Do You Need Dental Surgery? Here’s How Your Dental Insurance Can Help

While the nature of the injuries these days is much different than 200 years ago, the need for oral surgery hasn’t diminished. Many students of dentistry opt to become oral surgeons as well as maxillofacial surgeons for this very reason. Some of the most common reasons people need dental surgery include

• A blow to the mouth
• Temporomandibular Joint Disorder (TMJ)
• Receding gums
• Teeth needing to be extracted (including wisdom teeth)
• Jaw bone needing partial removal or realignment

Root canals and procedures that require drilling a tooth are technically considered surgery, though they are very low risk in terms of invasiveness. Dental implants are also becoming more and more popular, though few (if any) insurance companies cover them.

The point of dental surgery is to correct something in the mouth, whether it is due to injury or deteriorating condition of the teeth, gums or jaw. Whatever the reason, dental insurance is an important factor to consider when booking a surgery.

Types of Dental Surgery

An oral surgeon is a specialist who only performs surgery. Some general practitioners are skilled at surgery as well, but it’s the specialists that you need to pay particular attention to, because the services provided by an oral surgeon will not be reimbursed in full by your insurance. Most plans have a stipulation that specialist fees are covered to a degree, but more often than not their charges will exceed the maximum amount allowable for any particular treatment.

For example, let’s say you have a tooth pulled by a general practitioner. Their fee will likely align with the current year’s dental fee guide, meaning the set maximum amount allowable for each procedure. An oral surgeon will charge specialist fees, which always exceed the general practitioner fees, thereby exceeding the dental fee guide.

Be prepared to cover the remaining amount after your insurance pays its portion. If you’re unclear as to how much that might be, ask your dental care provider to send an estimate to your insurance company and they will let you know in writing what amount they will pay.

Some of the most common dental surgeries include tooth extractions, apicoectomies (removing part of the jawbone), jaw re-alignment, gum grafts, pulpectomies, pulpotomies, root canals, and implanting dental prostheses.

Some of these surgeries fall within the basic dental maximum, but many may not be covered at all. A dental estimate should always be sent to your insurance provider in advance.

Accidental Dental Services

Imagine how stressful it would be to have an accident and need emergency dental surgery! Here in Canada, it’s not uncommon for winter sports-related injuries to occur, or falls on the ice. Sometimes sports injuries also result in the need for oral surgery.

Unlike regular dental procedures, accidental dental claims fall under the extended health insurance benefit. This means that whatever costs you incur, they will not affect your dental maximums. They can be performed in a hospital and all related services will be considered under the Accidental Dental benefit.

What About Anaesthesia?

Most of us can agree that most kinds of surgery should have some sort of anaesthetic or means of minimizing pain and discomfort. Oral surgery is certainly no different. Your practitioner will determine what the best means of providing comfort should be with relation to your surgery, but the most common local anaesthetic is lidocaine, which is a numbing agent. Other options are injectable nerve blockers, and nitrous oxide (laughing gas).

Sometimes a local anaesthetic isn’t enough and the patient will need to be put under completely. This would require the use of general anaesthesia which would put the patient into an unconscious state, unaware of pain. Some of these types are administered intravenously.

Be sure to discuss this aspect with your practitioner so that you know what to expect. If you aren’t sure if it would be covered by your dental insurance, please ask your dental provider to include the anaesthesia in an estimate.

For example, if you just send an estimate with a code for anaesthesia, it should also list the code(s) of the treatment you are also receiving.

Is Your Pending Dental Surgery Covered?

As mentioned before, an estimate is always advised when expensive dental treatment is anticipated. If you are looking for a skilled oral surgeon who is an accredited member of the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS), you can check out the CAOMS website.

An estimate can help you figure out exactly what your insurance plan will pay. It will take into account the dental codes being used, the fees the practitioner is charging per service, and the oral surgeon’s name and credentials, as well as your personal information.

Call Our Office

If you need more information about your dental insurance coverage, and whether or not dental surgery is included in your benefits package, give our office a call! We’ll be happy to walk you through your coverage details and can answer any questions you may have.