Question: I have a dental PPO plan though Anthem Blue Cross from my employer.  Even though I have had it for a few years this was the first time I really used it for anything more then my free cleaning.    About a month ago I had some dental work that was rather costly.  Now I get an additional billing from my dentist stated that the insurance did not pay out much for the full porcelain crown that I got.  However my dental plan says they will pay out half the cost for crowns.

Calling up the dental insurance company right away I was told that they do not cover out that ADA code but will cover up to the UCR rate for covered crowns on non covered crowns.  It really seemed like double talk to me.  A crown is a crown!  What do they mean ADA code?  Please help me understand.

Answer: ADA codes are the service code for each individual dental service. This code number does not change and it let everyone from the dental office, insurance company and claims department know what dental service you had done. Although wording can very the code dose not.  There are many ADA codes for crowns here is a sample

2740 Crown porcelain ceramic substrate
2783 Crown ¾ porcelain ceramic
2750 Crown-porcelain fused to high noble metal
2751 Crown-porcelain fused to predominantly base metal
2791 Crown-full cast predominantly base and
2810 Crown-3/4 cast metallic

There are more but I listed a few to show you that a crown is not just a crown. Under many PPO plans they may only provide benefits for a lower cost crown so when you get a higher cost crown they paid out only up to the UCR for the crown that they cover. This offers you some saving but now as much as if you would have chosen a covered crown.  One way to avoid having billing surprises such as these is to have your dental office submit claims as a quote only, to your insurance company prior to dental services being render.  That way you will know your cost ahead of time and then can decide if that is something you wish to continue with based on your budget.

Question: I have four sliver filling that where put in when I was a kid.  Now that I am older and working I like to change them out for new white filling can that be done?

Answer: If you are asking can a dentist change out old silver filling to Resin-Based Composite (tooth color filling), in most cases yes. However if you are wanting to know if dental insurance will provide benefits for this type of dental service, often times they will not. Many dental insurance plans will not cover this type of dental service, since it is viewed as a cosmetic service.

Yet most dental insurance plans will provide benefits, when there is a new cavity in the tooth that has the old silver filling requiring the filling to be removed in order to fix the cavity. In this case, you do not have to replace the filling with a silver filling but can at that point replace it with a resin base composite filling.

Before the appointment, obtain and review the patient’s medical history. Consultation with physicians, family, and caregivers is essential to assembling an accurate medical history. Also, determine who can legally provide informed consent for treatment.

Talk with the parent or caregiver to determine your patient’s intellectual and functional abilities, and then communicate with the patient at a level he or she can understand.

Use a “tell-show-do” approach to providing care. Start by explaining each procedure before it occurs. Take the time to show what you have explained, such as the instruments you will use and how they work. Demonstrations can encourage some patients to be more cooperative.

BEHAVIOR PROBLEMS –which may include hyperactivity and quick frustration–can complicate oral health care for patients with autism. The invasive nature of oral care may trigger violent and self-injurious behavior such as temper tantrums or head banging.

• Plan a desensitization appointment to help the patient become familiar with the office, staff, and equipment through a step-by-step process. These steps may take several visits to accomplish.
• Have the patient sit alone in the dental chair to become familiar with the treatment setting. Some patients may refuse to sit in the chair and choose instead to sit on the operator’s stool.
• Once your patient is seated, begin a cursory examination using your fingers.
• Next, use a toothbrush to brush the teeth and gain additional access to the patient’s mouth. The familiarity of a toothbrush will help your patient feel comfortable and provide you with an opportunity to further examine the mouth.
• When the patient is prepared for treatment, make the appointment short and positive.
• Pay special attention to the treatment setting. Keep dental instruments out of sight and light out of your patient’s eyes.
• Praise and reinforce good behavior after each step of a procedure. Ignore inappropriate behavior as much as you can.
• Try to gain cooperation in the least restrictive manner. Some patients’ behavior may improve if they bring comfort items such as a stuffed animal or a blanket. Asking the caregiver to sit nearby or hold the patient’s hand may be helpful as well.
• Use immobilization techniques only when absolutely necessary to protect the patient and staff during dental treatment–not as a convenience. There are no universal guidelines on immobilization that apply to all treatment settings. Before employing any kind of immobilization, it may help to consult available guidelines on federally funded care, your State department of mental health disabilities, and your State Dental Practice Act. Guidelines on behavior management published by the American Academy of Pediatric Dentistry (www.aapd.org) may also be useful. Obtain consent from your patient’s legal guardian and choose the least restrictive technique that will allow you to provide care safely. Immobilization should not cause physical injury or undue discomfort.
• If all other strategies fail, pharmacological options are useful in managing some patients. Others need to be treated under general anesthesia. However, caution is necessary because some patients with developmental disabilities can have unpredictable reactions to medications.

