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Dental Benefits 101

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So you just got dental benefits through your employer, hurray! Where do we begin?

Dental Plan Basics

Some individuals purchase their own dental plan, but most have dental benefits through their employer. When your employer chooses your insurance plan, they decide the plan’s cost and how often you use their benefits. Most employers will also deduct a portion of each of your paychecks to split the cost of the insurance premiums.

Although they choose the plan, your employer is not responsible for administering your dental plan. Instead, they enter into a contract with an insurance company who then acts as your dental plan administrator. Your dental plan administrator can answer questions about your insurance coverage and must reimburse you based on the terms of the dental plan contract.  For some dental services, payment is based on a cost-sharing arrangement between you and your employer. In these cases, you pay for part of the cost, while the plan pays for the rest.

Your Responsibilities

Your dentist may not be familiar with your specific plan coverage so it’s important to know how your plan works. Always read the information booklet or other materials available from your benefits provider.

Some things you should know about your plan:

  • What is covered each year?
  • Is there a deductible?
  • Is there a total dollar limit on my coverage?
  • Can I choose a procedure other than the one my plan covers?
  • Will I still be covered if I change jobs?
  • How much am I covered for cleanings and X-rays?
  • How much am I covered for fillings and root canals?
  • What about other treatments like bridges and crowns, dentures and oral surgery?

You should also be aware of your co-payment. Co-payment — also called co-insurance — is the part of the bill you won’t be reimbursed for. Many dental plans have a percentage of the claim amount (typically 20 to 50 per cent) that is not covered by the dental plan.

Can my dentist waive my co-payment?

No — waiving a co-payment is insurance fraud and is against the law. Your dentist could be fined or even lose their license.   The claim forms you and your dentist sign state which services were provided and how much was charged. The insurance company pays its share based upon the assumption that you will do the same.

Your Dentist’s Responsibilities

Dentists make their treatment plan based on your dental needs. Sometimes, your dental plan coverage and your treatment plan won’t align. If your dental plan only covers part of the cost of your treatment plan, you’ll need to cover the rest.

Your dentist will take you through your personalized treatment plan and answer any questions you may have. They can also help you understand how much may be covered before you move ahead by submitting a pre-treatment form to your dental benefits administrator. Your benefits administrator will provide you with a “predetermination of benefits”. This doesn’t guarantee that the treatment will be covered by your health insurance plan. But it will show you what services are covered and the limitations of your plan.

Remember that your dentist is treating you, not your dental plan. Read more about your dentist’s obligations according to the Royal College of Dental Surgeons of Ontario.

Your Plan and the Claims Submission Process

Once your dental appointment is over, it’s time to make your payment and submit your claim. The way you submit your claim and get reimbursed depends on:

  • whether the dentist submits it for you;
  • whether you assign your benefits to the dentist;
  • or have the plan pay you directly.

Some dentists accept the assignment of benefits. The assignment of benefits means your insurer pays your dentist directly. The dental claim can be submitted to the insurance company by the dental office. All you need to do is provide the dental office staff with your benefit plan number and/or benefits card. Any fees that are not covered by your plan must be paid by you to the dentist.

There are some dentists who do not accept the assignment of benefits; there are some dental plans that will not allow benefits to be assigned. This means that the plan member (you) will be paid by the insurance company. In both cases, this means you’ll need to pay your dental bill upfront. The dental office can still submit the claim electronically to your insurance provider on your behalf and then you wait to get reimbursed.

Getting reimbursed is much faster than it was years ago. Thanks to electronic claims submission, you can see the dentist on Monday and usually get reimbursement before the end of the week. Also, many dentists accept credit cards, which typically have a monthly billing cycle. If you need complex treatment, speak to your dentist about arranging a payment schedule that allows you to budget for expenses.

Benefits of Non-Assignment

The main benefit of the assignment of benefits is the convenient payment process for patients. However, the ODA opposes the assignment of benefits; instead, we believe that non-assignment of benefits is best.

Why does the ODA oppose something most patients find convenient? Because non-assignment means that patients are more involved in their care and the costs involved. 

