There are many reasons a dental insurance might deny payment. It is important to remember that dental insurance is designed to help you pay for your care, but it was never intended to become the only way you pay for your dental care. Another important thing to remember is that if you have insurance through your workplace, your employer chooses the plan and what it covers. With those two thoughts in mind, let’s look at some of the common reasons that an insurance doesn’t pay:
Deductible: A deductible is the amount of money that you have to pay for your care before your insurance kicks in. To further complicate matters, some preventive procedures are not subject to the deductible. So you might be able to get your dental cleanings and check ups done but if you have a high deductible plan and need a filling, you might have to pay for that first filling out of your pocket. Until you have paid your deductible on applicable services, your insurance will not pay for your dental care.
Waiting Period: Some insurances will not cover certain services until you have had the plan for a certain amount of time. This seems to apply most often to fillings and major services. If you have treatment during the waiting period’s time, you have no benefits for that service. So if there is a particular reason why you are buying insurance (needing a crown, for example), check to see if there is a waiting period for that service before you buy the plan (or at least before you schedule)!
Exclusions: Almost all dental plans have certain services that they exclude from coverage, meaning that they will not pay anything for these procedures. Cosmetic services, such as teeth whitening, are a good example of this. Your insurance will not pay for a procedure that is excluded from your plan. Exclusions vary from plan to plan, so if you’re looking for insurance to help pay for a specific procedure (such as a dental implant), make sure to pick a plan that does not exclude them.
Limitations: Most dental insurances place limits on certain procedures. This includes how often they will pay for a service (frequency limitation) and reasons why a certain procedure can be performed. If your insurance specifies a frequency limitation of 2 dental exams a year, and you have 3, the insurance won’t pay for the third one. If your insurance says it will cover a cleaning once every 6 months, and you have your second one at 5 ½ months, the insurance will not pay for the cleaning. If your insurance will pay for a crown once every 5 years per tooth, it will not pay to replace your crown if it is 4 years old. If your insurance specifies that a tooth must have 3 surfaces filled in order to qualify for a crown, and you want to put a crown on an unfilled tooth, the insurance may deny payment (unless you and your dentist can show a really good reason for needing the crown that meets another criteria that the insurance company has in place.) Limitations vary from plan to plan, and sometimes you (and we) have to read carefully to find out what they are.
Exhausted Benefits: Dental insurances specify a maximum amount per year that they will pay toward dental care (most often $1,000-$2,000). Once the insurance has paid that amount, it will not pay any more until the next benefit year begins. One of the common beliefs we hear is that “I get two free cleanings a year.” Those cleanings might be “free” to you, but the insurance company picks up the cost for them. The cost is incorporated into that maximum amount per year. If you’ve already spent the maximum on other services, the insurance will not pay for your cleaning—you will (should you choose to schedule it).
For any dental services sent to insurance, both you and your dentist should receive a statement from your insurance company. That statement usually contains a message which will say why the payment was not sent. (If you have problems understanding it, call your dentist’s office or your insurance company to ask for an explanation.)
*Note: The information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Dr. Jennifer Robb is a general dentist with a practice in Lorain, Ohio. She is currently accepting new patients. If you would like an appointment, please call 440-960-1940 or use the contact form at www.drjrobb.com to let us know your phone number so we may call you.
Getting dental implants is going to require surgery. But don't let that concern you—it's a relatively minor procedure.
Currently the “gold standard” for tooth replacement, an implant consists of a titanium post surgically imbedded in the jawbone. We can affix a life-like crown to a single implant or support a fixed bridge or removable denture using a series of them.
Because placement will determine the restoration's final appearance, we must carefully plan implant surgery beforehand. Our first priority is to verify that you have adequate jawbone available to support an implant.
Additionally, we want to identify any underlying structures like nerves or blood vessels that might obstruct placement. We may also develop a surgical guide, a retainer-like device placed in the mouth during surgery that identifies precisely where to create the holes or channels for the implants.
After numbing the area with local anesthesia, we begin the surgery by opening the gum tissue with a series of incisions to expose the underlying bone. If we've prepared a surgical guide, we'll place it in the mouth at this time.
We then create the channel for the insert through a series of drillings. We start with a small opening, then increase its size through subsequent drills until we've created a channel that fits the size of the intended implant.
After removing the implant from its sterile packaging, we'll directly insert it into the channel. Once in place, we may take an x-ray to verify that it's been properly placed, and adjust as needed. Unless we're attaching a temporary crown at the time of surgery (an alternate procedure called immediate loading), we suture the gums over the implant to protect it.
