The loss of tooth structure caused by a hard toothbrush, poor brushing technique
A localized infection in the bone or soft gum tissue; usually occurs at the end of the root tip.
A tooth or implant used to support a prosthetic (crown or bridge
Availability of care for a patient.
Actual dollar amount a dentist charges for services.
(American Dental Association®) A professional organization of dentists that promotes the field of dentistry through education, research, advocacy and the development of standards.
Claim processing to determine eligibility and payment.
1) A minimum or maximum age sometimes set for coverage of certain dental procedures; 2) A minimum age required by insurers in order to qualify for individual coverage; 3) A maximum age for coverage for dependent children under the policyholder’s policy.
The tiny particles of aluminum oxide blasted in a stream of water at the tooth to remove the decayed debris and ruined enamel from cavities.
An unfavorable reaction to a foreign substance or drug.
Alternate Benefit Provision
A provision in an insurance contract that applies when there are two or more clinically recommended dental services available to correct the same dental condition. The provision determines that the insuring company will provide coverage for the less expensive service.
The jaw bone to which the tooth is attached.
The most common material used in fillings; also known as “silver” fillings.
American Dental Association®
(ADA) A professional organization of dentists that promotes the field of dentistry through education, research, advocacy and the development of standards.
An agent that lessens pain without loss of consciousness.
An agent that removes the sensation of pain from the entire body, usually accompanied by loss of consciousness; see general anesthesia, IV sedation and local anesthesia.
The maximum dollar amount a program will pay toward the cost of dental care incurred by an individual or family during a defined one-year time period.
The six upper or six lower front teeth.
A drug that stops or slows the growth of bacteria.
The tip or end of the root of a tooth.
The surgical removal of the apex (root tip) to treat a dead tooth.
Information provided as a signed statement that an insurer uses to determine whether or not to issue an insurance policy.
The alignment of the upper or lower teeth.
The loss of tooth structure due to natural wear.
A device used to sterilize instruments with pressurized steam.
The difference between the dentist’s normal charge and what the insurer pays for a given procedure. The member is responsible for paying that difference.
The cement placed under a dental restoration to insulate the nerve chamber.
1) The amount payable by the insurance company toward the cost of eligible covered services and procedures; 2) The services or procedures covered by the insurance plan.
A plan that provides payments for covered services for covered individuals in return for a premium paid in advance (by the member, employer or both). Benefit plans typically include deductibles, maximums, coinsurances, and exclusions and limitations.
Bicuspid or Pre-Molar
The transitional teeth behind the cuspids (pointed teeth at the corners of the mouth).
The amount a dentist submits to a dental insurer for services provided to a covered person.
The removal of a small piece of tissue for microscopic examination.
The way in which the upper and lower teeth meet when closing the mouth.
An x-ray that detects tooth decay; called a bitewing because patients bite down on the x-ray film.
A cosmetic dental procedure that whitens natural teeth through chemical or laser treatment.
The covering of a tooth surface with a composite resin (tooth-colored material also used for fillings) to correct stained or damaged teeth.
The devices used by orthodontists to gradually reposition teeth (also known as Orthodontics).
The prosthetic (false) teeth or row of teeth that spans between two natural teeth
Grinding or clenching of the teeth.
The natural element needed for healthy teeth, bones and nerves.
The hard residue that forms on teeth due to plaque buildup, often stained yellow or brown; also known as “tartar”.
A mouth sore, whitish in color, which often appears with a red halo.
A fixed bridge that attaches to adjacent teeth on one end.
A common term for dental crown; see crown.
Commonly used term for tooth decay.
Decay in tooth caused by caries; also referred to as a “carious lesion.”
A statement sent to an insurance carrier that lists the treatment performed, the date of that treatment and a list of associated costs; serves as the basis for payment of benefits.
Review of a claim by the insurance company before a reimbursement payment is made.
A device that holds a removable partial denture to stationary teeth.
The removal of plaque and tartar from teeth, generally above the gum line.
The part of the dentist’s fee that the patient is required to pay to the dentist after the patient’s insurance carrier has paid its portion (after any deductibles).
A tooth-colored filling; also called a “resin,” “composite resin” or “white” filling.
Coordination of Benefits
A provision in an insurance contract that applies when a person is covered by more than one insurance plan. It requires all insurance plans to coordinate with each other when paying benefits in order to avoid repeat payments or overpayment.