By being more involved you can:

  • Have a better understanding of your dental plan and can use it wisely.
  • Evaluate your dental plan and identify parts that could be improved.
  • Develop the confidence to discuss fees with your dentist.
  • Most dental offices can submit your claim for you electronically as a courtesy. If you need to submit your own dental claim form and need help, your human resources department or your dental plan administrator can assist you.

This article was adapted from the Ontario Dental Association: https://www.oda.ca/visiting-the-dentist/dental-benefits/

When Should Children Brush Independently?

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When Should Children Brush Independently?

We often find that young children are quite enthusiastic about their independence with brushing, yet they still get cavities! We know it is tempting to take a hands off approach when your youngster is able to brush with an appropriate amount of toothpaste, but if they are not doing a good job then food and plaque left on the teeth overnight can lead to cavities. There are a few considerations regarding the quality of brushing:

Time

When the recommendation for brushing is 2 minutes, this is the average amount of time needed to effectively clean all surfaces of the teeth and tongue. The 2 minutes is not a good indicator of the quality of brushing if some surfaces are left behind!

Dexterity

A certain level of manual dexterity is needed to reach all the surfaces of the teeth, particularly the backsides of the upper and lower molars. Because it is a difficult area to brush and not an area of the tooth that gets swept by the tongue, there is often a large build up of food and plaque that requires more time to clean. Cleaning behind the molars is also quite difficult because of how little space there is towards the back of the mouth. Young children can develop good manual dexterity/hand skills at different ages, and so it is important to recognize that some children will need more help that others.

Consistency

Just like we are motivated to brush and floss before and after seeing the dental hygienist, children can put more effort into brushing only when under supervision. It is possible that when they are not being supervised, young children are not doing as good of a job brushing as they used to!

In general, it is recommended that young children be supervised when brushing to check on the quality of the brushing. Especially when there are new teeth coming in (6 year and 12 year molars), it is important to make sure that the children are brushing further back. Once children are able to demonstrate tasks that require a certain level of manual dexterity (eg. tying their own shoelaces, or being able to write well) they are usually capable of all the toothbrush motions for adequate brushing.

Can Infants Get Cavities?

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Can Infants Get Cavities?

It’s never easy to deliver the news of cavities to parents, let alone when their child is only an infant. It is absolutely possible for children under the age of three to develop cavities.

Let’s take a step back and talk about tooth development. We normally expect a baby’s first teeth around the age of 6 months old, give or take a month or so. Up until the age of 3 years, infants will continue to develop teeth in a symmetrical pattern (left and right sides). A full set of baby teeth comprises of 20 teeth (10 on the top, and 10 on the bottom).

At any point during development, babies can develop dental decay. That means that dentists can see cavities in babies as young as 4-6 months old!

There are usually five reasons why infants develop dental decay:

  1. Goes to bed with a bottle
    • Allowing infants to sleep right after having a bottle or right after nursing is a continuous source of nourishment for your baby AND the bacteria that causes cavities. Even though milk/formula does not usually have added sugar, it does contain some natural sugars which can feed cavity-causing bacteria.
  2. Shares foods and kisses with a caregiver/parent who has cavities
    • Individuals who have untreated cavities have higher concentrations of cavity-causing bacteria in the mouth, and these bacteria can be spread through close contact and sharing food utensils!
  3. Does not clean teeth after meals
    • Regardless if an infant is still nursing or using a bottle, the teeth and gums should be cleaned with a soft toothbrush or soft washcloth to remove milk/formula residue from the mouth because of the sugars in these foods.
  4. Enamel defects
    • It is rare, but new teeth can erupt from the gums with deformities. These deformities can make the teeth more prone to cavities than they ordinarily would be. Enamel defects can be the result of genetic or environmental disturbances that occurred when the teeth were forming.
  5. Sugar-sweetened medications
    • It is a little known fact that many medications formulated for infants and young children contain sugar syrups (‘simple syrup’) which help with medication compliance. It is important to try to take these medications at meal times if possible or brush the teeth after taking the medication.

