Complete Glossary of Dental Insurance Terminology

Understanding the definitions for common dental insurance expressions and terms will give you a better understanding of how medical insurance works.

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Abrasion

Loss of tooth structure caused by a hard toothbrush, poor brushing technique, or Bruxism (grinding or clenching the teeth).

Abscess

A swelling caused by an an infection resulting in a pus filled hole.

Abutment

Tooth, root or implant used to support an artificial tooth restoration.

Abutment Crown

See Crown.

Accepted Fee

The dollar amount the attending dentist has agreed to accept as payment in full from the insurance company and the patient.

Acid Etching

Use of an acidic chemical substance to prepare the tooth enamel surface to provide retention for bonding.

Acute Necrotizing Ulcerative Gingivitis (ANUG)

See ANUG.

Additional Insured

Anyone covered under your plan that is not named as insured in your documentation from the insurance company.

Adhesive Dentistry

Contemporary term for dental restorations that involve "bonding" of composite resin or porcelain fillings to natural teeth.

Administrative Costs

Overhead expenses incurred in the operation of a dental benefit program, exclusive of costs of dental services provided.

Adverse Selection

A statistical condition within a group when there is a greater demand for dental services and/or more services necessary than the average expected for that group. See Antiselection.

Air Abrasion

A method of removing tooth decay without a drill and anesthesia, by using compressed air and fine sand particles.

Allergy

Unfavorable systemic response to a foreign substance or drug.

Allogenic

See Graft.

Alloplastic

Refers to the synthetic material often used for tissue augmentation.

Allowable Charge

The maxmum dollar amount on which benefit payment is based for each dental procedure.

Alveolar Bone

The jaw bone that anchors the roots of teeth.

Alveolar Process

The part of the jaw that holds the teeth.

Alveolus

The tooth socket or cavity in which the root of the tooth is held in place by the periodontal membrane.

Alveoloplasty

A surgical procedure for recontouring alveolar structures, usually in preparation for a prosthesis.

Amalgam

Metal filling material, a mixture primarily of mercury and silver with small amounts of tin, zinc and copper. Usually called a silver filling.

Analgesia

Loss of pain sensation without loss of consciousness. An agent to lessen pain.

Anatomical Crown

See Crown.

Anesthesia

Partial or complete elimination of pain sensation; numbing a tooth is an example of local anesthesia; general anesthesia produces partial or complete unconsciousness.

Annual Maximum Benefit

Maximum dollar amount paid by the dental plan in a plan year.

Anniversary Year

Beginning on the day of the month the patients´ insurance becomes effective.

Anomaly

Deviation from the normal anatomic growth, development or function; an abnormality.

Anterior Teeth

The six upper or six lower front teeth.

Antibiotic

A drug that stops or slows the browth of bacteria.

Antiselection

The tendency of persons who present a poorer-than-average risk to apply for, or continue, insurance to a greater extent than do persons with average or better-than-average expectations of loss.

Antiseptic

A chemical agent which can be applied to living tissue to destroy germs.

ANUG (Acute Necrotizing Ulcerative Gingivitis)

A progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums. Also known as Trench Mouth.

Apex

The end of the tooth root.

Apexification

The process of induced root development.

Apicoectomy

Amputation of the tip of the root.

Appeal

A request to a dental plan to review a decision that denied or limited the treatment or proposed treatment to the beneficiary of the plan; usually made by the attending dentist on behalf of the plan beneficiary.

Applicant

The employer, association, group or individual contracting to obtain benefits.

Approved amount

The total fee chargeable for a Single Procedure.

Arch

The curved structure of the natural dentition or the ridge remaining after the loss of some or all of the natural teeth.

Arthrogram

A diagnostic X-Ray technique used to view bone structure following injection of a contrast medium into a joint.

Articulator

A special holder for models of your teeth. An Articulator holds the models in the same alignment as your jaw so the Orthodontist can look carefully at your bite.

Aspirator

A tube like a straw which the dentist puts in your mouth to suck up all the saliva.

Aspiration

Removal of fluids from your mouth with an aspirator..

Assignment of benefits

When a covered person authorizes his or her health benefits plan to directly pay a health care provider for covered services. Traditional health insurance pays benefits directly to the covered person.

Association

A goup. Often, associations can offer individual dental insurance plans specially designed for its members.

Attending Dentist´s Statement

Also known as the ADA Dental Claim Form; used to report dental procedures to a third-party payer. This claim form was developed by the American Dental Association.

Attrition

Loss of structure due to natural wear.

Audit

An examination of records and accounts to check their accuracy. A post-treatment record review or clinical examination to verify information reported on claims.

Autoclave

A device that has a chamber where instruments are placed and steam under pressure is injected, in order to complete sterilization.

Autogenous

See Graft.

Avulsion (Evulsion)

Separation of tooth from its socket due to trauma.

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Baby Teeth (Deciduous)

First set of teeth (10 upper and 10 lower) that is later replaced by permanent teeth.

Back Teeth

See Posterior Teeth.

Balance Billing

Billing a patient for the difference between the dentist´s actual charge and the amount reimbursed under the patient´s dental benefit plan.

Base

Cement placed under a dental restoration to insulate the nerve chamber.

Basic Service

Dental procedures to repair and restore individual teeth due to decay, trauma, impaired function, attrition, abrasion or erosion. These usually include fillings and extractions.

Bell's palsy

Paralysis of the facial nerve resulting in the permanent or temporary immobilization of the eye on either side of the face. Usually caused by injury or infection.

Beneficiary

A person eligible for benefit under a dental insurance policy. See Insured.

Benefit / Benefits

The dollar amount your insurance company will pay when you file a claim for a covered loss.

Benefit Accumulation

Amount that has been paid for the covered person during the plan year.

Benefit Booklet

A booklet provided by the subscriber which contains a general explanation of the benefits and related provisions of the dental benefit program. Also known as a 'Summary Plan Description'.

Benefit Period

The interval during which you will be eligible for benefits.

Benefit Plan Document

See Certificate of Coverage.

Benefit Plan Summary

The description or synopsis of employee benefits required by ERISA to be distributed to the employees.

Benefit Year

Begins on the month that the employer purchased the plan.

Benign

The mild character of an illness or the non-malignant character of a neoplasm.

Bicuspids or Pre-Molar

Teeth between the canine teeth and molars. See (Premolars).

Bifurcation (Trifurcation)

Juncture of two (three) roots in posterior teeth.

Bilateral

Occurring on, or pertaining to, both right and left sides.

Biopsy

Process of removing tissue for laboratory evaluation.

Bite

Relationship of the upper and lower teeth on closure (occlusion).

Bitewing / Bite Wings X-ray

X-rays used to reveal the crowns of several upper and lower teeth as they bite down. They are called Bitewings because the X-ray film holder provides a surface to bite down on and hold the X-ray securely in place. See X-Rays.

Black Hairy Tongue

Elongated papillae on the tongue, promoting the growth of microorganisms.

Bleaching

Chemical or laser treatment of natural teeth for whitening effect.

Block Injection

Anesthesia of a nerve trunk that covers a large area of the jaw; a mandibular block injection produce numbness of the lower jaw, teeth, half the tongue.

Bonding

A cosmetic procedure in which teeth are coated with composite resin in order to cover stains or improve apperance.

Bone Resorption

Decrease in bone supporting the roots of teeth; a common result of Periodontal (Gum Disease).

Braces

Devices used by Orthodontists to gradually reposition teeth.

Bridge

An artificial fixed or removable prosthesis replacing one or more teeth.

Bruxism

The habit of tooth grinding, usually during sleep, often resulting in loose or worn teeth, gum recession, destruction of the supportive bone and TMJ disorders.

Bruxomania

Persistent "nervous" grinding of the teeth while the patient is awake.

Buccal Surface

Surface of the back teeth next to the cheek.


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Cafeteria Plan

A benefit program in which employees are given the ability to choose from a selection ("menu") of benefit plans. Also known as "Flexible Benefits."

Calendar Year

The twelve months of the year from January 1 – December 31.

Calendar Year Deductible

The dollar amount for covered services that must be paid during the calendar year (January 1 – December 31) by members before any benefits are paid by the insurance company.

Calendar Year Maximum Benefit

This is the maximum dollar amount that we will pay per year for covered expenses for each covered member

Cal-COBRA (Consolidated Omnibus Budget Reconciliation Act)

Cal-COBRA (in California) applies to groups with 2-19 employees (COBRA applies to groups with 20+ employees). Cal-COBRA provides for the continuation of coverage for employees and eligible dependents of qualifying groups with 2-19 employees. Cal-COBRA provides continuation of coverage for groups of 2-19 eligible employees for at least 50% of the working days in the previous calendar year. Groups of one employee are not eligible for Cal-COBRA. An employee and/or his/her eligible dependents are eligible for continuation of coverage under Cal-COBRA for up to 36 months, if coverage was terminated due to any of the following qualifying events:

  1. Death of the plan subscriber (continuation for dependents);
  2. Employee´s termination of employment or reduction in hours;
  3. Spouse´s divorce or legal separation from the subscriber;
  4. Loss of eligible dependent status of an enrolled child;
  5. Subscriber becoming entitled to Medicare;
  6. Loss of eligible status of enrolled family member.
NOTE: Cal-COBRA rates are 110% of the group rate. See Consolidated Omnibus Budget Reconciliation Act.

