Dentists and insurance companies use a lot of words to describe parts of the mouth, procedures and dental insurance plans – Your dentist and our customer service representatives can explain any term you don’t know, but in the meantime here are some you can learn about:
Wear on a tooth caused by brushing too hard, holding things in your teeth, and other actions
The ability to obtain needed medical care and often affected by the availability of insurance, the cost of the care, and the geographic location of providers.
A measure of the average value of benefits in a dental insurance plan calculated as the percentage of benefit costs an insurance plan expects to pay for a standard population, using standard assumptions and taking into account cost-sharing provisions.
Maximum amount on which payment is based for covered dental care services
A mixture of different metals such as mercury, silver, tin and copper that's used to fill cavities
A request for your dental insurer or plan to review a decision or a grievance
The difference between the provider’s charge and the allowed amount
A metal ring put around a tooth with cement as part of orthodontic treatment
Set of services that are covered by an insurance policy or dental plan and specify any cost sharing requirements for services, limits on particular services, and annual or lifetime spending limits.
A tooth that has two cusps, or pointed areas on top
An X-ray of the crowns of the upper and lower molars when biting down
A tooth-colored resin material applied to a tooth to change its shape or color; also describes how a filling or orthodontic bracket sticks to the tooth
An appliance that attaches an artificial tooth or teeth to the teeth next to it
An unconscious habit of grinding or clenching of the teeth that often happens when a person is sleeping or during the day
Of or near the inside surface of the cheeks or surfaces of the teeth or restorations directed toward the cheeks
A hard deposit of minerals coated with bacterial plaque that can build up on the teeth and cause gums to become inflamed if not scraped off when a dentist cleans your teeth
Areas of tooth decay
An area of a tooth that's damaged due to caries
The thin, hard tissue that covers the root of a tooth
A request for payment that you or your dental care provider submits to your dental insurer when you get items or services you think are covered.
A method of cost sharing in dental insurance plans in which the plan member is required to pay a defined percentage of their medical costs after the deductible has been met.
A tooth-colored material made of several types of substances that's used to repair teeth
A fixed dollar amount paid by an individual at the time of receiving a covered dental care service from a participating provider. The required fee varies by the service provided and by the dental plan.
A feature of health and dental plans where beneficiaries are required to pay a portion of the costs of their care. Examples of costs include co-payments, coinsurance and annual deductibles.
The top part of the tooth that's covered with enamel; also an artificial cover for a tooth to repair it or restore it to its normal shape and size after a root canal or other dental work
One of the pointed parts on the top of a tooth
A feature of health and dental plans in which consumers are responsible for covered care costs up to a specified dollar amount.
Thin strands of material used to clean between the teeth and around the gums at home
The substance underneath the enamel on the top of a tooth and under the cementum at the root
Insurance coverage for family members of the policyholder, such as spouses, children, or partners
Pain and inflammation in a tooth socket after the tooth is removed
Electronic Health Record/Electronic Medical Records
Computerized records of a patient’s health or dental information including medical, demographic, and administrative data
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse
Insurance coverage provided to employees, and, in some cases, their spouses and children, through an employer
The hard, calcium-rich surface on the crown of a tooth
A specialist who treats problems of the tooth nerve (pulp) or infections in the bone associated with infected nerves using procedures such as root canal
Essential Health Benefits
A package of benefits set by the Secretary of Health and Human Services that insurers must offer under the Marketplaces.
Dental care services that your insurance carrier or plan doesn’t pay for or cover.
The removal of all or part of a tooth
A traditional method of paying for medical services under which doctors and hospitals are paid for each service they provide. Bills are either paid by the patient, who then submits them to the insurance company, or are submitted by the provider to the patient’s insurance carrier for reimbursement.
Material used to repair a damaged area of a tooth; it can be made of metals, plastic or porcelain
The soft tissues around the teeth; also called gums
An early form of gum disease where the gums are inflamed and become red and swollen and bleed easily; usually caused by plaque buildup
Group Dental Insurance
Dental insurance that is offered to a group of people, such as employees of a company
Requires insurers to offer and renew coverage, without regard to health status, use of services, or pre-existing conditions
Health Insurance Marketplace
A purchasing arrangement through which insurers offer and smaller employers and individuals purchase health insurance
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Through The Health Insurance Portability and Accountability Act of 1996, individuals in many states who lose group health coverage after a loss of employment have access to coverage through high-risk pools, with no pre-existing condition exclusion periods. HIPAA also sets standards that address the security and privacy of personal health data.
