PATIENT CONSENT FORM — Dental Crown
What is a Dental Crown?
A dental crown is a custom-made hat that fits over your tooth, restoring its shape, size, strength, and appearance. Crowns can be made from various materials including porcelain, ceramic, zirconia, gold alloy, or a combination of these. Your dentist will advise on the most suitable material for your tooth.
For more information on Dental Crowns, please click here
Why You May Need a Crown
To restore a tooth that is heavily decayed or broken
To protect a weakened or cracked tooth from further damage
To cover a tooth following root canal treatment
To replace a large filling where there is insufficient natural tooth structure remaining
To improve the appearance of a discoloured or misshapen tooth
To anchor a dental bridge
The Procedure
Crown placement typically requires two appointments.
Appointment 1 — Preparation: The tooth is reshaped under local anaesthetic to create space for the crown. An impression (or digital scan) is taken and sent to a dental laboratory. A temporary crown is fitted to protect the tooth.
Appointment 2 — Fitting: The temporary crown is removed and the permanent crown is checked for fit, bite, and appearance before being cemented in place.
Risks, Complications & Limitations
Common: Temporary tooth sensitivity (to hot, cold and sweet foods and drink) — this usually settles within a few weeks. Mild discomfort or soreness after preparation.
Occasional: Crown fracture or debonding. Bite adjustments may be required after fitting. The appearance of the adjacent gum tissue may change over time.
Rare: Nerve damage requiring root canal treatment (if not already performed). Allergic reaction to crown materials (very rare). Tooth may not be restorable and extraction may become necessary.
Alternatives to a Crown
- No treatment — the tooth will continue to deteriorate and may break further and require extraction
- Onlay or inlay — a partial coverage restoration where appropriate
- Extraction followed by a bridge, denture, or implant to replace the tooth
Your dentist will discuss whether any of these alternatives are clinically suitable for your situation.
Long Term Maintenance
Maintain good oral hygiene around the crowned tooth including attending regular hygiene appointments. We will check your crown at your regular dental check ups, and we encourage you to attend these as scheduled.
Cost & Guarantee
The fee for your crown has been discussed and confirmed in your treatment plan. Please note that crowns are not guaranteed indefinitely and their lifespan depends on your oral hygiene, diet, and habits such as grinding or clenching (bruxism). If you grind your teeth, your dentist may recommend a protective night guard.
Patient Declaration & Consent
A copy of this completed form will be retained in your patient records. You are entitled to request a copy at any time.