Calcium

Chemical element needed for healthy teeth, bones and nerves.

Calculus

Hardened deposit of mineral salts formed around the teeth. See Tartar.

Canal

The narrow chamber inside the root of the tooth that contains the nerve and blood vessels.

Canine Teeth (Cuspids)

Teeth next to the lateral incisors identified by pointed cusp used for tearing food.

Canker Sores

Painful noncontagious sores, appearing whitish, often with a red halo, of ten to fourteen day duration, that form inside the mouth and on the lips.

Cantilever Bridge

Fixed bridge that attaches to adjacent teeth only on one end.

Cantilever Extension

Part of a fixed prosthesis that is supported at only one end.

Cap

Common term for dental crown.

Capitation

A plan (usually DHMO's) where the dentist is contracted with the administrator to provide dental services to persons covered under the program in return for payment on a per-capita basis (per head).

Caries

Tooth decay or "Cavities".

Carrier

The insurance company you receive your dental plan from. See Third Party.

Case Management

The monitoring and coordination of treatment rendered to patients with specific diagnoses or requiring high cost or extensive services.

Cast or Model

Reproduction of structures made by pouring plaster or stone into a mold.

Cast Post and Core

An anchoring pin or post that is cemented into the root of the tooth (after a root canal) when there is not enough remaining tooth to support a crown.

Cast Restoration

A procedure that uses a model of the tooth (an impression) to make a casting which replaces missing parts. Example: a crown.

Cavity / Cavities

A decay lesion or hole in a tooth (Tooth decay or "caries)".

Cavitron

Dental tool that uses high frequency ultrasonic waves to clean teeth.

Cellulitis

Soft tissue infection causing extensive, hard swelling, a potentially dangerous condition requiring immediate attention.

Cement Base

Material used under a filling to replace lost tooth structure.

Cementum

Hard tissue that covers the roots of teeth.

Centrals / Laterals

The four front teeth.

Certificate of Coverage / Insurance

This is the printed description of your benefits and coverage limits that forms a contract between you and your carrier. It spells out precisely what will be covered, what won´t, and the dollar maximums.

Certificate Holder

  1. The person, usually the employee, who represents the family covered by the dental benefit program; family members are referred to as 'dependents'.
  2. Generally refers to a subscriber of a traditional indemnity program
  3. In reference to the program for dependents of active-duty military personnel, the certificate holder is called the sponsor. See Subscriber

Chart

A log of dental or medical records.

Claim

A claim is a request for payment under the terms of a dental plan.

Claim Form

The form used to file for benefits under a dental benefit program; includes sections for the patient and the dentist to complete.

Claimant

Person who files a claim for benefits. May be the patient or the Certificate Holder.

Clasp

A device that holds a removable partial denture to stationary teeth.

Cleaning

Removal of plaque and calculus (tarter) from teeth, generally above the gum line. See Prophylaxis.

Cleft Lip

Congenital facial deformity characterized by non-fusion or malfusion of the development process that form the lips.

Cleft Palate

Congenital deformity resulting in lack of fusion of the soft and/or hard palate, either partial or complete.

Clenching

The forceful holding together of the upper and lower teeth, which places stress on the ligaments that hold the teeth to the jawbone and the lower jaw to the skull.

Clinical Crown

See Crown.

Closed Panel

A dental plan where enrollees must visit a pre-selected or assigned network dentist in order to receive benefits.

Closed Reduction

The repositioning of a fractured bone without open surgery.

COBRA

See Consolidated Omnibus Budget Reconciliation Act.

Co-Insurance / Coinsurance

The share of a dentist´s fee that an enrollee is responsible for paying, expressed as a fixed percentage. For example, a benefit paid at 80% by the plan creates a 20% coinsurance share for the enrollee. Coinsurance usually applies after the enrollee has satisfied the deductible.

Complete Series

See Full Mouth X-rays.

Composite Resin

A tooth colored mixture of plastic resin and finely ground glass. Used to fill cavities in teeth.

Composite / Plastic Resin

White or tooth-colored filling material.

Composite Filling

Tooth colored filling. Insurance companies usually only allow them on the front teeth (anterior teeth). When composites are done on the back teeth (posterior teeth) the insurance company usually pays them as an amalgam. Composites are also known as resin fillings.

Compound Fracture

Break in bone which is exposed to external contamination.

Comprehensive Oral Evaluation

See Evaluation.

Condyle

Joint of the jaw.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

The Consolidated Omnibus Budget Reconciliation Act of 1985, commonly known as COBRA, requires group health plans with 20 or more employees (in California: 2 to 19 employees for Cal-COBRA) to offer continued health coverage for employees and their dependents for 18 months after the employee leaves the job.  Longer durations of continuance are available under certain circumstances.  If a former employee opts to continue coverage under COBRA, the former employee must pay the entire premium, usually 110% of the cost of their group coverage.

The plan administrator must notify the employee and the covered spouse of their right to continue coverage within 44 days of the event, except in the case of legal separation or divorce. In those cases, the individual must first notify the plan administrator of the separation or divorce, and the administrator then has 14 days to notify them of their continuation rights. After any of these events, individuals must notify the plan administrator that they want continuation benefits within 60 days after they receive their COBRA or Cal-COBRA notice.

Employees and their dependent spouses and children of these firms who are enrolled in the employer´s employee benefit plans at the time of a qualifying event (defined below) are known as "qualified beneficiaries" and are eligible for COBRA (or Cal-COBRA), unless the individual:

  1. becomes covered under another group benefit plan which does not impose any pre-existing condition limitations affecting the individual;
  2. becomes eligible for Cal-COBRA;
  3. becomes eligible for Medicare;
  4. becomes eligible for Medi-Cal;
  5. fails to notify the health plan of a qualifying event in the time specified by the law (generally 60 days); OR
  6. fails to pay their premium on a timely basis.

Contract

An agreement between Dental Insurance Company and the Applicant including the Enrollment and Payment Authorization Form, the attached schedules, and any appendices, endorsements or riders. This Contract constitutes the entire agreement between the parties.

Contract Allowance

The maximum amount allowed for a Single Procedure. It is the lesser of the Dentist's submitted fee, and the Scheduled Maximum, if any, and the Dentist's fee filed in the Participating Dentist Agreement, if any, or the UCR.

Contract Dentist

A dentist that contractually agrees to provide services under special terms, conditions and financial reimburseent arrangements.

Contract Fee Schedule Plan

A dental benefit plan in which participating dentists agree to accept a list of specific fees as the total fees for dental treatment provided.

Contract Term

The period of time, usually 12 months, for which a contract is written.

Contract Type

Type of contract or plan: such as Traditional, PPO or Prepaid/DHMO.

Contract Year

The 12-month period over which a group´s deductibles, maximums and other provisions apply. This may or may not be the same as a calendar year. Also known as the benefit year.

Contributory Program

A dental benefits program in which the en-rollee shares in the monthly premium of the program with the program sponsor (usually the employer). Generally done through payroll deduction.

Conventional Denture

A denture that is ready for placement in the mouth about eight to 12 weeks after the teeth have been removed.

Coordination Of Benefits (COB)

This process becomes involved when the patient is covered by more than one plan. Coverage is then divided between the two plans using guidelines established by the National Association of Insurance Commissioners.

Copayment / Co-Pay

A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered.

Coronal

Refers to the crown of the tooth.

Cosmetic (Aesthetic) Dentistry

Any dental treatment or repair that is solely rendered to improve the appearance of the teeth or mouth.

Cost Containment

Features of a dental benefit program or the administration of the program designed to reduce or eliminate certain charges to the plan.

Cost Sharing

The share of dental expenses that a beneficiary must pay, including the deductibles, copaykments, coinsurance, and charges over the amount reimbursed by the dental benefit plan.

Coverage

Benefits available to an individual covered under a dental benefit plan.

Covered Charges

Charges for services rendered or supplies furnished by a dentist that qualify as covered services and are paid for in whole or in part by te dental benefits program. May be subject to deductibles, copayments, coinsurance, annual or lifetime maximums, as specified by the terms of the contract.

Covered Expenses

The various dental procedures that your insurer has agreed to provide you coverage for.

Covered Person

An individual who meets eligbility requirements and for whom premium payments are paid for specified benefits of the contractual agreement. See Insured.

Covered Services

Services for which payment is provided under the terms of the dental benefit contract.

Cross Bite

Reverse biting relationship of upper and lower teeth (under bite).

Cross Contamination

Passing bacteria, viruses or AIDS indirectly from one patient to another through improper sterilization procedures, unclean instruments, or "recycling" of orthodontic products.

3/4 Crown

A crown, usually metal, that leaves part of the visible surface of the tooth intact.

Crown (Crown of Tooth)

The part of the tooth covered with enamel, the part that is normally visible above the gum line.