A tooth that's blocked from coming up through the gums by another tooth, bone or soft tissue
A device put into the jaw bone to hold a prosthesis such as a crown or bridge
Individual Insurance Market
The market where individuals who do not have group (usually employer-based) coverage purchase private health insurance.
The percent you pay of the allowed amount for covered dental care services to providers who contract with your dental insurance or plan.
A fixed amount you pay for covered dental care services to providers who contract with your dental insurance or plan.
Of or near the tongue
When the upper and lower teeth aren't lined up well in order to bite and chew properly
Certain benefits or services that state-licensed health insuring organizations are required to cover in their health insurance plans
The lower jaw
The upper jaw
Process of determining whether or not to accept an applicant for health care coverage based on their medical history
Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
The large teeth near the back of the jaws that are used for grinding food
A removable device that a person wears over his/her teeth to protect them from damage during sports
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
A removable device that a person wears over his/her teeth at night to protect them from damage due to bruxism
A provider who doesn’t have a contract with your health insurer or plan to provide services to you
The contact between the upper and lower teeth in order to bite and chew
Open Enrollment Period
Period of time set up to allow you to choose from available plans, usually once a year
A type of dentist who works to correct the position of teeth with braces and other tools
Percent you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan
Fixed amount you pay for covered health care services from providers who do not contract with your health insurance or plan
Health care costs, such as deductibles, co-payments, and co-insurance that are not covered by insurance
Yearly cap on the amount of money individuals are required to pay out-of-pocket for health care costs, excluding the premium cost
The hard and soft tissues that form the roof of the mouth
Pay for Performance
A health care payment system in which providers receive incentives for meeting or exceeding quality, and sometimes cost, benchmarks.
A dentist who only treats children
A deep area between a tooth and gum that's the result of gum disease
A dentist who specializes in treating the tissues that surround the teeth
Periodontitis (periodontal disease)
A severe infection of the gums that occurs when gingivitis gets worse; can cause the gums and bones that support the teeth to break down, teeth can then loosen and fall out
Health care services provided by a licensed medical physician
A 12-month period of benefits coverage under a group health plan
A sticky film of bacteria and other substances that coat the teeth every day. Brushing and flossing help remove plaque; if not removed regularly, plaque can lead to gum disease
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary, sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
Pre-existing Condition Exclusions
An illness or medical condition for which a person received a diagnosis or treatment within a specified period of time prior to becoming insured
Amount paid, often on a monthly basis, for health insurance
Activities to prevent illness such as routine check-ups, immunizations, patient counseling, and screenings
Health care that emphasizes the early detection and treatment of diseases.
An artificial replacement of a tooth or teeth
A physician, health care professional or health care facility licensed, certified or accredited as required by state law
Provider Payment Rates
Total payment a provider, hospital, or community health center receives when they provide medical services to a patient
The soft tissue inside the tooth that has blood vessels and nerves
Qualified Health Plan
Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by an Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements.
Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions.
Insurance for insurance companies and employers that self-insure their employees’ medical costs
A kind of treatment that repairs or replaces teeth
A removable device worn in the mouth to prevent teeth from moving out of position
The bottom part of the tooth that anchors it in the jaw and is covered by bone and the gums
A treatment that removes the tooth nerve (pulp) and seals the space formerly occupied by the nerve with an inert material; a crown is recommended to cover the tooth to prevent it from breaking
Cleaning of a tooth root to remove bacteria, calculus and diseased surfaces
A procedure that uses tools to remove plaque, tartar and stains from teeth
A plastic resin that can be put on the biting surfaces of back teeth to help prevent caries
A plan where the employer assumes direct financial responsibility for the costs of enrollees’ medical claims.
Small Group Market
Firms with 2-50 employees can purchase health insurance for their employees through the Marketplace, which is regulated by states.
Under the tongue
Below the lower jaw
A hard deposit of minerals coated with bacterial plaque that can build up on the teeth and cause gums to get inflamed
Temporomandibular joint (TMJ)
The joint that connects the lower jaw to the skull
Temporomandibular Joint Dysfunction
Pain, clicking and other symptoms that are caused by problems with the temporomandibular joint and the associated muscles
A thin, artificial cover for a tooth to correct its shape or color, made to look and feel like a real tooth; veneers can be made of porcelain, ceramic, composite or acrylic resin
Waiting Period (Job-based coverage)
The time that must pass before coverage can become effective for an employee or dependent, who is otherwise eligible for coverage under a job-based health plan.
Dry mouth caused by salivary glands that don't work properly or reduced flow of saliva from medications
An image of bones, teeth and restorations made with radiation