Similar to other dental procedures, discomfort after surgery is usually mild to moderate and manageable with pain relievers like acetaminophen or ibuprofen (if necessary, we can prescribe something stronger). We may also have you take antibiotics or use antibacterial mouthrinses for a while to prevent infection.
A few weeks later, after the bone has grown and adhered to the implant surface, you'll return to receive your new permanent crown or restoration. While the process can take a few months and a number of treatment visits, in the end you'll have new life-like teeth that could serve you well for decades.
If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implant Surgery.”
A dental visit is probably the last thing on your mind if you’ve been told you have cancer. However, 40% of chemotherapy patients develop oral complications. With a bone marrow transplant, the number goes up to 75% and radiation to the head or neck region almost ensures oral problems. These oral complications can interfere with your cancer treatment schedule, so your dentist and your cancer doctors need to work together. Your dentist will help protect your mouth, teeth, and jaw bones from damage caused by radiation and chemotherapy.
Ideally, you should see your dentist for an exam and cleaning before starting cancer treatment. Some dental care, such as tooth removal, is best done beforehand because cancer treatments can change your jaw bone, and any areas of dental infection need to be resolved so that they will not cause a problem when your immune system is depressed during cancer therapy. While nothing can guarantee that you won’t have some oral side effects from cancer treatment, having a healthy mouth minimizes them. Pre-treatment oral care reduces the risk of severe oral complications including pain, improves the likelihood that you can have the optimum schedule and dose for your cancer treatment, prevents or reduces later instances of bone necrosis, and generally improves your quality of life while undergoing cancer treatment.
The most common oral complications are:
- Inflammation of the tissues of your mouth—results in soreness or ulcerations and increases the risk of pain, local or systemic infections, and poor nutrition.
- Infection—results from the combination of the depressed immune system and damaged soft oral tissues that allow bacteria, viruses and fungi to enter your body.
- Dental decay and tooth erosion—results from acids in vomit, from changes to the amount and type of saliva or from radiation to the head or neck region.
- Dry Mouth—results from changes to amount and type of saliva or damage to the salivary glands.
- Bleeding—results from low platelet levels and provides an opportunity for bacteria, viruses and fungi to enter your bloodstream.
- Taste Alteration—results from changes to saliva and from medications and can range from mild to severe to loss of taste. May contribute to nutritional deficiencies.
Besides the dental visit you should make before starting any treatment, you can also care for your teeth and mouth at home. Your dental hygiene routine should include gently brushing your teeth and tongue with a soft toothbrush after every meal, after vomiting, and at bedtime; gently flossing your teeth once a day; keeping your mouth moist by rinsing often with water and checking your teeth and gums daily so you can report any changes to your dentist and cancer doctor immediately.
Severe mouth sores that are significantly interfering with your nutrition or quality of life may need to be treated with a soft tissue laser on an “oral bandage” setting. For less severe sores, treatments include prescriptions to numb the pain so that you can eat more comfortably.
Your dentist will be able to recommend specific products for you to use and your cancer care team may also recommend that you use a custom tray to apply fluoride to your teeth at home for the duration of your treatment to combat the effects of dry mouth, acidic vomit, and radiation treatment. Your dentist can make this tray for you.
You should also continue dental visits during your cancer treatments. Timing of these visits may need to be coordinated between your dentist and your cancer doctors.
Hearing the words cancer, chemotherapy and radiation tend to overshadow everything else in your life. Understandably so. But continuing to see your dentist and having your dentist join your cancer team, can not only lessen long-term damage, but could ease some of the oral side effects of your treatments.
*Note: The information in this article is not meant to replace the clinical judgement of your healthcare providers.
Dr. Jennifer Robb is a general dentist and cancer survivor. Her office is located at 1320 Cooper Foster Park Rd, Lorain, OH 44053.
Call 440-960-1940 to reserve an appointment time.
In addition to the usual tooth and gum problems, dentists also see patients with soft tissue infections in and around the mouth. One of the more common of these is the irritation or "cracking" of the corners of the mouth.
Formally known as angular cheilitis (or perleche, a French word, meaning "to lick"), cracked mouth corners are localized irritations made worse by saliva accumulation or an accompanying yeast infection. They're prominent among children and young adults who drool during sleep or while wearing orthodontic braces.
Older adults can also develop cracked mouth corners because of deep wrinkle lines around the mouth ("marionette lines") or tissue irritation from wearing dentures. Teeth loss, especially in the back of the jaws, can weaken facial support leading to collapse of the bite, which can contribute to angular cheilitis.
The condition can cause anything from minor discomfort at the mouth corners to a yeast infection that spreads throughout the mouth and throat. Whatever the symptoms, treatment usually begins with antifungal medication in the form of a mouthrinse or a topical ointment. The dentist may also prescribe a steroid ointment like zinc oxide paste to control inflammation and serve as a barrier against infection.