  1. Anatomical Crown: That portion of tooth normally covered by, and including, enamel;
  2. Abutment Crown: Artificial crown serving for the retention or support of a dental prosthesis;
  3. Artificial Crown: Restoration covering or replacing the major part, or the whole of the clinical crown of a tooth;
  4. Clinical Crown: That portion of a tooth not covered by supporting tissues.
  5. Crown Lengthening: A surgical procedure exposing more tooth for restorative purposes by apically positioning the gingival margin and/or removing supporting bone.

Crown Lengthening

A surgical procedure exposing more tooth for restorative purposes by apically positioning the gingival margin and/or removing supporting bone.

Curettage

Removal of diseased tissue from a periodintal pocket.

Cusps

The raised round parts on the chewing surface of a tooth.

Cuspids

See Canine teeth or Eyeteeth.

Customary Fee

The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure. See Usual, Customary or Reasonable.

Cyst

A pathological cavity or space, containing fluid or soft matter.

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DDS

Doctor of Dental Surgery - equivalent to DMD.

DMD

Doctor of Medical Dentistry - equivalent to DDS.

Debridement

Removing foreign matter or dead tissue.

Decalcification

The loss of calcium from your teeth. This weakens your teeth and makes them more succeptable to decay.

Decay

Destruction of tooth structure caused by toxins produced by bacteria.

Deciduous Teeth / Milk Teeth

See Baby Teeth.

Deductible

The dollar amount that a plan member must pay for eligible dental expenses before a traditional dental plan kicks in with benefits.

Deep Cleaning (Deep Scaling and Root Planing)

If you notice when you are brushing your teeth, or eating, and sometimes your gums may bleed a bit. This is the early stage of gum disease called gingivitis. If you have gingivitis, your dentist or hygienist will clean your teeth by scaling and polishing them. See Root Planing.

Dental Caries

Decay, cavities

Dental Contract

See Contract.

Dental Floss

A thin, nylon string, waxed or unwaxed, that is inserted between the teeth to remove food and plaque.

Dental Hygienist

A dental professional who specializes in cleaning the teeth by removing plaque, calculus, and diseased gum tissue. He/She acts as the patient's guide in establishing a proper oral hygiene program.

Dental Health Maintenance Organization (DHMO)

A legal entity that accepts the responsibility of providing services at a fixed price. The enrollees in these plans must have dental care provided through designated doctors. Typically, the least expensive of dental plans.

Dental Implant

A (usually) titanium cylinder surgically placed in the bone of the upper or lower jaw to provide support for a dental restoration or appliance.

Dental Insurance

An insurance plan that financially assists in the expense of treatment and care of dental disease and accidents to teeth.

Dentin

The hard bonelike connective tissue making up the root of the tooth and the crown under the shell of enamel. Dentin has feeling through a series of tubules that act like nerves.

Dentist

A person licensed to practice dentistry when and where services are performed.

Dentition

The arrangement of natural or artificial teeth in the mouth.

Denture

Removable artificial teeth in a plastic base that rests directly on the gums. A denture may be complete or partial depending on the number of missing natural teeth.

Denture Base

The part of the denture that holds the artificial teeth and fits over the gums.

Denturism

The production of dentures dispensed directly by laboratory technicians.

Dependents

Spouse and/or unmarried children (whether natural, adopted or step) of an insured.

Detailed and Extensive Oral Evaluation

See Evaluation.

DHMO (DMO)

See Dental Health Maintenance Organization.

Diagnostic

Procedures performed by the dentist to evaluate the condition of the teeth and mouth.

Diagnostic Cast

Plaster or stone model of teeth and adjoining tissues; also referred to as a Study Model.

Diastema

Space between two adjacent teeth in the same jaw.

Direct Billing

This is where the dentist bills a patient directly for his/her fees.

Direct Pulp Cap

Procedure in which the exposed pulp is covered with a dressing or cement with the aim of maintaining pulp vitality.

Direct Restoration

A restoration fabricated inside the mouth.

Discectomy

Excision of the intra-articular disc of a joint.

Disinfection

A cleaning process which destroys most microorganisms, but not highly resistant forms such as bacterial and mycotic spores or the AIDS virus.

Disinfectant

A chemical agent which is applied onto inanimate surfaces (like chairs or tables) to destroy germs.

Displaced Tooth

A partial evulsion of a tooth-may be mesial, distal, facial, lingual or incisal.

Disposable Materials

Materials intended for one use and discarded. (e.g. gloves, paper gowns, cotton rolls, sponges, etc.)

Distal

Surface of a tooth farthest from the center line of the face.

DMO

See Dental Health Maintenance Organization.

DOB

Date of birth.

Dysplasia

An abnormality of development characterized by the loss of normal cellular architecture.

Dry Socket

A localized inflammation of the tooth socket following an extraction due to infection or loss of a blood clot.


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Edentulous

Having lost most or all of the natural teeth. Without teeth.

Effective Date

The date your dental insurance coverage begins.

Eligibility

Requirements that must be satisfied by people who wish to be insured to establish eligibility.

Eligible Dependent

A dependent of a covered person (spouse, child, or other dependent) who meets all requirements specified in the contract to qualify for coverage and for who premium payment is made.

Eligible Employee

  1. Full-time employees, employed on a permanent basis with a normal work schedule of at least 30 hours per week, and compensated for that work by the employer (subject to withholding appearing on a W-2 form);
  2. Part-time employees, employed on a permanent basis with a normal work schedule of either 15-29 hours or 20-29 hours (employer chooses desired option) and compensated for that work by the employer (subject to withholding appearing on a W-2 form). It is the employer´s option to offer coverage to part-time employees; if exercised, employer must offer all similarly situated individuals the same coverage opportunity;
  3. Sole Proprietors/Partners/Corporate Officers must work at least 20 hours per week to be eligible for coverage;
  4. Others who may also be eligible subject to underwriting approval include seasonal workers employed by selected agricultural SIC code businesses and private household staff.

Eligible Person

A person as listed in The Group Highlights pages, designated by the Applicant as eligible for Benefits.

Employee Retirement Income Security Act (ERISA)

A broad-reaching law that establishes the rights of pension plan participants, standards for the investment of pension plan assets, and requirements for the disclosure of plan provisions and funding.

Enamel

The extremely hard outer shell of the tooth. Enamel, like hair and fingernails, has no feeling.

End Date

Date the member's coverage ends.

Endodontics (Root Canals)

An area of dentistry that deals with the diagnosis, prevention and treatment of diseases of the dental pulp and the tissues at the root apex.

Endodontist

Specialist who treats injuries, diseases and infections of the tooth pulp.

Enrollee

A person who is covered under a dental benefit plan. There are usually two types of enrollees —primary enrollees (e.g. the person who purchased the coverage or an employee of a group that purchased coverage) and dependent enrollees. The coverage contract defines who may be a dependent enrollee. See Insured.

Enzootics

The dental specialty that deals with injuries to or diseases of the pulp, or nerve, of the tooth.

Equilibration

Reshaping of the occlusal surfaces of teeth to create proper contact between the upper and lower teeth; also know as occlusal adjustment.

Epidemiology

Study of the incidence of disease in a population.

ERISA

See Employee Retirement Income Security Act.

Erosion

Wearing down of tooth structure, caused by chemicals (acids).

Erupt, Eruption

When a tooth emerges or pushes through the gums.

Established Patient

A patient who has a record of recent care.

Estimate

Details on how benefits would be covered by a member´s plan when a dentist submits an estimate of services.

Evaluation

  1. Comprehensive oral evaluation - Typically used by a general dentist and/or a specialist when evaluating a patient comprehensively. It is a thorough evaluation and recording of the extraoral and intraoral hard and soft tissues. It may require interpretation of information acquired through additional diagnostic procedures. Additional diagnostic procedures should be reported separately. This would include the evaluation and recording of the patient's dental and medical history and a general health assessment. It may typically include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships, periodontal conditions (including periodontal charting), hard and soft tissue anomalies, etc.
  2. Detailed and extensive oral evaluation - problem - focused, by report - a detailed and extensive problem-focused evaluation entails extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation. Integration of more extensive diagnostic modalities to develop a treatment plan for a specific problem is required. The condition requiring this type of evaluation should be described and documented. Examples of conditions requiring this type of evaluation may include dentofacial anomalies, complicated perio-prosthetic conditions, complex temporomandibular dysfunction, facial pain of unknown origin, severe systemic diseases requiring multi-disciplinary consultation, etc.
  3. Limited oral evaluation - problem focused - an evaluation or re-evaluation limited to a specific oral health problem. This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive procedures may be required on the same date as the evaluation. Typically, patients receiving this type of evaluation have been referred for a specific problem and/or present with dental emergencies, trauma, acute infections, etc.
  4. Periodic oral evaluation - an evaluation performed on a patient of record to determine any changes in the patient's dental and medical health status since a previous comprehensive or periodic evaluation. This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately.

Evulsion (Avulsion)

Separation of tooth from its socket due to trauma.

Excision

Surgical removal of bone or tissue.

