Dental Insurance Overview Part I

So you’ve got dental insurance…great! Do you understand your dental benefit? If you’re like most of our patients, your knowledge of your benefits has a few gaps.  Maybe you feel like you should know more because we make it look so easy.  We’ve got some tips for understanding your dental benefit.

Understanding Dental Insurance

Let’s start with the definition of insurance: It’s a promise for compensation for potential specific future losses in exchange for periodic payment.  Typically, when we think of insurance, we think of protection against catastrophic, unpredictable loss.  Auto insurance protects against that big accident, homeowners insurance protects against a flood, or your health insurance covers expenses relating to an illness or disease.  Since most dental needs and treatments are predictable and non-catastrophic, it is probably more accurate to dub dental insurance as “dental benefit”.

Your dental benefit is a contract between your employer and a dental insurance provider. The amount of the benefit is decided upon between the employer and insurance, based on how much your employer wishes to pay in premium costs.  Then your employer offers you that dental insurance policy as an employment perk. 

Insurance company ----->Employer ---->You.

We bill insurance companies for your treatment as a courtesy to you, but we are in no way “affiliated” with your insurance policy.  We have contracts with certain dental insurance companies that make us “in network” providers. In a nutshell, this means that we have negotiated a fee schedule for dental services with that insurance company and that means a better deal for you.  But it does not make us party to your dental insurance contract.  If you are in any way unsatisfied with your dental insurance coverage, you should discuss it with your employer.

Our goal is to optimize your dental insurance benefit without sacrificing quality dental care.  Sometimes, that means that the treatment Dr Willis recommends is not a covered benefit under your insurance policy.  That doesn’t mean that the treatment isn’t appropriate or needed, it just means that the insurance won’t help you pay for it.

Next, we'll give you an overview of general policy benefits....stay tuned!

Dental Injuries

Summer is upon us! Imagine sunny days, picnics, and lots of outdoor activities. Pull out the bicycles, skateboards, baseball bats, balls, and nets. You pack your kids (or yourself) in helmets, knee and elbow pads, buy the fancy shoes and uniforms, and they are ready to go! Right?

With the increase in summer sports, come sports-related injuries. Everyone should experience the positive benefits of participating in exercise or sports, but there is also risk of injury including to the face or mouth. These injuries can occur due to falls, collisions, contact with hard surfaces, and contact with sports equipment. Sports accidents account for as many as 10-39% of all dental injuries in children. Children are more susceptible to these types of injuries between the ages of 7 and 11 years. Trauma injuries to the mouth and teeth can affect a family in multiple ways. There is the potential for pain and psychological effects, and economic factors.

The majority of sport related dental injuries affect the upper lip, maxilla (upper jaw bone), and maxillary incisors, with 50-90% of injuries involving the maxillary incisors. Use of a mouth guard can help to protect the upper incisors. The National Youth Sports Safety Foundation in 2005 estimated that the cost to treat an avulsed (knocked out) permanent tooth and provide follow-up care is $5,000 to $20,000 over the course of a lifetime.  

Just because there is a risk of injury during play or sports, you do not need to sit out. The simplest measure you can take to prevent dental injury is to get a mouth guard. Mouth guards range in cost from $10 to $550. That old adage “An ounce of prevention is worth a pound of cure” comes to mind.

Initially, mouth guards were used by professional boxers as a protective device starting in the early 1900’s. Mouth guards work by absorbing the energy imparted at the site of impact and by dissipating the remaining energy. There are 3 basic types of mouth guards.  “Stock mouth guards” are purchased over the counter and are meant to be worn with no modifications and must be held in place by clenching together. As you can imagine, trying to keep one of these appliances in place can be uncomfortable, at best. It also affords the least amount of protection. “Mouth formed” mouth guards, or “boil and bite” are customized by placing in boiling water and then molding them to the teeth using finger, tongue, and biting pressure. These appliances are available in sporting goods stores and vary in effectiveness and cost. Finally, “custom fabricated” mouth guards are produced on a dental model at the dental office or dental lab. The custom fabricated type is superior in protection, retention, and comfort.

What to do if a permanent tooth is knocked out? There are a few things you can do to ensure the best possible outcome in case a tooth is knocked out.

1.        Carefully pick up the tooth by the crown (the part that you normally see). Never grab a tooth by the root.

2.        Rinse and store the tooth in milk -- never water!

3.        Call the dentist immediately!!

The sooner the tooth can be re-implanted by a dentist, the better the chances the tooth can be retained for life.  The critical time frame is 5 minutes to 60 minutes.  Now, all that being said, if the child shows any sign of head injury (unconsciousness, nausea, headaches) they should be evaluated by an appropriate medical professional first. If head injury has been ruled out, they may proceed to the dentist. 

So, pull out the sunglasses, slather on the sunscreen, add a mouth guard to the sporting equipment, and get out there!