If the infection has spread beyond the mouth corners, patients may also need to use an antibacterial mouthrinse (usually chlorhexidine) to clear up the infection and help prevent a relapse. Besides cleaning their appliances with chlorhexidine, denture wearers with angular cheilitis should also take their dentures out at night to reduce the chances of a reoccurrence.
Along the same vein, patients who contend with frequent cracked mouth corners and who have missing teeth should have those teeth replaced by some form of restoration. If that involves dentures, it's important to maintain a good fit with them to reduce the chances of tissue irritation. And patients with deep wrinkle lines around their mouth may be able to lessen them through dermatological treatment.
Even though cracked mouth corners rarely pose a major health problem, the discomfort they cause can be a drag on your daily life and activities. Remember that you don't have to suffer—a visit to your dentist could start you on your journey toward relief from this irritating problem.
If you would like more information on angular cheilitis and similar mouth conditions, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Corners of the Mouth.”
When you think of a workplace accident, you probably think of something medical: cuts, sprains, etc. But some workplace accidents also involve your teeth, mouth or jaws and may require dental attention.
To some extent, a dental injury sustained in the workplace is similar to any other dental injury, but there are a few differences. For example, if your regular dentist does not participate as a provider in the Worker’s Comp program, you may need to find a dentist, such as myself, who does.
Depending on the extent of your injuries, you may be transported to a hospital to have your medical issues treated first. Most hospitals are not equipped to deal with dental injuries. If you suspect a dental problem, have the hospital staff document your dental condition. Your future dental treatment will move more quickly if your dentist does not have to ask Worker’s Comp to allow an additional condition.
As with any accident, some problems show up quickly while others may show up days, weeks, months or even years later. The most common injury is a chipped or broken tooth. Other possible problems are loose teeth, knocked-out teeth, and TemporoMandibular Joint (TMJ) symptoms.
Chips on teeth range from small areas to the entire top part of your tooth being broken off at or below your gumline. Even small chips can be painful or unsightly and lead to tooth decay. Small breaks can often be treated with a tooth colored filling. Crowns or veneers are also a possibility if the damage to your tooth is extensive.
Very large chips that expose the nerve require a root canal to keep your tooth. Even when a root canal is not indicated right away, it is possible that you will need one in the future due to the trauma to your tooth.
A loose tooth may mean that your tooth’s root has broken in an area that you can’t see or it could just be a result of trauma. Looseness ranges from very slight to noticing your tooth is no longer in the right place. Your dentist can determine if your loose tooth is the result of trauma from the accident or a broken root. Even if your root is not fractured, loose teeth are often painful and make it hard to eat.
If your tooth is out of place, visit a dentist as soon as possible. If you are at the hospital, see if they have an oral surgeon who could put your tooth back in the correct place. (You will still need to see your dentist to have your tooth evaluated.) You may need root canal treatment or tooth removal for a broken root. Otherwise, your tooth may be temporarily bonded to the teeth next to it to strengthen it. If multiple teeth are involved or if your bite feels like it has shifted you might need braces to move them back to the proper place.
If your entire tooth (including root) is knocked out, pick up the tooth by the part you’d see in your mouth when you smile. Try not to touch the root portion and do not clean the tooth. If possible, put the tooth back into the socket in your mouth. If you cannot put it back, place the tooth in Sav-A-Tooth container (if available), or into cold milk. Time is of the essence if you want to try to save your natural tooth, so ask for an oral surgeon at the hospital or go to a dentist or oral surgeon right away.
Though teeth injuries are more common, your jaw can also be hurt in an accident. If you experience pain or difficulty opening your mouth after a trauma, you should be checked to make sure you do not have a broken jaw. If there is not a fracture, you may have TMJ/TMD. If the pain is mild, take anti-inflammatories (such as ibuprofen), rest your mouth as much as possible, and eat soft foods that don’t require much chewing. Sometimes the symptoms of TMJ will go away without additional treatment. If not, your dentist may make you an occlusal guard appliance. Other treatment options include physical therapy for your jaw or professional massage of your TMJ.
Many of these treatment principles apply no matter how your dental injury occurs. However, if your injury occurs in your workplace or is related to your job, there are a few extra steps to take to make sure Worker’s Comp will cover needed care. Since many more workplace injuries are medical rather than dental, it can be hard to find a dental office that is familiar with Worker’s Comp. If you are having trouble finding an office to help you with your dental injury, we invite you to call Dr. Jennifer Robb at 440-960-1940.
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