Exclusions

Dental care services not covered by a dental benefits plan.

Exfoliate

Process of shedding Deciduous (baby teeth).

Exodontia

Practice of dental extractions.

Exostosis

The overgrowth of normal bone. See Torus.

Expiration Date

The date coverage expires.

Explanation of Benefits

The statement you are mailed detailing how your claim payment was calculated. It is sometimes called an Notice of Payment.

Explorer

Sharp instrument used to detect decay on the surface of teeth.

Extracoronal

Outside the crown of a tooth.

Extraction

Removal of a tooth.

Extraoral

Outside the oral cavity.

Extrusion

The jutting of a tooth beyond it's correct position.

Exudate

A material usually resulting from inflammation or necrosis that contains fluid, cells, and/or other debris.

Eyeteeth

The four upper and lower canine (cuspid) teeth.

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Facial

The surface of a tooth directed toward the face (including the buccal and labial surfaces).

Facing

Tooth colored overlay on the visible portion of a crown.

Family Deductible

Deductible that may be satisfied by the combined expenses of all covered family members.

Fee for Services

A plan design in which the dentist is reimbursed for each service, rather than on a periodically paid fixed amount per patient.

Fee Schedule

A set amount paid by the insurance company that is unrelated to the doctor's fee.

Filling

Restoration of lost tooth structure with metal, porcelain or resin materials.

Filtrum

The dimple or indentation under the nose directly above the upper lip.

Fistula

Channel emanating pus from an infection site; a gum boil.

Fixed Bridge

One or more false teeth (pontics) attached to the adjacent tooth or teeth by a crown or crowns.

Fixed Partial Denture

A prosthetic replacement of one or more missing teeth cemented or attached to the abutment teeth or implant abutments adjacent to the space.

Flap Surgery

Lifting of gum tissue to expose and clean underlying tooth and bone structures.

Flexible Benefits

A benefit program in which an employee has a choice of credits or dollars for distribution among various benefit options, e.g, health and disability insurance, dental benefits, child care, or pension benefits. See Cafeteria Plan or Flexible Spending Accounts (FSA).

Flexible Spending Accounts (FSA)

A flexible Spending Account is an employer-sponsored benefit which allows you to defer a portion of your paycheck into an account specifically intended to reimburse you for out of pocket costs. FSAs can be used for reimbursement of any medically related cost that is not covered by your health care plan, such as: deductibles and co-pays; birth control; Dental; Vision; etc. See Cafeteria Plan.

Fluoride

A chemical compound used to prevent dental decay, utilized in fluoridated water systems and/or applied directly to the teeth.

Floss

See Dental Floss.

Foramen

A natural opening into or through bone.

Forceps

Instrument used for removal of teeth.

Forensic Dentistry

The practice of gathering legal evidence for body identification or judicial issues.

Fracture

The breaking of a part, especially of a bony structure; breaking of a tooth.

Fraud

A false representation of a matter of fact (whether by words or conduct, by false or misleading allegations, or by concealment of that which should have been disclosed) which deceives and is intended to deceive another to his/her legal injury. IE: Insurance fraud is any act committed with the intent to fraudulently obtain payment from an insurer.

Freeway Space

The distance between the upper and lower teeth with the lower jaw in rest position.

Frenectomy

Removal of connective tissue between the front teeth to allow spaces to close, restore proper shape of gum tissue or free the tongue for normal function.

Frenum

Muscle fibers covered by a mucous membrane that attaches the cheek, lips and or tongue to associated dental mucosa.

Front Teeth

See Anterior Teeth.

Full Crown

A metal, plastic or porcelain restoration that covers the whole crown of the tooth. Sometimes called a cap.

Full Denture

Plastic or porcelain teeth on a plastic base replacing all of the upper and/or lower natural teeth.

Full Mouth Reconstruction

Extensive restorations of natural teeth with crowns and or fixed bridges to manage bite problems.

Full Mouth X-Rays

A combination of 14 or more periapical and 4 bitewing films of the back teeth. This series of x-rays reveals all the teeth (their crowns and roots) and the alveolar bone around them.

Furcation

The anatomic area of a multirooted tooth where the roots diverge.

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Gatekeeper

A primary care dentist in a managed care environment who is responsible for managing the patient´s overall dental care and who must authorize all specialist referrals.

General Anesthesia

Medication that relieves the sensation of pain on the whole body. General anesthesia renders you unconscious.

Geographic Tongue

Benign changes in the usual color and texture of tongue; does not require treatment.

Gingiva

Gum tissue.

Gingival Hyperplasia

An overgrowth of gingival tissues.

Gingival Hypertrophy

The abnormal enlargement of the gingiva surrounding the teeth caused by poor oral hygiene.

Gingivectomy

Removal of gum tissue to promote proper maintenance.

Gingivitis

Beginning gum disease, inflammation of the gingiva. The first sign of periodontal (gum) disease.

Graft

A piece of tissue or material placed in contact with tissue to repair a defect.

GTR (Guided Tissue Regeneration)

A new technique for replacing bone tissue.

Gum Boil

See Fistula.

Gum Disease

See Gum Disease, Signs of

Gum Recession

Exposure of dental roots due to shrinkage of the gums as a result of abrasion.

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Halimeter

An instrument used in the diagnosis and treatment of chronic halitosis.

Halitosis

Bad breath, caused by tooth decay, gum disease, digestive problems, smoking or some systemic diseases.

Hard Palate

The approximate two-thirds of the front section of the palate, composed of relatively hard and unyielding tissue.

Heat Sterilization

A procedure that involves a chamber into which instruments are placed and which raises the temperature for a period of time to kill all microorganisms. See Autoclave.

Hematoma

Swelling of effused blood beneath tissue surface.

Hemisection

Surgical separation of a multirooted tooth so that one root and/or the overlaying portion of the crown can be surgically removed.

Health Maintenance Organization (HMO)

A type of pre-paid benefit plan in which enrollees receive the majority of their covered treatment from the primary medical or dental office to which they are assigned. Commonly, the primary care provider receives a fixed monthly payment from the HMO (see Capitation) for each enrolled assigned patient, as opposed to payments for each service provided. Services requiring referral to a specialist must be preauthorized before benefits are payable. See DHMO.

Heterologous

Made up of tissue not normal to the part.

Histopathology

The study of composition and function of tissues under pathological conditions.

Homologous

See Graft.

Hydrogen Peroxide

Disinfecting solution used in dental irrigation procedures or as mouth rinse.

Hygienist

See Dental Hygienist.



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Imaging, Diagnostic

A photograph of teeth stored in a computer and then displayed on a television monitor. The Dentist is able to show you an image of your smile with new, repaired or whitened teeth.

Immediate Denture

A denture constructed for placement immediately after removal of all remaining teeth.

Impacted tooth

See Impaction.

Impaction

Unerupted tooth that is tipped or blocked so that it cannot come in normally.

Impaction (Soft Tissue)

Impacted tooth just under gum line.

Impaction (Partially Bony)

Impacted tooth partly covered by bone.

Impaction (Completely Bony)

Impacted tooth completely covered by bone.

Implant

Tooth replacement inserted into the bone in order to provide structure for an artificial fixed restoration.

Implantation, Tooth

Placement of an artificial or natural tooth into an Alveolus.

Impression

Mold made of the teeth and soft tissues.

Incentive Program

A program that promotes prevention by increasing coverage from one benefit period to the next as long as you visit the dentist regularly. For instance, cleanings might be covered at 70 percent during the first year, 80 percent during the second year and up to 100 percent as long as the program is used at least once a year.

Incisal

The cutting edge of the front teeth.

Incisal Angle

One of the angles formed by the junction of the incisal and the mesial or distal surfaces of an anterior tooth; called the mesial and distal incisal angle respectfully.

Incision and Drainage

Surgical incision of an Abscess to drain suppuration (pus).

Incisors

The four front teeth used for cutting food (central and lateral).

Indemnity Plan

A Dental Indemnity plan is commonly known as a Fee For Service or traditional plan. In this type of dental insurance plan, you have the option to visit any dentist or dental care professional you wish. You do not need to select your dentist from a list of network providers or approved providers to qualify for benefits and coverage. You will need to pay a deductible on your indemnity dental insurance. After you have done so, your insurance provider will cover a part of "usual and customary" dental costs. How much your dental insurance will reimburse you will vary according to your provider. However, many insurance providers offering this sort of plan will pay for 80% or even 100% of “usual and customary” dental costs.

Indirect Pulp Cap

Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin.

Indirect Restoration

A restoration fabricated outside the mouth.

Individual Deductible

Amount of eligible expense a covered person must pay each year before the dental plan will pay for eligible benefits.

Infiltration

Local anesthetic procedure effective for upper teeth and soft tissue; placement of anesthetic under the gum, allowing it to seep into bone.

Inlay

Cast Metal, ceramic or lab cured composite filling cemented to the tooth but not completely covering the chewing surface.

In-Network

Describes a provider or health care facility which is part of a health plan's network. When applicable, insured individuals usually pay less when using an in-network provider.

Insured

A person who has obtained dental insurance coverage under a dental insurance plan.