People with autism often engage in perseveration, a continuous, meaningless repetition of words, phrases, or movements. Your patient may mimic the sound of the suction, for example, or repeat an instruction over and again. Avoid demonstrating dental equipment if it triggers perseveration, and note this in the patient’s record.

UNUSUAL RESPONSES TO STIMULI can create distractions and interrupt treatment. People with autism need consistency and can be especially sensitive to changes in their environment. They may exhibit unusual sensitivity to sensory stimuli such as sound, bright colors, and touch. Reactions vary: Some people with autism may overreact to noise and touch, while exposure to pain and heat may not provoke much reaction at all.

• Use the same staff, dental operatory, and appointment time to sustain familiarity. These details can help make dental treatment seem less threatening.
• Minimize the number of distractions. Try to reduce unnecessary sights, sounds, odors, or other stimuli that might be disruptive. Use an operatory that is somewhat secluded instead of one in the middle of a busy office. Also, consider lowering ambient light and asking the patient’s caregiver whether soft music would help.
• Allow time for your patient to adjust and become desensitized to the noise of a dental setting. Some patients may be hypersensitive to the sound of dental instruments.
• Talk to the caregiver to get a sense of the patient’s level of tolerance. People with autism differ in how they accept physical contact. Some are defensive and refuse any contact in or around the mouth, or cradling of the head or face. Others find such cradling comforting.
• Note your findings and experiences in the patient’s chart.

UNUSUAL AND UNPREDICTABLE BODY MOVEMENTS are sometimes observed in people with autism. These movements can jeopardize safety as well as your ability to deliver oral health care.Make sure the path from the reception area to the dental chair is clear.

Observe the patient’s movements and look for patterns. Try to anticipate the movements, either blending your movements with those of your patient or working around them.SEIZURES may accompany autism but can usually be controlled with anticonvulsant medications. The mouth is always at risk during a seizure: Patients may chip teeth or bite the tongue or cheeks. People with controlled seizure disorders can easily be treated in the general dental office.Consult your patient’s physician. Record information in the chart about the frequency of seizures and the medications used to control them.

Determine before the appointment whether medications have been taken as directed. Know and avoid any factors that trigger your patient’s seizures.

Be prepared to manage a seizure. If one occurs during oral care, remove any instruments from the mouth and clear the area around the dental chair. Attaching dental floss to rubber dam clamps and mouth props when treatment begins can help you remove them quickly. Do not attempt to insert any objects between the teeth during a seizure.

Stay with your patient, turn him or her to one side, and monitor the airway to reduce the risk of aspiration.

Question: So I have a dental PPO plan I get though my job.  What I do not understand is how my dental insurance states my coverages are one thing but when a claim is filed the numbers do not add up.  For an example, not that long ago I had a large filling and a crown put on.  The filling coverages where to be at 80% paid.  Which it was so that was fine   However the crown I got cost $1000.00 and my plan said that it paid out 50% for the cost of a crown.  Straight forward math right I should only have to pay $500.00 which was my co-payment of 50%.   I then get the billing from the dental office stating the insurance company only paid out only $450.00 so my cost is $550.00 now it is only $50.00 more but this happens quite a lot. What should I do about this?

