Almost all dental insurance companies use what is called a “usual, customary and reasonable” (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set.
If you are on a dental insurance policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the dental insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket, however, you cannot put a price tag on quality dental care.
A direct reimbursement plan is a dental insurance plan that is usually entirely funded by your employer and allows you to choose any dentist without the hassle of networks.
With a direct reimbursement plan, you are reimbursed for money spent on dental work, which is not limited to specific treatments. Some employers may choose to reimburse you after you have paid for your dental work, and some may choose to pay the dentist directly — leaving you with less out-of-pocket expense.
The yearly maximum is the most money a dental insurance plan will pay out within one full year. A yearly maximum could run on a calendar year (January to December), or on a fiscal year, depending on the dental insurance company.
The yearly maximum will automatically renew every year. If you have unused benefits, these will not roll over. Most dental insurance companies allow an average yearly maximum of $1,000.
According to most dental insurance companies, dental procedures are broken down into three categories:
Most insurance companies consider routine cleanings and examinations as preventative dental care, however, X-rays, sealants and fluoride can be deemed as preventative or basic, depending upon the specific insurance carrier.
- Basic or Restorative
Basic or restorative dental treatment usually consists of fillings and simple extractions. Root canals can be considered basic or major. However, the majority of dental plans list root canals as basic.
Crowns, bridges, dentures, partials, surgical extractions and dental implants are dental procedures that most dental insurance companies consider as a major procedure.
Since all dental insurance carriers are different, it is important to clarify which dental procedures fall under each specific category. This is important because some insurance plans don’t cover major procedures and others have waiting periods for certain procedures. If you know that you will need major dental work that is not covered by a given plan, you should probably look elsewhere to find one that suits all of your needs.
TMJ-Temporomandibular Joint Disorder
The temporomandibular joint, also known as TMJ, is the ball and socket joint that connects the lower jaw to the bone on each side of the head. The temporomandibular joint is stabilized by muscles that make it possible to open and close the mouth. The pain, discomfort or tenderness in or around these joints are referred to as TMJ disorders. According to the National Institute of Dental and Craniofacial Research, TMJ disorders are more common in women than men and over 10 million people are affected by TMJ disorders.
The pain, discomfort or tenderness in or around the temporomandibular joints are referred to as TMJ disorders.
Signs and symptoms of TMJ disorders can include:
- Tenderness or pain in the face
- Pain in the jaw
- Pain in or around the ear
- Pain in the neck area
- Stiffness in jaw
- Chewing discomfort
- Difficulty chewing
- Difficulty opening and closing the mouth
- Locking of the jaw
- Painful clicking of the jaw
- Teeth that don’t come together properly when eating or chewing
It’s also important to note that some clicking of the jaw is normal and that other problems can cause facial pain, such as sinus, headaches and earaches.
Nitrous Oxide Questions
Nitrous Oxide is a gas that’s combined with Oxygen to produce a calming effect and a sense of well being when inhaled. Many dentists use Nitrous Oxide to help a patient relax during dental treatments.
When the dental procedure is over, the dentist will have the patient breathe only Oxygen for a few minutes to eliminate the effects of the Nitrous Oxide.
Unlike other sedations, the patient should have a clear head within minutes of coming off of the Nitrous Oxide allowing them to function normally with no lingering effects. Nitrous Oxide is also known as laughing gas.
Nitrous oxide is very safe, because it’s easy to take and mild. Nitrous oxide is not addictive. While inhaling nitrous oxide, you remain fully conscience and aware of your surroundings. After coming off of the gas, the effects of it are gone.
If you have respiratory problems or other breathing problems, such as asthma, you should talk with your dentist to see if you are a candidate for nitrous oxide.
Canker sores are very painful sores found inside the mouth that often appear out of nowhere, leaving suffers asking: What causes canker sores?