Insurer

An organization that bears the financial risk for the cost of defined categories or services for a defined group of beneficiaries. See Third Party.

Intentional Reimplantation

The intentional removal, radicular repair and replacement of a tooth into its alvelous.

Interocclusal

Space between upper and lower teeth.

Interproximal

Between the adjoining surfaces of adjacent teeth.

Intracoronal

Refers to 'within' the crown of a tooth.

Intraoral

Inside the mouth. For example, orthodontic rubber bands are called intraoral products since they are designed to go in your mouth.

Intraoral camera

A small video camera used to view and magnify oral conditions; images may be viewed on a monitor or printed.

IV / Intravenous Sedation

Anthesia used for people who want to be asleep during dental procedures. It is sometimes described as a "light" anesthesia. See Anesthesia or Local Anesthesia.

Invasion

The infiltration and active destruction of surrounding tissues.

Irrigation

The technique of using a solution to wash out your mouth and to flush debris.

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Jacket

Crown for a front tooth, usually made of porcelain.

Jaw

The term to indicate either the maxilla (upper) or mandible (lower).

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Keratin

A protein present in all cuticular structures of the body, such as hair, epidermis, horns, and the organic matrix of the enamel of the teeth.

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Labial

Pertaining to or around the lip. Referring to the surfaces of the anterior teeth that oppose the inner surface of the lip.

Laminate / Laminate Veneer

A laminate is a thin plastic or porcelain veneer produced in a dental laboratory and then bonded to a tooth to improve its appearance.See Veneer.

Laser

Dental lasers are a family of instruments, some used for surgery, some to cure restorative tooth materials and enhance tooth bleaching, and others to remove tooth structure to eliminate disease.

Laterals / Centrals

See Centrals.

Laughing Gas

See Nitrous Oxide.

Lesion

Injury of bodily tissue due to infection, trauma or neoplasm.

Liability

An obligation for a specified amount or action.

Lifetime Maximum Benefit

The cumulative dollar amount that a plan will pay for dental care incurred by an individual enrollee or family (under a family plan) for the life of the enrollee or the plan. Lifetime maximums usually apply to specific services such as orthodontic treatment.

Limitations

Provisions stated in the dental plan coverage contract which explain limits on coverage of certain benefits. Limitations are typically related to frequency (e.g., the number of treatments allowed), time (e.g. services covered within a given period), or age (e.g. orthodontic coverage for dependent children only).

Limited Oral Evaluation

See Evaluation.

Limiting Age of Coverage

The age at which a dependent covered by a dental plan is no longer eligible to receive benefits. Most dental plans offer an extension of benefits beyond the limiting age of coverage to students and handicapped dependents.

Line Angle

An angle formed by the junction of two planes; used to designate the junction of two surfaces of a tooth, or of two walls of a tooth cavity preparation.

Lingual Surface

The area pertaining to or around the tongue.

Local Anesthesia

Relieves the sensation of pain in a localized area. See Anesthesia or IV Sedation

Local Anesthetic

The injection given in the mouth to numb the areas where a tooth or area needs a dental procedure. Often referred to as novocaine.

Locus

A site or location.


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Maintenance, Periodontal

Therapy for preserving the state of health of the periodontium.

Major Services (Major Care)

Dental procedures concerned with the restoration of teeth by cast restorations such as inlays, onlays, crowns or vaneers. Also may include endodontics (root canals) or periodontics (tissue/bone treatment).

Malar

Pertaining to the cheek bone.

Malignant

Having the properties of Dysplasia, Invasion, and Matastasis.

Malocclusion

Abnormal contact between upper and lower teeth (bad bite).

Managed Care

Program whereby patient-dentist agreement and dentist reimbursement is administered by a separate, external organization.

Mandible

The lower jawbone.

Mandibular

Pertaining to your lower jaw.

Margin

Interface between a restoration and tooth structure.

Maryland Bridge

A bridge that is bonded to the back of the adjacent teeth; requires minimum tooth reduction.

Masticate / Mastication

Process of chewing food.

Maxilla

The upper jawbone.

Maxillary

Pertaining to your upper jaw.

Maxillofacial

Relating to the lower half of the face.

Maxillofacial Surgeon

See Oral Surgeon.

Maximum / Maximum Benefits

A dollar limit that the plan will pay for dental benefits received by an enrollee or the family (for family coverage). Some maximums apply to the lifetime of the benefit plan; others apply to a particular period of time (calendar year, benefit year, etc.) or particular services (such as separate maximum for orthodontic benefits).

Maximum Fee Schedule

A compensation arrangement in which a participating dentist agrees to accept a prescribed sum as the total fee for one or more covered services.

Maximum Out-Of-Pocket (OOP) expenses

See Out-Of-Pocket (OOP) maximum/limit.

Medicaid

This is a joint state/federal health insurance program that is administered by the state. It provides health coverage for low-income individuals, especially pregnant women, children and the disabled.

Medicare

A federal government hospital expense and medical expense insurance plan primarily for elderly and disabled persons. See also Medicare Part A,  Medicare Part B,  Medicare Part C, and Medicare Part D.

Medicare Part A

The part of Medicare that provides basic hospital insurance coverage automatically for most eligible persons. See also Medicare.

Medicare Part B

A voluntary program that is part of Medicare and provides benefits to cover the costs of physicians' services. See also Medicare.

Medicare Part C

The part of Medicare that expands the list of different types of entities allowed to offer health plans to Medicare beneficiaries. Also known as Medicare+Choice. See also Medicare.

Medicare Part D

A voluntary program that is part Medicare and provides benefits to cover the costs of Prescription drugs.

Medicated Filling

A provisional or temporary filling which incorporates a pallative or soothing medication to calm an inflamed tooth nerve.

Member

An individual or dependent who is enrolled in and covered by a dental care plan. Also called enrollee or beneficiary. See Insured.

Member ID

Unique identifying number for a member under the dental plan (sometimes their Social Security number).

Meniscus

Capsular cushion between temporomandibluar joint and glenoid fossa.

Mesial

Toward the front of a tooth or the dental arch (towards the midline).

Metastasis

The transport of neoplastic cells to parts of the body remote from the primary tumor and the establishment of new tumors in those sites.

Midline

A plane through the very center of your mouth perpendicular to your nose.

Milk Teeth / Deciduous Teeth

See Baby Teeth.

Mixed Dentation

The situation when both deciduous and permanent teeth are present.

Molars

Back teeth used for grinding food. The furthest (third) molars are also known as wisdom teeth.

Moniliasis (Thrush)

Opportunistic fungal infection after administration of antibiotic; not uncommon in the mouth.

Moulage

A cast mold reproduction of the face which may be wax or plaster.

Mouthguard

A removable appliance used to protect teeth from injury during athletic activities.

Mucoa

See Mucous Membrane.

Mucogingival Junction (MGJ)

Meeting of thick, protective gingival tissue around the teeth and the friable mucous lining of the cheeks and lips.

Mucous Membrane

The lining of the oral cavity; also called mucosa.

Myofacial Pain Dysfunction (MPD)

Hyperactivity of the jaw, usually affecting the facial muscles and chewing muscles.

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Necessary Treatment

A necessary dental procedure or service as determined by a dentist, to either establish or maintain a patient´s oral health. Such determinations are based on the professional diagnostic judgment of the dentist, and the standards of care that prevail in the professional community.

Nerve

Tissue that conveys sensation, temperature, position information to the brain.

Nerve Root Canal

Dental pulp; the internal chamber of a tooth.

Network

The group of physicians, hospitals, and other medical care providers that a specific managed care plan has contracted with to deliver medical services to its members.

Network Dentist

A dentist who contracts with company and agrees to accept that companys determination of fees as payment in full for services provided to plan enrollees and to comply with that companys administrative guidelines.

Nightguard

A removable acrylic appliance to minimize the effects of grinding (Bruxism) or joint problems (TMJ). Usually worn at night to prevent grinding or relieve joint pain. Also known as an Occlusal Guard.

Nitrous Oxide

A gas used as an anesthetic in dentistry and other medical procedures. Sometimes known as laughing gas.

Non-Autogenous

A graft from a donor other that the patient.

Non-Duplication of Benefits

A term used to describe a method of coordination of benefits where the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows as a fee for that dentist.

Non-Participating Provider

Dentist who has not contracted with a carrier to be a participating dentist for a plan.

Non-Precious Metal

Metal that contains no gold or platinum.

Notice of Payment

The statement you are mailed detailing how your claim payment was calculated. It is sometimes called an Explanation of Benefits.

Novocaine

A generic name for the many kinds of anesthetics used in the dental injection, such as Xylocaine, Lidocaine, or Novocaine. Also see local anesthesia.

NSAID

Non steroidal anti-inflammatory drug, often used as a dental analgesic

Nursing Bottle Syndrome

Severe decay in baby teeth due to sleeping with a bottle of milk or juice. The drink´s natural sugars combine with bacteria in the mouth to produce acid that decays teeth.

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Obturator

A disc or plate which closes an opening; a prosthesis that closes an opening in the palate.

