few different things, whether you were involved in an accident or ate something hard, but whatever the reason, leaving the underlying tooth exposed underneath is dangerous. This can lead to decay or gum disease and ultimately, lead to more procedures having to be done and more money having to be spent. 

Though your dentist will check any crowns you have at each appointment, it’s important to remember to continue maintaining proper oral hygiene at home to preserve its life. Just because the crown covers the tooth that was previously damaged, doesn’t mean it’s protecting you from gum disease. 

Gum disease is mainly caused by a lack of brushing and flossing of the teeth and can lead to a number of different oral health issues like tooth decay, infection, and teeth falling out. If detected early enough, it can be reversed with proper care and dedication. 

How To Pay For A Dental Crown

If your workplace provides you with dental plan benefits, there is a chance your crown will be paid for, but it depends on the reason you’re getting it. If you’ve requested one to replace a tooth you’re unhappy with the appearance of, chances are, the plan won’t cover the cost. 

If you absolutely need one in order to preserve your oral health and improve the function of your teeth, a portion of it will likely be covered. You can always contact your dentist and insurance company beforehand to ask about estimated costs and coverage plans since you’ll still have to pay some out of pocket costs.

If you don’t have any medical insurance plan and are concerned about how you’ll pay for the crown, there are government-funded programs to help you as well as colleges and universities who are always more than happy to practice their studies on real-life patients accompanied by a certified professional.

Dr Christopher Sims

After attending the University of Toronto to obtain his DDS, Dr. Christopher Sims made his way to Hamilton to complete an undergrad at McMaster Unversity. But his education didn’t stop there. He’s completed a number of additional courses to best serve his patients and be able to educate them too.

No matter your age, dental condition, and if you have a million questions, Dr. Sims can assist you or your young children in a professional manner and loves answering any of your questions or concerns.
Dr. Sims grew up in Grimsby playing basketball, so he’s always up for talking about the Raptors! He’s also a football fan - go Buffalo Bills! In his free time, if he’s not watching a basketball game or football game, you’ll likely find him working out, cooking (got any new recipe ideas?), and of course, spending time with his amazing family.
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