02/16/2012 05:15 pm ET | Updated Apr 17, 2012

The Rising Cost of Gold (and Dentistry)

Every time the price of gold rises, I wince a little. The reason is twofold: First, I'm annoyed at myself for not buying it back when it was a few hundred an ounce. But the other reason I wince is because the price of dental crowns is going to rise, and that makes exactly nobody happy -- my patients don't like it, the insurance companies don't like it and I certainly don't like it.

This may surprise you, but your dentist really doesn't want to charge you a lot. Obviously, we want to get paid at a level that reflects our skill level and schooling, but most of our charged costs are for "materials and machines" as opposed to profit. Dental crowns are a big one -- in plain terms, they are costly before I even sit down to work on you.

Now I'm not trying to make anyone feel sorry for us dentists. I realize we aren't getting any sympathy from the general public for charging $1,500-$2,500 for a third-of-an-inch cube of porcelain and metal that we spent an hour or so putting in. I'll do a post sometime in the future breaking down costs, just so you can see we're not getting rich here. (Heck, if I wanted to be "rich," I would have been a lawyer. Or an insurance executive. Or heck, the guy who SELLS me my equipment. Trust me, he's doing just fine. I'll put it to you this way -- he drives a Porsche. I don't.)

The big portion of your dental bill is in things like dental crowns and the like. To begin, many dental crowns are made by hand, in a lab (they can be made by machine as well, but the best ones are handmade.) So this alone is going to result in a high cost. But just as important are the materials used in the crown. And that brings us to our gold connection.

The simple fact is this -- most dental crowns use some gold. Some of them use gold in a big way (a "full" gold crown, for those who want a gold tooth). But even if you do not see any gold and have a "porcelain fused to metal" crown (the most popular kind), these usually have a gold coping underneath (not always, but usually). The reason is simple -- gold is an extremely "workable" metal, and also lasts a lifetime. Dental crowns are not meant to be quick fixes -- they are meant to last years and years. (In fact, done well, a crown should last your lifetime.) We can substitute other metals (and indeed, many dentists do), but assuming you want quality dental work, gold is the way to go.

Because gold is used in crowns, it is reasonable to see why when the price of gold goes up, the cost of getting a crown at your dentist is going to go up, too. (Assuming your dentist uses crowns with a gold coping... By the way, this is usually not presented as a choice to the patient -- a dentist uses the lab he or she uses, and that's that. So if they use gold, they use gold, and generally won't be asking you, "Would you like silver instead?")

So we have this handmade item (which costs a lot, no matter the material) being made with one of the more expensive metals on earth -- this results in a costly end result. According to the latest gossip around the campfire at the dentists' convention, crowns are generally running $1,500 or so in the Midwest and up to $2,500 on the coasts. This is up considerably from where it was a few years ago. But then again, the price of gold has almost doubled in that time as well (as I write -- February 2012 -- gold is over $1,700 an ounce). And how much gold is in a dental crown? That's hard to say, because it's directly related to the size of the tooth. But even one-fourth of an ounce tops $400, and that's just raw cost for the gold part alone, never mind everyone along the way marking it up a little, and then the handcrafting (which is probably the biggest expense). Thus, you can see why dental crowns are so darn expensive.

I truly wish there was another way. Believe me, as an NYC Cosmetic Dentist, I'd love to do $400 crowns for people. But the reality is, I'm in a health-related field, and I personally believe in quality work -- I won't cut corners for cost. So for myself, that means using the best materials, made by the best people. Some dentists differ -- they'll use cheaper crowns (even some that are made right there in-office), and that's ok with them (and their patients). The good part is, you do have a choice. Ask your dentist what materials are used -- just expect to pay more when the answer is "gold." But, of course, you'll get a better crown.

Until next time, keep smiling.

For more by Thomas P. Connelly, D.D.S., click here.

For more on dental health, click here.