Answer:  In general PPO plans pay out by percentage in your case 80% for basic services such as fillings and 50% for major services such as crowns.  But it dose not just stop there.  Normally they will state that the percentage paid out is up to UCR (Usual, Customary, and Reasonable) There for if the dentist you are going to is above the UCR rate for the company you will have an additional charge.     Also some PPO plans will have two sets of coverage one for network dentist and another for out side network dentist. Out side network dentist normally will have less benefits then inside network providers.    As to why you are paying more, I could not say which is the case for you. That will be something I would advise you call your plan’s member services for. They can go over your benefits and directly answer what is effecting your cost on claims.

However here is a tip you may want to keep in mind. Prior to having any dental services started, have your dental office submit to your insurance company as a quote only. That way you will know your true cost for any needed dental care without having to worry about additional cost.

Cerebral Palsy: Dental Health Care

People with cerebral palsy may present with physical and mental challenges that have implications for oral care. Before the appointment, obtain and review the patient’s medical history. Consultation with physicians, family, and caregivers is essential to assembling an accurate medical history. Also, determine who can legally provide informed consent for treatment.

The different TYPES OF CEREBRAL PALSY are classified according to associated motor impairments:

Spastic palsy presents with stiff or rigid muscles on one side of the body or in all four limbs, sometimes including the mouth, tongue, and pharynx. People with this form of cerebral palsy may have legs that turn inward and scissor as they walk, or arms that are flexed and positioned against their bodies. Many also have intellectual disability, seizures, and dysarthria (difficulty speaking).

Dyskinetic or athetoid palsy is characterized by hypotonia and slow, uncontrolled writhing movements. People with this type of cerebral palsy experience frequent changes in muscle tone in all areas of their bodies; muscles may be rigid during waking hours and normal during sleep. Dysarthria is also associated with this type.

Ataxic palsy is marked by problems with balance and depth perception, as well as an unsteady, wide-based gait. Hypotonia and tremors sometimes occur in people with this rare type of cerebral palsy.

Combined palsy reflects a combination of these types.

Everyone who has cerebral palsy has problems with movement and posture. Observe each patient, then tailor your care accordingly.

• Maintain clear paths for movement throughout the treatment setting. Keep instruments and equipment out of the patient’s way.
• Clinician standing behind a patient, cradling the patient’s head while resting her hand around the patient’s mandible. The clinician is using a transfer board.
• Positioningfor treating a patient in a wheelchair.  Note the support asliding board can provide.  Sliding or transfer boards areavailable from  home health care companies.
• Some patients cannot be moved into the dental chair but instead must be treated in their wheelchairs. Some wheelchairs recline or are specially molded to fit people’s bodies. Lock the wheels, then slip a sliding board (also called a transfer board) behind the patient’s back to support the head and neck.
• If you need to transfer your patient from a wheelchair to the dental chair, ask about special preferences such as padding, pillows, or other things you can provide to ease the transition. The patient or caregiver can often explain how to make a smooth transfer. (See Wheelchair Transfer: A Health Care Provider’s Guide, also part of this series.)

  UNCONTROLLED BODY MOVEMENTS are common in people with cerebral palsy. Their limbs move often, so providing oral care can be difficult. When patients with cerebral palsy attempt to move in order to help, their muscles often tense, increasing uncontrolled movements.

• Make the treatment environment calm and supportive. Try to help your patient relax. Relaxation will not stop uncontrolled body movements, but it may reduce their frequency or intensity.
• Place and maintain your patient in the center of the dental chair. Do not force arms and legs into unnatural positions, but allow the patient to settle into a position that is comfortable and will not interfere with dental treatment.
• Observe your patient’s movements and look for patterns to help you anticipate direction and intensity. Trying to stop these movements may only intensify the involuntary response. Try instead to anticipate the movements, blending your movements with those of your patient or working around them.
• Softly cradle your patient’s head during treatment. Be gentle and slow if you need to turn the patient’s head.
• Exert gentle but firm pressure on your patient’s arm or leg if it begins to shake.
• Try to keep appointments short, take frequent breaks, or consider prescribing muscle relaxants when long procedures are needed. People with cerebral palsy may need sedation, general anesthesia, or hospitalization if extensive dental treatment is required.

