Question: A week or so ago my daughter hit my top lip under and cut my gum. Now it hurt to smile or eat anything too hot.  It is all red and I think I may have an abscess.  Should I try popping it myself or have it checked out.

Answer: Stay on the safe side and see a dentist about it.  An Oral abscess in not to be taken lightly and can start to cause you to have other dental issues if not address right away. Also a dentist will be able to prescribe you an antibiotic to help fight any infection if needed.

Question: I have a dental PPO plan though Anthem Blue Cross from my employer.  Even though I have had it for a few years this was the first time I really used it for anything more then my free cleaning.

About a month ago I had some dental work that was rather costly.  Now I get an additional billing from my dentist stated that the insurance did not pay out much for the full porcelain crown that I got.  However my dental plan says they will pay out half the cost for crowns.

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

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

There are many ADA codes for crowns here is a sample

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

There are more but I listed a few to show you that a crown is not just a crown. Under many PPO plans they may only provide benefits for a lower cost crown so when you get a higher cost crown they paid out only up to the UCR for the crown that they cover. This offers you some saving but now as much as if you would have chosen a covered crown.

One way to avoid having billing surprises such as these is to have your dental office submit claims as a quote only, to your insurance company prior to dental services being render.  That way you will know your cost ahead of time and then can decide if that is something you wish to continue with based on your budget.

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

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

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

Question: I have a dental PPO plan I get though my job.  What I do not understand is how my dental insurance states my coverages are one thing but when a claim is filed the numbers do not add up.  For an example, not that long ago I had a large filling and a crown put on.  The filling coverages where to be at 80% paid.  Which it was so that was fine

However the crown I got cost $1000.00 and my plan said that it paid out 50% for the cost of a crown.  Straight forward math right I should only have to pay $500.00 which was my co-payment of 50%.   I then get the billing from the dental office stating the insurance company only paid out only $450.00 so my cost is $550.00 now it is only $50.00 more but this happens quite a lot. What should I do about this?

Answer:  In general PPO plans pay out by percentage in your case 80% for basic services such as fillings and 50% for major services such as crowns.  But it dose not just stop there.  Normally they will state that the percentage paid out is up to UCR (Usual, Customary, and Reasonable) There for if the dentist you are going to is above the UCR rate for the company you will have an additional charge.

Also some PPO plans will have two sets of coverage one for network dentist and another for out side network dentist. Out side network dentist normally will have less benefits then inside network providers.

As to why you are paying more, I could not say which is the case for you. That will be something I would advise you call your plan’s member services for. They can go over your benefits and directly answer what is effecting your cost on claims.

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

Many people over the age of 55 are now regretting that they may not have taken the best care of their teeth when they were younger.  Research shows that six out of ten people age 55 and over in the UK regret not taken better care of their teeth.

Around one in five people in the UK wear full or partial dentures and an estimated 2.5 million people have no natural teeth. Despite oral health improving significantly in recent decades many people born in the 1960s and earlier lived in an era when oral health education was not widely available and their oral health has suffered.

Question: I had braces now for about six months and I noticed that I been grinding my teeth while I sleep. At first I thought I would stop as soon as I got used to having the braces on but I am still grinding my teeth while I sleep.  I not sure what to do I think the best bet is to get a night guard but since I wear braces and I will be in them for at least a year and a half how do I wear a night guard with braces on?

Answer: There are night guard that are available for people that have braces such as SmartGuard.  I would look into them and then talk to your dentist to make sure that is a good option for you.

Question: I have no luck with dentist or dental office.  I have dental insurance where I can see whatever dentist I want too.  However I either find that I do not care for the dentist.  Or when I do like the dentist the dental office staffing is so bad that I still do not like going to them.

What does one have to do to find a dentist without a bad attitude or with a good front office staffing?  This is becoming a big issue for me.  How do I pick a good dentist office with staffing that know how to process out claims?

Answer: Finding a “Good Dentist” takes work on your part.  Here are some tips that may help you in your search.

1) Ask you friends, family and even co-workers to see where they go and if they are happy with their dentist.

2) When you call a new dental  office ask if they have their own website that tell you how long the dentist as been in practice and provides you information on the type of dental services they render.

3) See if they have any reviews.  There are many review sites you can refer to in order to see if a dental office has many of few complaints.

4) Be clear to the dental office and the dentist about your needs and what type of insurance you have if any.

5) If you do have dental insurance make sure you understand how your plan works. Often times the issues can rise when you are not sure about your coverages/benefits.

6) Find out how their dental office files claims before having any dental work done.  Some dental office will required you  pay them in full at the time services are render making you file your own claims for return premium due you.

7) Ask questions when shopping out a new dental provider. The more you know and understand about the dentist and how the dental office is run the more you are able to work within their system if you choose to go to that dental office.

Question: I have had my braces for two years now and they are finally coming off in about two months. I would like to whiten my teeth then. I read where some people said whitening toothpaste would work,  but won’t that leave spots around the brackets?

Answer: You can not use any whitening products while you have braces on. Regardless of what you would try and use (toothpaste, gel, mouthwash, baking soda, etc) might make the exposed areas of your teeth whiter, but it would not be able to get under your braces. You will need to wait until your braces are removed to consider whitening your teeth.  Talk to your dentist for the best options.

Question: I had a filling done on a cavity a month ago. However, whenever I chew or eat something hot or cold, it is very painful. I am worried now and not sure what to do.

Answer: Go back to the dentist that did the filling. It is normal to have some pain after having a filling even for a few days, but not a month and not at the pain level you are saying you are in. Pain is never a good sign and should not be taken lightly.

Question: I am looking to have my teeth whiten.  I have slightly yellowish teeth and whitening toothpaste is not really helping me whiten them up. My dentist said they can do a whiten treatment there at the office that would really make my teeth look nice.   However after checking with my dental insurance I was told they would not cover anything for teeth whitening treatments. Is there any dental insurance plan that I could get just to cover my whitening treatment?  If not any advise on how to whiten my teeth?

Answer: In general insurance companies normally will not provide benefits for teeth whitening treatments, as it is review as cosmetic service which is generally not covered.   You may wish to review a dental discount plan. With most dental discount plans you will be able to save 15 to 20 percent off the cost of whitening treatments as well as provide you saving off all your dental care needs.

The bacteria released with chronic oral infections can spread and contribute to disease in other parts of the body. Gum disease is linked to several other health conditions in seniors, including coronary heart disease and stroke. Having periodontal disease makes it more difficult for people with diabetes to manage their blood sugar levels. It can also pose a threat to people with respiratory diseases or osteoporosis

Question: I live in California and do not have any affordable dental insurance.  What I do have is this PPO though Delta dental that I get though my employer.   However the plan does not work well for me.  I have a $1000.00  which is not much coverage when dental work cost so much.

I also seem to always go over the UCR fees that are some mystery figures that the company comes up with. I just tired of the limitations this plans has build into it.  Are there any affordable dental plans where I do not have a yearly max nor do I have to worry about what my billing going to be after the fact.

Answer:  I would suggest reviewing our HMO plans though California Dental and PrimeCare.  Both are HMO insurance plans that do not have have waiting periods or yearly maximum limitations.  They are fee based plans that show your cost for all the different services covered under the plan.  Therefore no guessing at your cost for dental care services.

Many people feel that they would be able to spot the signs of gum disease before it really get too bad. However, gum disease is not easy to detect, especially early on. In fact, many seniors do not know that they have periodontal disease because it has been developing slowly over time. That is why regular dental visits are so important. A professional deep cleaning will remove any plaque build up in places you might not be able to reach on your own.