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FAQs

My dentist recommends a treatment that my plan will not pay for. Does this mean the treatment really isn’t necessary?

It is common for dental plans to exclude treatment that is covered under the company’s medical plan. Some plans, however, go on to exclude or discourage necessary dental treatment such as sealants, pre-existing conditions, adult orthodontics, specialist referrals and other dental needs.

Some also exclude treatment by family members. Patients need to be aware of the exclusions and limitations in their dental plan but should not let those factors determine their treatment decisions.

My dentist recommends that I get a crown, but my dental benefit only covers a large filling. Which treatment should I have?

Some plans will only provide the level of benefit allowed for the least expensive way to treat a dental need, regardless of the decision made by you and your dentist as to the best treatment. Sometimes, special circumstances may be explained to the third-party payer to request an adjustment to this lower benefit allowance, but there is no guarantee that the third-party payer will alter its coverage.

As in the case of exclusions, patients should base treatment decisions on their dental needs, not on their dental benefit plan.

My dental plan says that it covers 100% for 2 checkups/cleanings each year. I just had my first checkup and now I owe. Why?

Plans that describe benefits in terms of percentages, for example, 100 percent for preventive care or 80 percent for restorative care, are generally Usual, Customary and Reasonable (UCR) plans. The administrators of UCR plans set allowable fees for each dental procedure. If your dentist’s fee exceeds this allowable fee, your benefit will be based on a percentage of the allowable fee instead of your dentist’s fee.

Exceeding the plan’s allowable fee, however, does not mean your dentist has overcharged for the procedure. These plans pay a set percentage of the dentist’s fee or the plans allowable fee limit, whichever is less.

These limits are the result of a contract between the plan purchaser and the third-party payer. These limits may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the “customary” fee level.

What are crowns?

A crown is a restoration that covers, or “caps,” a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Crowns are necessary when a tooth is generally broken down and fillings won’t solve the problem. If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn’t get worse.

Crowns are also used to support a large filling when there isn’t enough of the tooth remaining, attach a bridge, protect weak teeth from fracturing, restore fractured teeth, or cover badly shaped or discolored teeth.

What is a root canal?

Underneath your tooth’s outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth’s nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.

Why do I feel pain?

When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

Why do I need root canal therapy?

Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall-out. Pain usually worsens until one is forced to seek emergency dental attention.

The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it’s always best to keep your original teeth.

Why do I need X-rays?

Radiographic or X-ray examinations provide your dentist with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal disease, abscesses and many abnormal growths, such as cysts and tumors.

X-rays also can show the exact location of impacted and un-erupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

Do all patients have X-rays taken every six months?

Your radiographic schedule is based on the dentist’s assessment of your individual needs, including whether you’re a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.

What kind of X-rays does my dentist usually take?

Typically, most dental patients have “periapical” or “bitewing” radiographs taken. Bitewing X-rays typically determine the presence of decay in between teeth, while periapical X-rays show root structure, bone levels, cysts and abscesses.

My dentist has prescribed a “panoramic radiograph.” What is that?

Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, within one large picture a panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.

Why do I need both types of X-rays?

What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which a periapical or bitewing X-ray cannot show.

On the other hand, periapical or bitewing X- rays show a highly-detailed image of a smaller area, making it easier for your dentist to see decay or cavities between your teeth. X-rays are not prescribed indiscriminately. Your dentist has a need for the different information that each radiograph can provide to formulate a diagnosis.

What is a mouthguard?

To protect your mouth from injuries. The dental profession unanimously supports the use of mouthguards in a variety of sports activities. More than 200,000 injuries to the mouth and jaw occur each year.

A mouthguard is a flexible appliance made out of plastic that is worn in athletic and recreational activities to protect teeth from trauma.

A mouthguard can prevent serious injuries such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures and neck injuries by helping to avoid situations where the lower jaw gets jammed into the upper jaw. Mouthguards are effective in moving soft issue in the oral cavity away from the teeth, preventing laceration and bruising of the lips and cheeks, especially for those who wear orthodontic appliances.

The best choice is a mouthguard custom-made by your dentist. It offers the best protection, fit and comfort level because it is made from a cast to fit your teeth.

How can you brighten your smile?

Your wedding is coming up and you want your smile to be its brightest. Or maybe you have an important speaking engagement. Whatever the reason, tooth bleaching isn’t just for the movie stars, and it isn’t just for one day. Many people have had their teeth bleached, and probably millions more are thinking about it.

The desire for a brighter smile with whiter teeth is very strong, and tooth bleaching safely lightens the color of the teeth, lasting for up to five years. The most effective and safest method of tooth bleaching is dentist-supervised.

Is bleaching for you?

Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to lightening.

Other types of gray stains caused by fluorosis, smoking or tetracycline are lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage bleaching.

How long does it last?

Lightness should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea. At this point, you may choose to get a touch-up. This procedure may not be as costly because you can probably still use the same mouthguard. The retreatment time also is much shorter than the original treatment time.

What are realistic expectations?

No one can really predict how much lighter your teeth will become. Every case is different. Typically, there is a two-shade improvement as seen on a dentist’s shade guide. The success rate depends upon the type of stain involved and your compliance.

Bleaching can only provide a shift in color from gray to a lighter shade of gray, for example. Bleaching does not lighten artificial materials such as resins, silicants, or porcelains.