Answer: We know what canker sores are, but the exact cause is still unknown. Women statistically suffer from canker sores more often than men. Canker sores are typically seen in people between the ages of 10 and 40, although they have been known to show up at any age.
There is reason to believe that certain types of bacteria and/or viruses are responsible for the painful mouth sores. Canker sores are not contagious and are not related to the herpes simplex virus, also known as cold sores.
Canker sores are caused by:
- Injuries to the mouth, as seen frequently by contact sports players. Accidentally biting the inside of the cheek or lip may also result in a canker sore
- Temperature hot food or drink may cause a canker sore in the area of the mouth that was essentially burnt by the offending substance
- Spicy and/or acidic foods often produce a canker sore as a response to the irritation these spices and acids create in the mouth
- The use of chewing (smokeless) tobacco will often cause a canker sore to develop in the area of the mouth where the tobacco is held, due to the irritating chemicals found in the addictive product
- Poor-fitting, complete or partial dentures may cause canker sores in the area of the mouth where the denture may rubbing on the tissue. The development of a canker sore is often one of the first signs that indicate the need for a denture reline or adjustment by your dentist or denturist
- Orthodontic brackets, bands, and various other orthodontic attachments will often cause canker sores to develop in area of the mouth where there is constant friction on the oral tissues. This is common when orthodontic treatment first begins and may occur after each subsequent adjustments, throughout each stage of treatment
- Allergies to metals such as nickel may become evident in the mouth of a person wearing orthodontic devices necessary to move the teeth. Canker sores may begin to appear adjacent to the metal attachments. This is often referred to as contact dermatitis.
- Broken teeth are often sharp and may rub on the oral tissues to produce painful canker sores. Broken restorations may also cause a similar effect on the oral tissues
- Emotional stress has been identified as a possible trigger that may cause the development of canker sores
- Bacteria responsible for peptic ulcers known as Helicobacter pylori, has been linked to canker sore occurrence
- Vitamin deficiencies, specifically vitamin B12, foliate (folic acid), and iron, may trigger canker sore development
- Hormonal changes, notably during menstruation, pregnancy, and menopause, have been linked to canker sores
- Canker sores often run in families. Genetics may be a factor for many canker sore sufferers
- Allergic reactions and sensitivities to certain foods may cause a canker sore to develop. Allergic reaction to certain types of bacteria found in the mouth may also result in this type of mouth ulcer
- Celiac disease sufferers may experience canker sores. Gluten may be associated with the development of canker sores in those with celiac disease
- Information associated with inflammatory bowel disease (IBD) often will list canker sores as a complication associated with Crohn’s disease and ulcerative colitis
- Mouth sores are a common occurrence observed in immunosuppressed patients, such as those with HIV/AIDS
- Behcet’s Disease, a rare autoimmune disease that damages the body’s blood vessels notes mouth sores, more specifically canker sores, as a one of the four most common symptoms of the disease
- Sodium lauryl sulfate is a common ingredient in toothpaste and had been associated with the development of canker sores
Treatment is generally not necessary for most canker sores as they tend to heal quickly on their own. If canker sores persist for longer than 2 weeks, see the dentist.
See your dentist immediately if canker sores:
- Become unusually larger than normal
- Are extremely painful, interfering with eating, drinking, and talking
- Begin to appear more frequently than normal
- Do not heal after 14 days
- Are accompanied by a high fever
- Appear to become infected
Many people often wonder exactly what are canker sores?
Canker sores, also known as Aphthous Ulcers, are small lesions that occur inside the mouth, and are not contagious.
One to two days before appearing, a burning or tingling sensation may be present in the area of the mouth where the lesion is developing. Rarely, a fever might present itself when developing a canker sore.
Canker sores appear inside the mouth as round or oval sores typically with a red border and yellow or white center. Canker sores typically develop:
On the top surface of the tongue and the tip of the tongue
Underneath the tongue, on the floor of the mouth
The inside of the cheek and lip
On the gum tissue
Canker sores do not develop on the external surfaces of the lips and are not to be confused with cold sores.
