Variation in the use of crowns and their alternatives

The use of crowns and their alternatives for the restoration of compromised posterior teeth is of interest to educators, purchasers, and patients. Considerable curricular time is devoted to learning these techniques, substantial amounts of money are spent on these procedures, and differences in the outcomes of these treatments may have consequences for tooth survival. To begin to understand more about the actual use of these procedures, the provision rates of these services in a sample of U.S. dental practices were examined. This study reports on the extent to which utilization patterns and subsequent costs of crowns and their alternatives were associated with certain patient and practice characteristics. Insurance claims for dental services submitted by general dental practices through an electronic claims clearinghouse were used. Crown ratios (crowns/crowns plus alternatives) were calculated for dental practices to evaluate relationships with available explanatory variables. Findings indicated that older patients were significantly more likely to receive crowns than those in younger groups, resulting in as much as a 33 percent increase in the mean per tooth cost of treatment in the oldest group. Regional variation existed in the provision of crowns and resulted in up to a 31 percent difference in the mean per tooth treatment cost between regions. Crown ratios exhibited variation beyond that accounted for by patient and practice factors, thus raising questions about the consistency of treatment recommendations among dentists. These findings support the need to examine further the consistency of crown use among general dentists and to modify current approaches for teaching treatment planning in predoctoral restorative curricula.