Dental treatments performed to enhance appearance (e.g., bleaching, veneers).
An individual who is eligible for benefits and for/by whom premiums are paid under a dental policy.
Services for which payment is provided under the terms of the dental plan; subject to deductibles, maximums and waiting periods.
A reverse biting relationship of upper and lower teeth (such as an underbite).
1) A porcelain or gold cover for a decayed, damaged or discolored tooth; 2) the portion of the tooth above the gum line
Scraping or cleaning the walls of a cavity or periodontal pocket.
The large, pointed teeth at the corners of the mouth, located between the incisors and bicuspids; also known as “canine” or “eye teeth.”
The raised round parts on the chewing surface of the teeth.
The abbreviation for Doctor of Dental Surgery.
The abbreviation for Doctor of Medical Dentistry.
Date of Service
The date that a service was provided.
Removal of foreign matter or dead tissue.
The destruction of tooth structure caused by toxins produced by bacteria.
The first set of (usually) 20 teeth; also known as “baby teeth.”
The amount of dental expense the member must pay before the dental plan will consider payment of benefits.
A waxed or unwaxed piece of nylon string that is inserted between the teeth and moved in an up-and-down fashion to remove plaque or other food deposits.
A titanium rod surgically placed in the bone of the upper or lower jaw to provide support for a dental restoration or appliance (such as a crown).
An artificial device, such as a bridge, that replaces one or more missing teeth.
The inner layer of tooth structure, located immediately under the surface enamel.
The arrangement of natural or artificial teeth in the mouth.
A removable (partial or complete) set of artificial teeth.
An individual who is eligible for benefits through a policy issued to a parent, spouse or, in some states, domestic partner.
The space between teeth.
(Department of Defense Information Assurance Certification and Accreditation Process). Ongoing requirements and processes for protecting and securing information systems and physical facilities, mandated by the Department of Defense for its contractors.
The date that the policy goes into force and coverage begins.
A dependent of a policyholder (spouse, child or other dependent) who meets all of the requirements specified in the dental policy to qualify for coverage, and for whom premiums are paid.
Procedure that is eligible to be covered under the plan, subject to deductibles, maximums and waiting periods; also known as “covered procedure.”
The hard tissue covering the portion of tooth above the gum line; the hardest substance in the body.
The branch of dentistry concerned with the treatment of the dental pulp or nerve of the tooth; the most common procedure is a root canal.
A dentist who specializes in treatment of injuries, diseases and infections of the dental pulp or nerve of the tooth.
A person who receives benefits under a dental benefit contract; also known as “member”, “insured”, “covered person” or “beneficiary.”
(Explanation of Benefits) A written statement to a member/enrollee, from the dental insurance company, sent after a claim has been submitted and indicating the benefits/charges covered or not covered by the dental benefit plan.
Services not covered under a dental policy.
The date on which the dental benefit policy expires or the date that an individual ceases to be eligible for benefits; also known as “termination date.”
Explanation of Benefits
(EOB) A written statement to a member/enrollee, from the dental insurance company, sent after a claim has been submitted and indicating the benefits/charges covered or not covered by the dental benefit plan.
The removal of a tooth.
The tooth-colored overlay on the visible portion of a crown.
A list of the charges agreed to by a dentist for specific dental services (Also see MAC and Maximum Allowable Charge).
The restoration of lost tooth structure with metal, porcelain or resin materials.
A dental appliance that is cemented or bonded to the teeth.
Fixed Partial Denture
A device replacing one or more missing teeth that is cemented or attached to abutment teeth or implant replacements.
The lifting of gum tissue to expose and clean underlying tooth and bone structures.
A naturally occurring element that strengthens enamel, helping teeth resist decay.
The removal or reshaping of thin muscle tissue that attaches the upper or lower lips to the gum, or the tongue to the floor of the mouth.
A full set of x-rays, typically with 12-22 films, that show the crowns (the portion of tooth above the gum line) and roots of all of the teeth and the bone around them.
An agent that removes pain from the body by producing a controlled state of unconsciousness or “deep sleep.”
A primary care dentist.
The surgical removal of gum tissue.
The inflammation of gum tissue; early stage of gum disease.
A specified period of time allowed after a premium payment is due during which payment will still be accepted without loss of coverage.
A procedure that allows a member or a dentist to express complaints to the dental insurer and receive a response.