The difficulty with treating infants at a young age is often the difficulty of cooperation. Additionally, when infants get cavities at such a young age the enamel is still very thin and immature which allows cavities to progress quickly and cause toothaches. Having toothaches at such a young age has the potential to cause lifelong disturbances in development if there are oral aversions and feeding issues due to tooth pain. For these reasons, it is recommended that infants under the age of 3 years get dental check ups 1-2 times per year.

How to Care for Teeth

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How To Care For Teeth

We are told that we have to brush AND floss, but then advertisements say that we should also use toothpaste and mouthwash. Is it all just a clever marketing ploy? Do we really have to do all those things?

The simplest answer to caring for teeth is: “it depends”.

In general, caring for your teeth is surprisingly easy. All you have to do is avoid letting food sit around in your mouth for hours at a time. Just like your dinner plate, our teeth will retain some food residue after meals. When left in the mouth for extended amounts of time, these food remnants supply nutrition to the cavity-causing microbes in the mouth. Unlike a dinner plate, cleaning food remnants in the mouth is more difficult because of all the spaces between the teeth and deep pits and fissures on the tops of the molars. Make sure to clean your teeth before going to bed because leaving food residue on your teeth overnight is a big no-no!

At the very basic level, brushing and flossing before bed is extremely important.

Because necessity is the mother of all invention, humankind has created a number of different dental products that serve different purposes. Once you understand the purpose of each dental implement, you will be able to build an effective oral hygiene regimen suitable to your needs. At the very basic level, brushing and flossing before bed is extremely important.

Toothbrush

This is the most basic tool in dental care. The toothbrush is able to mechanically scrub off sticky food particles and plaque build up on the teeth and the tongue. It is not necessary to use toothpaste, but toothpastes can often make the brushing experience nicer because it imparts a fresh, clean feeling. Some toothpastes will also contain ingredients like fluoride which help to remineralize the teeth and/or triclosan which is an anti-plaque agent. The toothbrush is NOT able to clean tight spaces between the teeth, so you may also need to use floss.

Floss

When there are tight spaces between the teeth or places where food is stuck, floss seems to be the only effective way to clear things up. There is no difference between string floss and floss on a stick (sometimes called “floss picks” or “Plackers®”). If you have really tight teeth that keep tearing up floss, try a waxed floss or a flat ribbon floss.

Mouthwash

With a toothbrush and floss you can get pretty clean teeth, and mouthwash can only help. Mouthwash was actually intended to help clean the surfaces of the mouth that we are unable to brush or floss. These areas include the roof of the mouth, under the tongue, and inside the cheeks. Although the bacteria that causes cavities likes to stick to teeth, they can adhere to the gums and the soft linings in the mouth. Using a mouthwash that contains essential oils, hydrogen peroxide, cetylpyradimium chloride, or chlorhexadine are all effective at eliminating harmful bacteria in the mouth.

What if you are brushing and flossing but still get cavities?

Certain individuals are more predisposed to cavities than others. These so-called predispositions are also known as risk factors, and there are easy solutions to reduce or eliminate these risk factors in many cases. It is much too complicated to provide a comprehensive list of possible reasons, so if you feel like you are doing everything you can but are continuing to have problems it is recommended to seek the opinion of one or more dentists.

The frequency with which an individual is recommended to see the dentist varies. After any necessary treatment has been done and we have determined that you are doing a great job taking care of your own dental health, we recommend coming in for a check-up every year. In addition, we recommending coming in for a clean every 6 months.

If you are on the right track, x-rays can be taken less frequently, sometimes just every few years. Your dentist will explain the reason for any x-ray taken, and will also discuss the findings, if any, with you. We welcome questions, and it also shows us that you are being proactive in taking care of your oral health. Prevention and routine is always our preferred care, and its also easier on your wallet! We want you to keep the teeth that you have, that’s why regular dental care is important. If you haven’t been to the dentist for a while, we recommend coming in for an exam so that we can assess your specific needs.