Occlusal

Biting or grinding surfaces of molars and bicuspids.

Occlusal Guard

A removable acrylic appliance to minimize the effects of grinding (Bruxism) or joint problems (TMJ). Usually worn at night to prevent grinding or relieve joint pain. Also known as a Nightguard.

Occusal Plane

The imaginary surface on which upper and lower teeth meet.

Occlucal Radiograph

An intraoral X-Ray made with the film being held between the occluded teeth.

Occlusion

Any contact between biting or chewing surfaces of upper and lower teeth.

Odontogenic Cyst

See Cyst.

Odontoplasty

Adjustment of tooth length, size, and/or shape; includes removal of enamel projections.

Onlay

Like an inlay, but covering the chewing surface.

Obturator

A prosthesis that closes an opening in the palate.

Open Enrollment Period

The month of the year, as shown in the Group Highlights page, during which Eligible Persons may change coverage for the next Calendar year.

Open Reduction

Providing access to a fracture for purposes of anatomic approximation by cutting tissue or surrounding bone.

Operculectomy

Removal of the Operculum.

Operculum

The flap of tissue over an unerupted or partially erupted tooth.

Oral

Pertaining to the mouth.

Oral and Maxillofacial Surgeon

A dental specialist whose practice is limited to diagnosing and treating diseases, injuries, deformities and defects of the mouth.

Oral and Maxillofacial Surgery

Surgical procedures on the mouth including extractions, removal of Cysts or tumors, and repair of fractured jaws.

Oral Cavity

The mouth.

Oral Hygiene

Process of maintaining cleanliness of the teeth and related structures.

Oral Mucosa

The pink-red tissues that line the mouth.

Oral Pathologist

A dentist specializing in the study of oral diseases.

Oral Pathology

The specialty of dentistry and pathology concerned with recognition, diagnosis, investigation and management of diseases of the oral cavity, jaws, and adjacent structures.

Oral Sedation

Any substance taken orally (i.e., a pill or liquid) to reduce anxiety and relax the patient.

Oral Surgery

Surgery of the mouth, such as, tooth removal and minor surgical procedures like tissue biopsy and drainage of minor oral infections.

Orthodonticts

Branch of dentistry that deals with the diagnosis of missaligned teeth. Straightening or moving misaligned teeth and/or jaws with braces and/or surgery.

Orthodontist

A dental specialist whose practice is limited to preventing and treating malocclusion of the teeth (improper alignment of the upper and lower teeth).

Osseous & Mucogingival Surgery

Removal and reshaping of bone and gum tissue.

Osseointegration

The process by which bone heals around an implant.

Osteoblasts

Cells which aid the growth and development of teeth and bones.

Osteoclasts

Cells which help create the sockets in bones.

Osteoplasty

Surgical procedure that modifies the configuration of bone.

Osteotomy

Surgical cutting of bone.

Orthognathic

The functional relationship between the maxilla and the mandible.

Out-of-Network

Dental care services received outside the HMO or PPO network.

Out-of-Plan

This phrase usually refers to physicians, hospitals or other health care providers who are considered non-participants in an insurance plan (usually an HMO or PPO).  Depending on an individual's health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered at a reduced benefit level.

Out-of-Pocket Costs

Any amount for dental treatment that an enrollee is responsible for paying, for example, copayments, deductibles and costs above the annual maximum.

Out-of-Pocket (OOP) maximum/limit

Total dollar amount an insured will be required to pay for covered medical services during a specified period, such as one year.  The out-of-pocket maximum may also be called the stop-loss limit or catastrophic expense limit.

Overbite

A vertical overlaping of the upper teeth over the lower teeth.

Overdenture

Denture that fits over residual roots or dental implants.

Overjet

Horizontal overlap of the front teeth.

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Palate

The hard and soft tissues forming the roof of the mouth.

Palliative / Palliative Treatment

Treatment that relieves pain but is not curative.

Panoramic Radiograph

An extraoral X-Ray on which the maxilla and mandible are depicted on a single film.

Panorex

An x-ray taken outside of the mouth that shows all the teeth on one film.

Papillae

Small projections on the surface of the tongue.

Parafunctional

Other than normal function or use.

Parasthesia

A partial loss of sensation; may be temporary or permanent.

Parotid Glands

Major salivary glands located in front of and below the ears.

Partial Denture

Replacement of missing teeth on a plastic base or metal bar.

Participating Dentist

See Contract Dentist.

Patient

An individual who has established a professional relationship with a dentist for the delivery of dental health care. For matters relating to communication of information and consent this term includes the patients parent, caretaker, guardian, or other individual as appropriate under state law and the circumstances of the case.

Patient´s Share

The portion of a dentist´s fee that an enrollee must pay for covered services, including coinsurance, copayment, any remaining deductible, any amount over plan maximums and/or any services the plan does not cover.

Pathogens

Disease producing organisms that can exist in many different places.

Pathology

Study of disease (abnormal tissue conditions).

PCD (PCP)

Primary care dentist.

Pediatric Dentist

A dental specialist whose practice is limited to treatment of children from birth through adolescence; formerly known as a pedodontist.

Pediatric Dentistry

Dental specialty focusing on treatment of children´s teeth.

Pedodontics

The dental specialty devoted to the treatment of children.

Pedodontist

See Pediatric Dentist.

Pellicle

A thin nonbacterial film from saliva that covers the teeth.

Periapical (PA)

The area that surrounds the root tip of a tooth.

Periapical Abcess

See Abscess.

Periapical Cyst

See Cyst.

Periapical Radiograph

An x-ray that shows several entire teeth (crowns and roots) and includes a small amount of the periapical bone (surrounding the root tips).

Pericoronal

Around the crown of a tooth.

Pericoronitis

An inflammation of the gum tissue around the crown of a tooth, usually the third molar.

Perio Pocket

The pocket that forms when the gums detach from the side of the tooth.

Periodic Oral Evaluation

See Evaluation.

Periodontal

Relating to the gums and bone structure that surrounds and supports teeth. See Gum Disease.

Periodontal Abscess

An infection in the gum pocket that can destroy hard and soft tissues. See Abscess.

Periodontal Chart / Perio Chart

Record measuring the depth of gum pockets around the teeth.

Periodontal Disease

Inflammatory process of the gingival tissues and/or periodontal membrane of the teeth, resulting in an abnormally deep gingival sulcus, possibly producing periodontal pockets and loss of supporting alveolar bone.

Periodontal Pocket

Pathologically deepened gingival sulcus; a feature of periodontal disease.

Periodontal Surgery

Recontouring or esthetic management of diseased gum and supporting tissue.

Periodontics

The treatment of diseases of the gum or bone (supporting structure).

Periodontist

A dental specialist treating the gums and supporting soft and hard tissues retaining natural teeth and the surgical placement of dental implants.

Periodontitis

Advanced gum disease, inflammation of the ligament that attaches the tooth to the bone.

Periradicular

The area which surrounds a portion of the root of the tooth.

Permanent First and Second Molars

The adult first and second molars, are the sixth and seventh teeth from the center of the mouth to the back of the mouth.

Permanent Molars

The adult first, second and third molars.

Permanent Dentition

See Permanent Teeth.

Permanent Teeth

The thirty-two adult teeth in a complete dentition. Also known as the permanent dentition.

Pin Build-up

Pins and support material placed into the tooth structure under crowns or fillings for strength.

Pit

A small defect in the tooth enamel; junction of four formative lobes of a developing tooth.

Placebo

Inert medication or treatment that produces psychological benefit.

Plan Certificate

The document that details your dental benefits.

Planing

See Root Planing

Plaque

A thin film on the the surface of teeth made up of material in saliva containing bacteria.

Policyholder

The individual or group to whom an insurance contract is issued.

Pontic

The false tooth on a fixed bridge, usually metal, porcelain, or a combination of the two.

Porcelain

Tooth colored ceramic material fired in a high temperature oven. Used to make crowns, bridges and veneers when esthetics is important.

Porcelain Crown

All porcelain restoration covering the coronal portion of tooth (above the gum line).

Porcelain Fused to Metal (PFM) Crown

Restoration with metal coping (for strength) covered by porcelain (for appearance).

Porcelain Inlay or Onlay

Tooth-colored restoration made of porcelain, cemented or bonded in place.

Porcelain Veneers

A thin layer of porcelain, fabricated by a laboratory) bonded to a natural tooth to replace lost tooth structure, close spaces, straighten teeth or change color and/or shape.

Post

A metal or carbon fiber support used to reinforce a tooh that has had a root canal therapy.

Post-core

Post and buildup to replace lost tooth structure and retain crown.

Post-crown

Single structure that combines post-core and crown.

Post Treatment Review

See Audit.

Posterior Teeth

Refers to teeth and tissues towards the back of the mouth (distal to the canines): maxillary and mandibular premolars and molars.

PPO

See Preferred Provider Organization.

Pre-Existing Condition

An oral health problem that existed before the date your insurance became effective.  Each dental insurance company uses its own particular definitions of pre-existing condition. However, the following statement is in line with most insurance company provisions:  "A pre-existing condition is a medical condition that would cause a normally prudent person to seek treatment during the twelve months prior to the beginning of coverage."

