Chairside Talk

Don’t Use Dental Insurance as Your Guide to Dental Health

Dental insurance is great. It’s even better when your company is paying for it. And like all great things, there are limitations. These limitations come in the form of money. Most dental insurance policies have a deductible, waiting period, a co-pay, an annual maximum, and limitations on x-rays, dental exams and cleanings.

These policies are commonly mistaken for dental health guidelines and it saddens me when patients refuse treatment because their insurance won’t pay. I get even sadder when I think about how the insurance industry fails to recognize that everyone is different and there is a need to expand its policies.

Most policies cover two cleanings a year, two exams, annual x-rays and have $1,000.00-$1,500.00 yearly maximum. That might have been great in the 1970s but we know more about dental disease and have better treatment and technology today. Not to mention the annual inflation over the last 40 years. Insurance companies just don’t reflect these changes and it’s unfair.

Did you know more that 50% of patients need more than two cleanings a year? Did you know that one dental crown costs more than the annual allowance? Or that most dental procedures are only covered at a percentage always leaving financial responsibility with the patient? With the reality as it is, dental insurance should be thought of as an adjunct benefit. People who want to keep healthy will always assume financial responsibility for their general well-being.

Using the unrealistic guidelines of dental insurance companies to determine what a patient does or doesn’t do with their oral health will always lead to the patient’s detriment. My advice is to let the dental professions do their job and prescribe what is in your best interest. Dental insurances only do what is in their best interest. Below is a great example of what can and does happen by following the guidelines of dental insurance.

A patient only wants two cleanings a year because that is what insurance covers. This patient builds up a lot of tartar and plaque. Six months between dental cleanings is too long often denoted by patient symptoms. Bleeding, tender gums, yellowing or browning of the teeth.

At the six month cleaning, the hygienist cleans most of the plaque and tartar, but she cannot access under the gums where the bacteria and tartar have travelled as a result of the inflammation and bleeding over the last several months.

The hygienist asks the patient to return in three months to allow the inflammation to subside and prevent more tartar from building up hoping to get the disease under control. The patient refuses stating they only want to do what insurance covers

Another six months go by and now the disease is worse. The gums are still inflamed and bacteria has access into the blood stream making its way down the sides of the teeth and into the body. The body reacts to the bacteria in the mouth by shying away. The gums pull away from the teeth, attachment is lost and the bone diminishes. What was gingivitis has now turned into periodontal disease.

For your information periodontal disease can only be treated with more aggressive measures such as scaling and root planing or even surgery. If not treated, the patient will lose their teeth in addition to putting their overall health in jeopardy. All of which could have been avoided if the patient had just come in for more frequent cleanings per the hygienists request. The extra couple hundred dollars out of pocket needed to prevent a scenario like this is well worth the prevention of dental problems. The latter will cost you more.

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