Types of Canker Sores
Canker sores may be classified as:
Minor – Although painful, minor canker sores are often fully healed within two weeks after onset. The size of a minor canker sore varies, but typically stays under 1/3 inch to 1/2 inch.
Major – Canker sores that appear larger that 1/3 inch to 1/2 inch, last longer than two weeks, and appear to have irregular margins — oddly shaped — may be classified as major. Rarely, this type of canker sore may leave behind a scar. Common in immunosuppressed patients.
Herpetiform Canker Sores – A cluster of several tiny lesions that appear to form one larger sore. This type of canker sore may last from one week to one month.
Canker sores may become painful, especially when eating, drinking, and talking.
The cause of canker sore development varies from person to person, with an exact cause unknown.
Treatments for canker sores also vary depending on the suspected cause.
It is recommended that you seek treatment from your dentist if you have recurrent canker sores and/or canker sores that do not heal after 14 days.
Also Known As:
Canker sores are very common and they are not contagious. These irritating little sores will normally go away on their own in about one to two weeks.
Even though treatment is usually not necessary for a canker sore, you should see a dentist if one or more of the following occur:
The canker sores persist more than two weeks
The canker sore is unusually large (more than one centimeter in diameter)
A persistent high fever accompanies the sores.
The pain from the canker sore is unbearable
You experience difficulty drinking with the sores
A dentist can easily diagnose and recognize the type of sore in your mouth based on where it is located and how it looks.
Fluoride inhibits loss of minerals from tooth enamel and encourages remineralization (strengthening areas that are weakened and beginning to develop cavities). Fluoride also affects bacteria that cause cavities, discouraging acid attacks that break down the tooth. Risk for decay is reduced even more when fluoride is combined with a healthy diet and good oral hygiene.
For children under 2-years-old, use a smear of fluoridated toothpaste. For those aged 2 to 5 years, a pea-sized amount is recommended.
Using fluoride for the prevention and control of decay is proven to be both safe and effective. Nevertheless, products containing fluoride should be stored out of the reach of young children. Too much fluoride could cause fluorosis of developing permanent teeth. Fluorosis usually is mild, with tiny white specks or streaks that often are unnoticeable. In severe cases of fluorosis, the enamel may be pitted with brown discoloration. Development of fluorosis depends on the amount, duration and timing of excessive fluoride intake. The appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments in esthetic dentistry.
Fluoride is a compound that contains fluorine, a natural element. Using small amounts of fluoride on a routine basis can help prevent tooth decay. In areas where fluoride does not occur naturally, it may be added to community water supplies. Research shows that community water fluoridation has lowered decay rates by over 50 percent, which means that fewer children grow up with cavities. Fluoride can be found as an active ingredient in many dental products such as toothpaste, mouth rinses, gels and varnish.
Topical fluoride is a preventive agent applied to tooth enamel. It comes in a number of different forms. A dental professional places gels or foams in trays that are held against the teeth for up to four minutes. Fluoride varnish is brushed or “painted” on the enamel. Varnish is especially useful for young patients and those with special needs who may not tolerate fluoride trays. Children who benefit the most from fluoride are those at highest risk for decay. Risk factors include a history of previous cavities, a diet high in sugar or carbohydrates, orthodontic appliances, and certain medical conditions such as dry mouth.
Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Brushing twice a day (after breakfast and before bedtime) provides greater benefits than brushing once daily. Parents should dispense toothpaste to prevent their young children from swallowing too much.
The pediatric dentist considers many factors before recommending a fluoride supplement. Your child’s age, risk of developing dental decay and dietary sources of fluoride are important considerations. Infant formulas contain different amounts of fluoride. Bottled, filtered and well waters also vary in the amount of fluoride they contain. Your pediatric dentist can help determine if your child is receiving — and not exceeding — the recommended amount.