Preauthorization

Statement by a Third-Party Payer indicating that a proposed treatment will be covered under the terms of the benefit contract.

Precertification

Confirmation by a Third-Party Payer of a patient´s eligibility for coverage under a dental benefit program.

Precision Attachment

An interlocking device integrated into a fixed or removable prosthesis to help keep the prosthesis in place.

Predetermination

An administrative procedure that may require the dentist to submit a treatment plan to the Third-Party Payer before treatment is begun. The third party usually returns the treatment plan indicating one or more of the following: patient´s eligibility, guarantee of eligibility period, covered services, benefit amounts payable, application of appropriate deductibles, copayment and/or maximum limitation. Under some programs, predeterermination by the third party payer is required when covered charges are expected to exceed a certain amount.

Preferred Provider Organization (PPO)

A network of dentists who have agreed to accept discounted fees for patients covered by a specific dental program. The participating dentist agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see a dentist who is not designated as a "preferred provider," that patient may be required to pay a greater share of the Fee For Service. Most PPO plans cover preventive care, cleanings, check-ups, protective dental sealants, x-rays, and fluoride treatment at 80-100%.

Premedication

The use of medication prior to dental procedures.

Premiums

A prepaid payment or series of payments made to a dental plan by purchasers, and often plan members, for dental benefits.

Premolars

See Bicuspids.

Prepaid Dental Plan

A benefits plan in which a carrier pays (prepays) network dentists a capitated amount for each patient assigned to his office. Enrollees receive all or most trestment through the dental office where they are assigned, and the enrollee pays a predefined copayment for each procedure. See DHMO.

Preparation Date

Date the tooth is prepared for an appliance, and an impression is taken of the tooth.

Pre-Treatment Estimate

An estimate of how much of proposed treatment will be covered under an enrollee´s dental plan as of a particular date. A pre-treatment estimate is not a guarantee of payment. When the services are complete and a claim is received for payment, the company will calculate its payment based on the enrollee´s current eligibility, amount remaining in the annual maximum and any deductible requirements.

Prevailing Fee

The fee commonly charged for a dental service in a given area.

Preventive Dentistry / Services (Preventive Care)

Dental procedures concerned with the prevention of dental diseases by protective and educational measures. May include exam, cleanings, x-rays and fluoride.

Primary Enrollee

An Eligible Person enrolled in the plan to receive Benefits.

Primary Teeth / Dentition

The first teeth which are shed and replaced by permanent teeth. The first primary tooth comes in at about 6 months of age and the 20th and last primary tooth erupts at around 2 1/2 years of age. The primary teeth are replaced beginning usually at about age 6. Also called Baby Teeth, milk teeth, temporary teeth or deciduous teeth.

Prior Authorization

See Predetermination.

Prognosis

The anticipated outcome of treatment.

Proof of Loss

Verification of services rendered expenses incurred by the submission of claim forms, radiographs, study models, and/or other diagnostic material.

Prophy Jet

Air polishing for stain removal.

Prophylaxis (Prophy)

Cleaning of the teeth for the prevention of periodontal disease and tooth decay. It’s a Greek word which means "to prevent beforehand" - in this case, it helps prevent gum disease.

Prosthesis

An artificial appliance for the replacement for a body part.

Prosthetic

See Prosthodontics.

Prosthodontics

Branch of dentistry that deals with replacement of damaged or missing teeth with artificial materials, such as a bridge or denture.

Prosthodontist

A dentist that specializes in the restoration of natural teeth and replacement of teeth. Expertise includes, but is not limited to: crowns, bridges, dentures, dental implants, TMD-jaw joint problems, and oral cancer reconstruction

Provider

The dentist who renders treatment to the patient.

Provisional

Formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration.

Proximal

Surface nearest the adjacent tooth.

Pulp

The soft tissue in the center of the tooth that holds the nerves and blood supply.

Pulp Cap

Medication placed over the exposed area of a live pulp (nerve) to promote healing of the pulp.

Pulp Cavity / Chamber

The center or innermost portion of the tooth containing the pulp.

Pulpectomy / Pulpotomy

Removal of all or part of the nerve of the tooth.

Pulpitis

Inflammation of the pulp; common cause of toothache.

Pyorrhea

Older term for periodontal (gum) disease.


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Quadrant

One of the four equal sections into which the dental arches can be divided; begins at the midline of the arch and extends back to the last tooth (right and left sides of both arches).

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Radicular

Pertaining to the root.

Radiographs

A form of radiation that produces a shadowy negative, which provides a means of diagnostic dental evaluation. See X-Rays.

Ranula

A Cyst that can develop under the tongue on the floor of the mouth.

Reasonable and Customary (R &C) Charge

A term used to refer to the commonly charged or prevailing fees for oral health services within a geographic area.  A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community.  "Reasonable and Customary (R&C) Charge" essentially means the same thing as "Usual, Customary or Reasonable (UCR)."

Rebase

The process of refitting a denture by replacing the base material.

Receded Gums

A condition characterized by the abnormal loss of gum tissue due to infection or bone loss.

Recession

Gradual drawing away of tissue from its normal position; for example, the recession of the gum away from the tooth.

Referral

When a dental patient from one office is sent to another dentist, usually a specialist, for treatment or consultation.

Regional Block Anesthesia

See Anesthesia.

Reimbursment

Payment made by a Third Party to a beneficiary or to a dentist on behalf of the beneficiary, towards repayment of expenses incurred for services covered by the contractual arrangement.

Reimplantation, Tooth

Insertion and temporary fixation of partially or completely avulsed tooth or teeth, resulting from traumatic injury.

Reline

New plastic bonded into the denture to reestablish the fit since the underlying bone and gum tissue shrink over time.

Removable Partial Denture

A removable partial denture is a prosthetic replacement for one or more missing teeth that can be removed by the patient.

Removable Appliance

Removable orthodontic appliances used to effect simple tipping movements of one tooth or several.

Removable Partial Denture

See Partial Denture.

Resin-Based Composite Filling

See Composite Filling.

Resorption

The breakdown and assimilation of the bone that supports the tooth, i.e. bone loss.

Restoration

Replacement of missing or damaged tooth structure with artificial materials.

Retained Root

Partial root structure remaining in jaw after extraction or fracture of a natural tooth.

Retainer

A removable dental appliance, usually used in orthodontics, that maintains space between teeth or holds teeth in a fixed position until the bone solidifies around them.

Retrograde Filling

A method of sealing the root canal by filling it from the root apex.

Retrospective Review

A post-treatment assessment of services on a case-by-case or aggregate basis after the services have been performed.

Root

The part of the tooth below the gum line that anchors the tooth into the jawbone.

Root Canal

Space in the root of tooth that contains pulp tissue.

Root Canal Filling

Reshaping and filling the nerve space in the root of the tooth after the death of the nerve. See Endodontics.

Root Canal Therapy (Endodontic Therapy)

Process of removing pulp of a tooth and filling it with an inert material. See Endodontics.

Root Canal Treatment

The removal of the pulp tissue of a tooth due to decay or injury.

Root Planing

Removal of calculus, reshaping and smoothing the surface of the root, the basic treatment for periodontitis. This is considered Deep Cleaning not prophylaxis.

Root Resection

Removal of a portion of diseased root structure, retaining the remaining natural tooth.

Rubber Dam

Soft latex sheet used to establish isolation of one or more teeth from contamination by oral fluids and to keep materials from falling to the back of the throat.

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Saliva

Clear lubricating fluid in the mouth containing water, enzymes, bacteria, mucus, viruses, blood cells and undigested food particles.

Saliva Ejector

Suction tube placed in the mouth to remove saliva.

Salivary Glands

Located under tongue and in cheeks, produce saliva.

Scale / Scaling

The removal of plaque, calculus and stain from teeth. See Root Planing.

Schedule of Allowances

A list of covered services with an assigned dollar amount that represents the total obligation of the plan with respect to payment for such services, but does not necessarily represent the dentist´s full fee for that service.

Scheduled Maximum

The maximum Contract Allowance for each dental procedure.

Sealant

A clear application of acrylic placed over the biting surface of the tooth to prevent decay.

Seat Date

Date the appliance is cemented (put in place). For orthodontics, it is the date the bands are place on the teeth.

Secondary Dentin

Reparative tooth structure produced by the pulp in response to tooth irritation.

Secondary Plan

When a patient is insured by two plans, the plan that is billed second is the secondary plan.

Sedative Base

Medication placed on top of pulp to help restore vitality of tooth.

Semiprecious Metals

Materials developed for dental restorations that have a lesser amount of precious metals (like gold or platinum).

Sequstrum

Loosened spicule of bone pushed to the surface.

Sextant

One of the six relatively equal sections into which a dental arch can be divided, for example: tooth numbers 1-5; 6-11; 12-16; 17-21; 22-27; 28-32. Sometimes used for recording periodontal charting.

Sialodochoplasty

A surgical procedure for the repair of a defect and/or restoration of a portion of a salivary gland duct.