  PRIMITIVE REFLEXES are common in many people with cerebral palsy and may complicate oral care. These reflexes often occur when the head is moved or the patient is startled, and efforts to control them may make them more intense. Three types of reflexes are most commonly observed during oral care.

  Asymmetric tonic neck reflex: When a patient’s head is turned, the arm and leg on that side stiffen and extend. The arm and leg on the opposite side flex.

  Tonic labyrinthine reflex: If the neck is extended while a patient is lying on his or her back, the legs and arms also extend, and the back and neck arch.

  Startle reflex: Any surprising stimuli, such as noises, lights, or a sudden movement on your part, can trigger uncontrolled, often forceful movements involving the whole body.

  Be empathic about your patient’s concerns and frustrations.    Minimize the number of distractions in the treatment setting. Movements, lights, sounds, or other stimuli can make it difficult for your patient to cooperate. Tell him or her about any such stimulus before it appears. For example, tell the patient before you move the dental chair.

  MENTAL CAPABILITIES vary. Many people with cerebral palsy have mild or moderate intellectual disability, but only 25 percent have a severe form. Some have normal intelligence.

• Talk with the parent or caregiver to determine your patient’s intellectual and functional abilities, then explain each procedure at a level the patient can understand. Allow extra time to explain oral health issues, instructions, or procedures.
• Use simple, concrete instructions and repeat them often to compensate for any short-term memory problems. Speak slowly and give only one direction at a time.
• Demonstrations can make patients more cooperative. For example, turn on the saliva ejector so the patient can hear it and feel it at the corner of the mouth. Then slowly introduce it inside the mouth, being careful not to trigger a gag reflex.
• Be consistent in all aspects of oral care. Use the same staff and dental operatory each time to help sustain familiarity. Consistency leads to improved cooperation
• Listen actively, since communicating clearly is difficult for some–show your patient whether you understand. Be sensitive to the methods he or she uses to communicate, including gestures and verbal or nonverbal requests.

  SEIZURES may accompany cerebral palsy, but can usually be controlled with anticonvulsant medications. The mouth is always at risk during a seizure: Patients may chip teeth or bite the tongue or cheeks. Patients with controlled seizure disorders can easily be treated in the general dental office.

• Consult your patient’s physician. Record information in the chart about the frequency of seizures and the medications used to control them. Determine before the appointment whether medications have been taken as directed. Know and avoid any factors that trigger your patient’s seizures.
• Be prepared to manage a seizure. If one occurs during oral care, remove any instruments from the mouth and clear the area around the dental chair. Attaching dental floss to rubber dam clamps and mouth props when treatment begins can help you remove them quickly. Do not attempt to insert any objects between the teeth during a seizure.
• Stay with your patient, turn him or her to one side, and monitor the airway to reduce the risk of aspiration.

  VISUAL IMPAIRMENTS affect a large number of people with cerebral palsy. The most common of these defects is strabismus, a condition in which the eyes are crossed or misaligned. People with cerebral palsy may develop visual motor skills, such as hand-eye coordination, later than other people.

• Determine the level of assistance your patient requires to move safely through the dental office.
• Use your patients’ other senses to connect with them, establish trust, and make treatment a good experience. Tactile feedback, such as a warm handshake, can make your patients feel comfortable.
• Face your patients when you speak and keep them apprised of each upcoming step, especially when water will be used. Rely on clear, descriptive language to explain procedures and demonstrate how equipment might feel and sound. Provide written instructions in large print (16 point or larger).

  HEARING LOSS and DEAFNESS can be accommodated with careful planning. Patients with a hearing problem may appear to be stubborn because of their seeming lack of response to a request.

