We’ve all been there. You diagnose a crown, and the patient immediately asks, “Can’t you just put a cheaper filling in there?”

How you handle that single moment is one of the biggest factors in your case acceptance and your patients’ long-term health. If you’ve ever felt yourself waver or struggle to explain it clearly, this is for you.

This is a complete, battle-tested framework to master this conversation once and for all. We’ll solidify your own clinical philosophy, give you a powerful analogy that makes the concept crystal clear to any patient, and provide a surprising strategy for what to do when they push back on cost.

Insight #1: The Conversation Starts with YOUR Conviction

Let’s start with a hard truth. The main reason this explanation is so difficult for many dentists is because, deep down, we aren’t 100% clear on our own red lines. We know that with modern materials, we can technically patch up almost any tooth. Because it’s possible, we waver.

The real work starts internally. You must decide what you stand for as a clinician. My core philosophy is this: I only recommend and perform dentistry that I am confident will last at least ten years. A temporary, unpredictable fix is a disservice to my patients.

With that foundation, the roles of a filling and a crown become crystal clear:

• A filling is a patch. Its job is to fill a small, contained hole. It is not designed to provide structural integrity.
• A crown is a structural brace. Its job is to act like a helmet, holding a fundamentally weak tooth together to prevent it from fracturing.

When you have this level of internal clarity, your conviction is unshakeable.

Insight #2: The “Wall & Foundation” Analogy

Now you need to translate that conviction to the patient without using jargon. This simple, powerful story is your greatest tool.

Here’s how it goes:

“Mrs. Jones, that’s a great question. Think of your tooth like a wall in a house. If you have a small hole from a picture nail, you use a little spackle to patch it. The spackle just fills the hole; it’s not holding the wall up. That’s what a dental filling does. It’s the spackle for your tooth.“

“But,” you continue, “what if that same wall has a giant, structural crack running down the middle? Are you going to fix that with spackle? Of course not. You need a structural solution, like a steel brace, to hold the whole thing together and prevent the wall from collapsing. That is what a crown does. It’s the structural brace for a tooth that is no longer strong enough to stand on its own.“

Once the patient understands “spackle vs. brace,” you can use your intraoral photo to show them exactly why their tooth is in the “cracked foundation” category. You can point to the crack, the fractured cusp, or the sheer width of the old filling, explaining that a patch will only act as a wedge, making the tooth weaker.

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Watch the full breakdown of this powerful communication framework

Insight #3: How to Handle Financial Pushback (The Answer is “Do Nothing”)

You’ve delivered the perfect explanation. The patient understands. But then they say it: “Doc, I just can’t afford that right now.”

This is the moment where most dentists crumble. We feel guilty, so we place the compromised “hero” filling that we know is going to fail.

This is a trap. When you place that compromised restoration, you are taking ownership of its future failure. When the tooth inevitably breaks, the patient will not thank you for trying to save them money; they will blame you for a filling that didn’t last.

The correct, professional, and most ethical response is to do nothing.

“I completely understand that the cost is a concern right now. Since the crown is the only treatment I can confidently recommend, the best option for now is to simply monitor the tooth. We can help you keep it clean, and when your situation changes, we can proceed with the crown then.”

If the patient cannot afford the right treatment, you are not obligated to do the wrong treatment. Holding this line protects your reputation, protects the patient from a poor investment, and places the final decision squarely where it belongs: with them.

By mastering these three keys—your 10-year philosophy, the “wall and foundation” analogy, and the confidence to “do nothing” when appropriate—you transform this conversation. You become the confident, trusted advisor, always advocating for your patient’s long-term best interest.

Now that you have the complete framework, we need to talk about the immense damage that happens when you ignore these principles and give in to the temptation of doing that one “heroic” big filling. If you click on this video called “Stop Doing Big Fillings,” I’ll break down the hidden costs and show you why committing to this philosophy will make you a more productive and less-stressed dentist.