Sialolithotomy

A surgical procedure by which a stone within a salivary gland or its duct is removed.

Silicate

Synthetic fillings other than silver, gold, or ordinary cement to set crowns, bridges, etc.

Single Procedure

A dental procedure that is assigned a separate Procedure Number. For example: a single x-ray file, or a complete upper denture.

Sinusitis

Infammation of the sinus that may mimic dental pain.

Site

A term used to describe a single area, position or locus.

Six-year Molar

The first permanent tooth to erupt, usually between the ages of five and six.

Socket

The hole in the jawbone into which the tooth fits.

Space Maintainer

Dental device that holds the space lost through premature loss of baby teeth.

Specialists

Providers whose practices are limited to treating a specific disease.

Speech Therapy

Treatment to correct a speech impairment that resulted from birth or from disease, injury or prior medical treatment.

Splint

A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured or traumatized. Also refers to devices used in the treatment of temporomandibular joint disorders.

Stainless Steel Crown

A pre-made metal crown, shaped like a tooth, that is used to temporarily cover a seriously decayed or broken down tooth. Used most often on children's teeth.

Stayplate

Plastic plate with teeth and clasps (usually temporary).

Stomatitis

Inflammation of the membranes in the mouth.

Stress Breaker

That part of a tooth-borne and/or tissue-borne prosthesis designed to relieve the abutment teeth and their supporting tissues from harmful stresses.

Study Model

Plaster models of the teeth made from an impression showing all the teeth in the upper and lower jaws, and the relationship between the teeth.

Subgingival Curettage

Removal of calculus and diseased tissue from the root and the cuff of soft tissue around the root.

Sublingual Glands

Major salivary glands located in the mucosa on the floor of the mouth.

Submandibular Glands

Walnut-sized major salivary glands located beneath the tongue.

Subscriber

The individual in whose name a contract is issued or the employee covered under an employer´s group dental contract. See Insured.

Summery Plan Description

See Benefit Booklet.

Supernumerary Tooth

Extra tooth.

Suppuration

Bacterial contamination of tissue exudate; pus.

Surgical Extraction

Extraction of a tooth that requires opening a gum tissue flap, removal of bone and placing sutures (stitches).

Suture

Stitch used to repair incision or wound.

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Tartar

A salivary deposit of calcium phosphate, calcium carbonate, and organic matter on natural or artificial teeth. See calculus.

Temporomandibular Joint

See (TMJ)

Temporary Removable Denture

An interim prosthesis designed for use over limited period of time.

TMD (Temporomandibular Disorders)

Problems associated with the temporomandibular joint (TMJ) which connects the lower jaw with the skull. Typically associated with pops and pain in the joint. Temporomandibular disorder (TMD) is a common ailment of the jaw joint. It is estimated that more than 10 million Americans have TMD symptoms at one time or another. A majority of these people are women between the ages of 20 and 40. The good news is that for most TMD sufferers, symptoms usually do not lead to a serious, long-term problem. In fact, with or without treatment, most people eventually get better. Unfortunately, some people have severe pain and discomfort that lasts for many years.

TMJ (Temporomandibular Joint)

A missaligment of the joint connecting upper and lower jaw resulting in muscle and joint pain in the jaw area. The temporomandibular joint (TMJ) is located just in front of the lower part of the ear. This joint allows the lower jaw to move. It is a ball-and-socket joint, just like the hip or shoulder. When the mouth opens wide, the ball (called the condyle) comes out of the socket and moves forward. It goes back into place when the mouth closes. The TMJ becomes dislocated when the condyle moves too far. Then, it can get stuck in front of a section of bone called the articular eminence. The condyle can't move back into place. This happens most often when the ligaments that normally keep the condyle in place are somewhat loose. The surrounding muscles often go into spasm and hold the condyle in the dislocated position.

TMJ Syndrome

Symtoms associated with malfunction of the temporomandibular joint. See TMJ.

Termination Date

See Expiration Date.

Third molar

The last of the three molar teeth, also called wisdom teeth. There are four third molars, two in the lower jaw and two in the upper jaw, one on each side.

Third Party Payer

Any payer of dental care services other than the insured person.  This can be an insurance company, HMO, PPO, or the federal government.

Thrush

See Moniliasis.

Tissue Conditioning

Material intended to be placed in contact with tissues, for a limited period, with the aim of assisting their return to healthy condition.

Tooth Bud

Early embryonic structure that becomes a tooth.

Tooth Whitening

A chemical or laser process to lighten the color of teeth.

Topical Anesthetic

Ointment that produces mild anesthesia when applied to tissue surface.

Topical Fluoride

Liquid or gel placed on teeth to help prevent caries.

Torus

A bony elevation or protuberance of normal bone. Usually seen on the upper palate behind the front teeth or under the tongue inside the lower jaw.

Transitional

Relating to a passage or change from one position, state, phase or concept to another.

Transplant, Tooth

Placing a natural tooth in the empty socket of another tooth.

Transseptal

Through or across a septum.

Trauma

Injury caused by external force, chemical, temperature extremes, or poor tooth alignment.

Trench Mouth

Gum disease characterized by severe mouth sores and loss of tissue.

Trismus

Limited ability to open the mouth, usually due to inflammation.

Types of Dental Insurance Plans


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UCR

Usual, Customary or Reasonable.

Ultrasonic Cleaning

Cleaning that uses high frequency sound waves to gently remove deposits, such as tartar and stain, from the teeth

Unerupted Tooth

A tooth that has not pushed through the gum and assumed its correct position in the dental arch.

Unilateral

Involves only one side.

Usual, Customary or Reasonable (UCR)

The amount reimbursed to providers based on the prevailing fees in a specific area.

  1. USUAL - A usual fee is that fee regularly charged and received for a given service by an individual Dentist, i.e. his own usual fee. If more than one fee is charged for a given service, the fee determined to be the usual fee shall not exceed the lowest fee which is regularly charged or which is offered to patients.
  2. CUSTOMARY - A fee is customary when it is within the range of usual fees charged and received by Dentists of similar training for the same service within the geographic areas determined by the insurance company to be relevant. Customary fees may be determined on the basis of fees filed by Participating Dentist. A Customary Fee for a Participating Dentist is that fee which is approved by the insurance company in the terms of the Participating Dentist Agreement.
  3. REASONABLE - A fee is reasonable if it is "usual" and "customary" or it falls above usual and customary or both, but is determined to be justifiable considering the special circumstances or extraordinary difficulty of the case in question.

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Veneer Crown

Plastic or porcelain facing bonded directly to a tooth to improve its appearance. See Laminate.

Vertical Dimension

Arbitrary space between upper and lower jaws upon closure; may decrease over time due to wear, shifting or damage to the teeth.

Vestibuloplasty

Any of a series of surgical procedures designed to increase relative alveolar ridge height.

Virgin Teeth

Teeth that have no decay or fillings.

Vitality Test

Test using thermal, electrical or mechanical stimuli to determine the vitality of the dental pulp.

Voluntary Plan

A comprehensive dental insurance plan that employers can offer at no cost to thei business. Some employees like the simplicity and convenience of having their dental insurance premiums deducted directly from their paychecks.

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Waiting Period

A period of time when the dental plan does not cover a person for a particular dental problem.

Wax Pattern

A wax form that is the positive likeness of an object to be fabricated.

Wax-Up

A wax form that is a model of an object to be fabricated.

Whitening

A process which lightens the color of teeth.

Wisdom Teeth

The third molar, or eighth tooth from the center of mouth to the back of the mouth. Wisdom teeth are often impacted (obstructed from erupting) and have to be extracted. They usually erupt at age 18-25 (when "wisdom is attained"). See Third Molar.

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X-Rays

X-ray films that help the dentist to detect beginning caries and gum disease that is not easily visible to the eye. The following terms are examples of dental X-rays taken:

Xerostomia (pronounced Zerostomia)

Dry mouth or decrease in the production of saliva.

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Yearly Maximum

Most PPO insurance plans have a yearly maximum of a $1000. Dental insurance, usually, is not cumulative, so if you don't use it, you lose it.

Yeast

A general term for a fungus occurring as a unicellular, nucleated organism that usually reproduces by budding, although some yeasts may reproduce by fission, many producing mycelia or pseudomycelia.

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Zerostomia

See Xerostomia

Zygomatic Bone

Quadrangular bone on either side of face that forms the cheek prominence.

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Signs of Gum Disease (Periodontal)

  1. Bleeding gums (even when you brush)
  2. Red, swollen or tender gums.
  3. Loose teeth
  4. Persistent bad breath
  5. Receding gums
  6. Teeth or dentures fit together differently when biting.
If you have any of these symptoms, call your dentist as soon as possible!

Did you know that more than 90% of all common diseases have oral symptoms? In recent years, studies have shown that Periodontal (gum) disease has been linked to other health concerns like:

  • An increased risk of heart disease and strokes
  • Difficulty controlling blood sugar levels in people with diabetes
  • An increased risk of delivering preterm, low birth weight babies

Oral Health and Diabetes Flyers

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