The exposure of dental roots due to shrinkage of the gums from abrasion, gum disease, unusual anatomy or surgery.
An instrument used in the diagnosis and treatment of chronic halitosis (bad breath).
The condition of bad breath.
Health Insurance Portability and Accountability Act of 1996
(HIPAA) A law that established national standards to protect the privacy of health insurance information.
A procedure that kills all microorganisms on dental instruments when placed into a chamber and the temperature is raised.
(Health Insurance Portability and Accountability Act of 1996) A law that established national standards to protect the privacy of health insurance information.
A type of dental professional qualified to clean and scale teeth. They also educate patients on proper dental care.
A photograph of teeth stored in a computer and then displayed on a television monitor. A dentist can show you an image of your smile with new, repaired or whitened teeth.
A tooth that fails to erupt properly and remains fully or partially embedded (covered by bone or gum tissue).
A fixed replacement for a missing tooth
A mold made of the teeth and soft tissues.
The four upper or lower single-cusped (pointed) front teeth designed for cutting food.
Coverage that is active because premiums are being paid.
A custom-made, cast-gold alloy that is cemented to a previously prepared cavity in the tooth.
Services provided by dentists contracted by a plan’s network.
A dental provider who has agreed by contract to accept a plan’s maximum allowable charge schedule; also known as a “participating” or “network” dentist.
A person who is covered by an insurance plan.
The surfaces between adjoining teeth.
The space between upper and lower teeth.
A small video camera used to view and magnify oral conditions; images may be viewed on a monitor or printed.
An anesthesia used for people who want to be asleep during dental procedures; often described as a “light” anesthesia; see anesthesia, local anesthesia.
A crown for a front tooth, usually made of porcelain.
A thin plastic or porcelain veneer produced in a dental laboratory and then bonded to a tooth.
Termination of a policy because premium was not paid.
An instrument used in dentistry for surgery to cure (harden) restorative tooth materials and enhance tooth bleaching, as well as to remove tooth structure to eliminate disease.
An odorless inhalation agent that produces relative sedation, reduces anxiety and creates a state of relaxation; also known as “nitrous oxide.”
An obligation for a specified amount or action.
Restrictions stated in a dental policy, such as age, length of time covered and waiting periods, which affect an individual’s coverage.
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 dependents with certain disabilities.
An agent that relieves the sensation of pain in a localized area; see anesthesia, IV sedation.
(Maximum Allowable Charge) The maximum dollar amount that a dentist agrees to charge covered individuals for services. Payment to the dentist may be from the plan, member or both.
A misalignment of the upper and lower teeth; also known as “bad bite.”
The lower jaw.
The point of contact between a restoration and the tooth structure.
A bridge that is bonded to the back of the adjacent teeth; requires minimum tooth reduction.
The upper jaw.
Maximum Allowable Charge
(MAC) The maximum dollar amount that a dentist agrees to charge covered individuals for services. Payment to the dentist may be from the plan, member or both.
Maximum Allowable Charge Schedule
A list of maximum allowable charges that network dentists contractually agree to accept as payment in full for covered services.
The maximum dollar amount that a dentist agrees to charge covered individuals for services. Payment to the dentist may be from the plan, member or both.
The maximum dollar amount that a dental plan will pay toward the cost of dental care incurred by an individual or family within a specific period, usually a calendar year or lifetime.
A temporary filling that incorporates a soothing medication to calm an inflamed tooth nerve.
A person enrolled in a dental benefit program; also known as “enrollee”,”insured”, “covered person” or “beneficiary.”
The back teeth that are designed for grinding food before swallowing.
A removable appliance used to protect teeth from injury during athletic activities.
Nerve (Root) Canal
The dental pulp; the internal chamber of a tooth.
A grouping of dentists who have entered into contractual agreement with an insurer to provide dental care services for members.
A dentist who has entered into a contractual agreement with an insurer to provide dental care services for members at agreed-upon charges.
A removable acrylic appliance used to minimize the effects of grinding the teeth (bruxism) or joint problems (TMD); usually worn at night.
An odorless inhalation agent that produces relative sedation, reduces anxiety and creates a state of relaxation; also known as “laughing gas.”
Any dentist who does not have a contractual agreement with a dental plan provider to provide dental care to members of the dental plan; also known as “non-network” or “out-of-network” dentist.