• Patients may want to adjust their hearing aids or turn them off, since the sound of some instruments may cause auditory discomfort.
• If your patient reads lips, speak in a normal cadence and tone. If your patient uses a form of sign language, ask the interpreter to come to the appointment. Speak with this person in advance to discuss dental terms and your patient’s needs.
• Visual feedback is helpful. Maintain eye contact with your patient. Before talking, eliminate background noise (turn off the radio and the suction). Sometimes people with a hearing loss simply need you to speak clearly in a slightly louder voice than normal. Remember to remove your facemask first or wear a clear face shield.

  DYSARTHRIA is common in people with cerebral palsy, due to problems involving the muscles that control speech and mastication.

• Be patient. Allow time for your patient to express himself or herself. Remember that many people with dysarthria have normal intelligence.
• Consult with the caregiver if you have difficulty understanding your patient’s speech.

  GASTROESOPHAGEAL REFLUX sometimes affects people with cerebral palsy, including those who are tube-fed. Teeth may be sensitive or display signs of erosion. Consult your patient’s physician about the management of reflux.

• Place patients in a slightly upright position for treatment.
• Talk with patients and caregivers about rinsing with plain water or a water and baking soda solution. Doing so at least four times a day can help mitigate the effects of gastric acid. Stress that using a fluoride gel, rinse, or toothpaste every day is essential.

Question: I am 52 years old and been fighting for years to keep my teeth. After years of having major dental services dealing with dental pain all the time and not to count the expense I am tired of it all. I am thinking of pulling the teeth I have left and getting complete dentures.  The dentist I going to now does not want to pull my teeth saying they do not need to be pulled and I should continue having dental care for them. Sure once there pulled and I get dentures there will be no more dental bills. I looking for a dental insurance plan that will let me have dentures if that is what I want and not say it is elective and not cover them. Please advise.

Answer: I suggest reviewing our dental discount plans. It sounds like you would want the flexibility that a dental discount plans gives you. With a dental discount plan what you have done is up to your and the dentist within the plan. The company does not state what you can or can not have done. You get discounted savings for all your dental needs at the time the services are render. If you want dentures you pay only the discounted cost for them as listed on the fee schedule. The thing is that you would need to find a dentist in the plan that is willing to pull out teeth that may not have to be pulled. So make phone calls and make sure you have a dentist in the plan will to work with you and your needs.

Applying sealants does not require drilling or removing tooth structure. The process is short and easy. After the tooth is cleaned, a special gel is placed on the chewing surface for a few seconds. The tooth is then washed off and dried. Then, the sealant is painted on the tooth. The dentist or dental hygienist also may shine a light on the tooth to help harden the sealant. It takes about a minute for the sealant to form a protective shield.

Your family oral health care is very important to maintain as your oral health has direct links to your overall health wellness. Therefore a few ways to maintain you and your family oral health is by having good at home oral health care habits and seeing your dentist regularly.   Studies also show that families that have dental insurance in place are more likely to see their family dentist regularly. In addition dental insurance helps keep your family dental care cost lower and more affordable.

Dental sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth to protect them from tooth decay. Most tooth decay in children and teens occurs on these surfaces. Sealants protect the chewing surfaces from tooth decay by keeping germs and food particles out of these grooves

For healthy teeth and gums it is important to understand that your dental health start at home. Make sure you are brushing your teeth twice a day and flossing daily.  Use mouthwash that kills germs and fights against gum disease.  Seeing your dentist regularly  is an important part of maintaining good oral health, by doing your part at home you help to avoid having larger dental care needs that only your dentist can address.

The best advise when shopping for dental insurance is to read each plan terms and conditions carefully.  It is in the terms and conditions that will let you know what is limited and or not covered under the  plan.  Fulling reading each plan is key to understanding how the plan works and if it will best fit your dental care needs.

Also remember our member services is here to help you if you have any questions about the different dental insurance and plan types provided on our website.  It is better to call us at 310-534-3444 if you have questions then to buy a plan that may not workout best for your dental health needs.

Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include deep cleaning of the tooth root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes corrective surgery.

To help prevent or control periodontal diseases, it is important to:

* Brush and floss every day to remove the bacteria that cause gum disease. See a dentist at least once a year for checkups, or more frequently if you have any of the warning signs or risk factors mentioned in our prior post.

Question: What is the average cost of a crown? Are crowns really cheaper with dental insurance?

Answer:

Average Cost for Crowns in California

* Porcelain-fused-to-metal crowns can cost around $500-$1,500 or more per tooth.

* Metal crowns of gold alloy or of base metal alloys can cost $600-$2,500 or more per tooth

* All-porcelain crowns require a higher level of skill and take more time to install than metal or porcelain-fused-to-metal crowns, and can cost $800-$3,000 or more per tooth.
With Insurance

* Generally dental PPO insurance plans will pay out 50% of the cost of major services (after any waiting periods the plan may have)

* With HMO dental insurance plans they are fee based which means they will have a schedule of Services braking down the cost for each covered item so cost will very but in many cases crowns would still much cheaper then not having dental insurance

* It is important to note that not all dental insurance plans will cover for All-porcelain crowns so make sure you read the plans terms and conditions.

Certain factors increase the risk for periodontal disease:

* Smoking
* Diabetes
* Poor oral hygiene
* Stress
* Heredity
* Crooked teeth
* Underlying immuno-deficiencies—e.g., AIDS
* Fillings that have become defective
* Taking medications that cause dry mouth
* Bridges that no longer fit properly
* Female hormonal changes, such as with pregnancy or the use of oral contraceptives

Question: A close friend of mine really needs dental health care.  She does not have dental insurance and only works about 20 hours work weeks.  She said she has tried getting payment plans from different dental offices, for dental services she will need but was turned down each time for poor credit.

Answer: I would suggest she review either our dental HMO insurance plans though California Dental or PrimeCare or our dental discount plans though Careington and Aetna. Both of these plan type are low in cost and will help to make her dental care more affordable.  However depending on how much dental care services she needs, she made still have to budget in her dental care and do a little at a time as she can afford it.

The following are warning signs of periodontal disease:

* Bad breath or bad taste that won’t go away
* Red or swollen gums
* Tender or bleeding gums
* Painful chewing
* Loose teeth
* Sensitive teeth
* Gums that have pulled away from your teeth
* Any change in the way your teeth fit together when you bite
* Any change in the fit of partial dentures

Question: I am in very bad shape and need major gum grafting care.   I am low income but I do have dental insurance for basic dental care.  So my current dental insurance will not cover the gum surgery I need. Are there any teaching hospitals for dental care I can go that will provide the services for free?

Answer: Dental school will normally still charge for their services provided. However at a much lower cost.  They also sometimes base their cost on what you can afford to pay.  You will need to call the local school that are near you to find out what their cost factors would be.

Bacteria in the mouth infect tissue surrounding the tooth, causing inflammation around the tooth leading to periodontal disease. When bacteria stay on the teeth long enough, they form a film called plaque, which eventually hardens to tartar, also called calculus. Tartar build-up can spread below the gum line, which makes the teeth harder to clean. Then, only a dental health professional can remove the tartar and stop the periodontal disease process.

Dental discount plans are a good low cost alternative to dental insurance. Like insurance it has it pros and cons.

Pros:
* Most dental discount plans starts the first of next month or within the next business day from ordering it on line.

* Most dental discount plans do not have any waiting periods, max limitations, or deductibles

* You are not assigned to a dental provider office though you do need to go to plan providers.

Cons: 

* You have to go to plan providers. There is no outside dental discounts.

* You pay for all dental services but at a reduced or discount price.

* Dental discount plans are not insurance they are discount plans..

Periodontal diseases are infections of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out. Periodontal disease is mostly seen in adults. Periodontal disease and tooth decay are the two biggest threats to dental health.