The relationship between the upper and lower teeth when the jaw is closed and their surfaces come in contact.
A gold or porcelain inlay extended to cover the cusps for protection of the tooth.
Oral and Maxillofacial Surgeon
A specialist who deals with the diagnosis and surgical treatment of diseases, injuries and deformities of the mouth and supporting structures.
Oral and Maxillofacial Surgery
Surgical procedures on the mouth including extractions, removal of cysts or tumors, and repair of fractured jaws.
The process of maintaining cleanliness of the teeth and related structures.
A dentist specializing in the study of oral diseases.
The specialty of dentistry concerned with the recognition, diagnosis, investigation and management of diseases of the mouth, jaws and adjacent structures.
Any substance taken through the mouth (such as a pill or liquid) to reduce anxiety and relax the patient.
A dentist who specializes in surgery of the mouth.
The specialty of dentistry concerned with the diagnosis and surgical treatment of diseases, injuries, deformities and defects of the mouth.
A dental specialty that treats misalignment of teeth; an extended treatment that usually consists of braces or a retainer.
A dentist who specializes in orthodontics.
Refers to dentists who are not contracted as part of a carrier’s network, or to procedures received from a nonparticipating dentist.
Any dentist who is not part of a dental plan’s dental provider network; also known as a “nonparticipating” or “non-network” dentist.
The amount the member must pay out of his or her own pocket for dental services and materials, such as deductibles, coinsurance amounts, and amounts balance-billed by out-of-network dentists.
A faulty alignment of the teeth in which the upper front teeth are positioned too far over the lower teeth when the mouth is closed.
A denture that fits over residual roots or dental implants.
Amount paid to dentists or members for eligible services.
The general term that refers to the roof of the mouth.
Treatment that relieves pain but does not cure the condition causing the pain.
A single, full-mouth x-ray.
A removable appliance (prosthesis) that replaces some of the teeth in either the upper or lower jaw.
A contracted or in-network dentist.
The study of disease
A dental specialist whose practice is limited to treatment of children from birth through adolescence; formerly known as a pedodontist.
A dental specialty focusing on treatment of children’s teeth from birth through adolescence.
The area surrounding the end of the tooth root.
The record measuring the depth of gum pockets around the teeth.
The general term for the inflammation or disease affecting the gums.
The recontouring or esthetic management of diseased gum and supporting tissue.
The treatment of diseases of the gum or bone (supporting structure).
A dentist who specializes in the treatment of gum disease.
The 32 adult teeth in a complete dentition
A small defect in the tooth enamel.
A sticky substance, composed mostly of bacteria, which accumulates on teeth.
A statement of coverage required by state law that provides a description of the benefits included in the plan and explains the coverage provided under the plan.
The applicant for and owner of the insurance policy; also referred to as “subscriber.”
The period of time from the effective date of the policy to the expiration date of the policy.
The maximum benefit amount payable for an individual or a family during a policy year.
The term used for an artificial tooth on a fixed partial denture (bridge).
An all-porcelain restoration covering the portion of a tooth above the gum line.
Porcelain Fused to Metal (PRM) Crown
A restoration with metal coping (for strength) covered by porcelain (for appearance).
Porcelain Inlay or Onlay
A tooth-colored restoration made of porcelain that is cemented or bonded in place.
A thin layer of porcelain bonded to a natural tooth to replace lost tooth structure, close spaces, straighten teeth, or change color and/or shape.
The thin metal rod inserted into the root of a tooth after root canal therapy, serving to strengthen and retain restorative material and/or a crown restoration.
(Preferred Provider Organization) A formal agreement between a purchaser of a dental benefit program and a defined group of dentists (network) for the delivery of dental services to a specific patient population, using discounted fees for cost savings.
A process through which a dentist submits a treatment plan to an insurer before beginning treatment to determine if the procedure(s) is/are covered and at what benefit amount. The insurer then notifies the dentist whether or not the treatment would be covered, and of the benefit payable and applicable coinsurances, deductibles and maximums.
Preferred Provider Organization
(PPO) A formal agreement between a purchaser of a dental benefit program and a defined group of dentists (network) for the delivery of dental services to a specific patient population, using discounted fees for cost savings.
The amount charged by a dental benefit company for coverage of a level of benefits for a specific time.
The dental procedures concerned with the prevention of dental diseases by protective and educational measures; may include exams, cleanings, x-rays and fluoride treatments.
(Prophylaxis) The professional cleaning and removal of plaque, stains, and calculus on the teeth.
Air polishing for stain removal.
The professional cleaning and removal of plaque, stains, and calculus on the teeth.
An artificial replacement for a missing tooth or teeth.
The restoration of natural teeth and replacement of missing or lost teeth; common procedures are crowns, bridges, dentures and dental implants.
A dentist that specializes in the restoration of natural teeth and the replacement of missing teeth with artificial substitutes; expertise includes, but is not limited to: crowns, bridges, dentures, dental implants, TMD-jaw joint problems and oral cancer reconstruction.
Protected Health Information (PHI)
Protected Health Information has two components, Health Information and Individually Identifiable Health Information: 1) Health Information is information that relates to an individual’s past, present or future health; the provision of health care to an individual; or the past, present or future payment for the provision of health care; 2) Individually Identifiable Health Information is information, such as social security number or name, that can be used to identify an individual.
The dentist or specialist.
The nerves, blood vessels and connective tissue inside a tooth.
The opening in the center of the crown of a tooth which contains the pulp (nerve tissue) and stretches to the tip of the root.
The complete removal of the pulp (commonly done in children’s teeth).
Surgical removal of a portion of the tooth pulp with the goal of maintaining the vitality of the remaining portion.
One-fourth of the mouth or half of the bottom or top section of the mouth.
An image produced on photographic film by radiation, such as x-rays passed through an object; also known as “x-rays.”
The process of refitting a denture by replacing the base material.
Payment made by the insurer to the dentist or the patient for expenses related to dental services or materials.
An insertion and temporary fixation of a partially or completely dislodged tooth or teeth resulting from traumatic injury.
The process of resurfacing the tissue side of a denture with new base material.
Devices, such as orthodontic devices, that a patient can remove.
Removable Partial Denture
An artificial device, replacing one or more missing teeth, which a patient can remove.
Continued coverage of a policy beyond its original term, with the acceptance of premiums by the insurer for a new policy term.
The replacement of the damaged portion of a tooth.
A partial root structure remaining in the jaw after extraction or fracture of a natural tooth.
An appliance for maintaining the positions of the teeth and jaws immediately after the completion of orthodontic treatment.
The tooth structure that connects the tooth to the jaw.
A procedure used to save an abscessed tooth in which the pulp chamber is cleaned out, disinfected, and filled with a permanent filling.
The deep cleaning of the teeth to remove hardened plaque below the gum line; usually performed one quadrant at a time.
The removal of a portion of diseased root structure, retaining the remaining natural tooth.
The clear, natural lubricating fluid in the mouth.
The suction tube placed in the mouth to remove saliva during dental procedures.
The mouth’s natural receptors, located under the tongue and in cheeks, which produce saliva.
Removal of plaque, calculus and stains from the teeth.
Schedule of Benefits
A listing of the services for which payment will be made in part or full by a dental benefit plan.
A plastic coating applied to grooves of the teeth to prevent decay; used primarily in children.
The dental device that holds the space lost through premature loss of baby teeth.
A device used to support, protect or immobilize teeth that have been loosened, replanted, fractured or traumatized.
The applicant for and owner of the insurance policy; also referred to as “policyholder.”
An extra tooth.
The calcified plaque that forms from mineral salts in the saliva and deposits on the teeth.
The date on which the dental benefit policy expires or the date that an individual ceases to be eligible for benefits; also known as “expiration date.”
An insurance company that pays all or a part of the cost of covered dental treatment.
The period of time following treatment during which a claim must be filed.
Temporomandibular Disorders (TMD)
The problems associated with the temporomandibular joint (TMJ) which connects the lower jaw with the skull; typically associated with pops and pain in the joint.
A chemical or laser process to lighten the color of teeth.
A cleaning that uses high-frequency sound waves to gently remove deposits, such as tartar and stain, from the teeth.
A tooth that has not pushed through the gum.
The facing which is bonded directly to a tooth to improve its appearance, producing a very natural-looking result.
The period of time between enrollment in a dental plan and the date when a covered person becomes eligible for benefits, or for a specific group or class of benefits.
A process that lightens the color of teeth
The third set of molars, the last teeth to come in, usually erupt at age 18-25.
Dry mouth or decrease in the production of saliva.