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If you have a hard time understanding your dental insurance plan, particularly the treatments and services it covers, you’re not alone. That’s why Dr. Smith, Dr. Ogletree, and Dr. Douglas and our team have put together a cheat sheet to help you through them.

It’s common for patients to get lost in the morass of the terms and phrases that surface when you’re dealing with a dental insurance plan. Knowing the commonly used terms can help speed up the process and enable you to get the most out of your coverage.

Common Terms

Annual Maximum: The most your policy will pay per year for care at Smith Dental Care. It is often divided into cost per individual or per family.

Co-payment: Typically, a small amount the patient has to pay at the time of service before receiving care, and before the insurance pays for any portion of it.

Covered Services: A list of all the treatments, services, and procedures the insurance policy will cover fully under your contract.

Deductible: An amount you must pay out of pocket each year before the insurance company will contribute for any treatments or procedures. The amount can vary according to your plan.

Diagnostic Services: A category of treatments or procedures that most insurance plans will cover before the deductible, which may mean services that occur during preventive appointments with Dr. Smith, Dr. Ogletree, and Dr. Douglas, including X-rays or general screenings.

Exclusions: Dental services not covered under a dental benefit program.

In-Network: An insurance company will usually cover a larger portion of the cost of the care if you see an in-network provider for treatment.

Out-of-Network: If you visit someone who is not a part of your provider’s network, the insurance company may pay for a portion of the care, but you will be responsible for a significantly larger share out of your pocket.

Lifetime Maximum: The most that an insurance plan will pay toward care for an individual or family over the entire life of the patient(s).

Limitations: A list of all the procedures the insurance policy does not cover. Coverage may limit the timing or frequency of a specific treatment or procedure, or exclude some treatments altogether.

Member/Insured/Covered Person/Beneficiary/Enrollee:  A person who is eligible to receive benefits under an insurance plan.

Premium: The regular fee charged by third-party insurers and used to fund the dental plan.

Provider: Dr. Smith, Dr. Ogletree, and Dr. Douglas or other oral-health specialist who provides treatment.

Waiting Period: A specified amount of time that the patient must be enrolled with an insurance plan before it will pay for certain treatments.

It’s essential to understand the various insurance options available to you. Knowing what your insurance covers can save you major costs in the future.

Dr. Smith, Dr. Ogletree, and Dr. Douglas and our dental staff hope this list of terms will help you understand your dental insurance plan better. Be sure to review your plan and ask any questions you may have about your policy the next time you visit our Tyler, TX office.

Adults are no strangers to feeling like there is never enough time in the day to get everything done. Your alarm clock rings and within minutes you ping pong around trying to spread peanut butter on sandwiches, answer your cell phone, remove the dog hair from your clothes, and make sure your child has completed his or her science fair project. Brushing your teeth can easily fall to the wayside. That is why our office promotes a simple, daily oral health regimen that you can easily incorporate into your busy lifestyle.

The American Dental Hygienists’ Association (ADHA), in partnership with the Wrigley Jr. Company, is celebrating National Dental Hygiene Month (NDHM) during October. The ADHA encourages people to “Brush. Floss. Rinse. Chew…Keep it Clean, Keep it Healthy!” and offers some great tips for a quick and effective home oral health routine, below:

Oral Health Routine at Home

• Brushing your teeth twice daily is the most important thing you can do to diminish the accumulation of plaque and the potential for other oral problems such as cavities and gingivitis.
• Flossing once daily removes plaque and food from beneath the gums and between teeth that brushing alone cannot remove. Tooth decay and gum disease often begin in these areas.
• Rinsing your mouth with an antibacterial, non-alcohol based mouthwash kills plaque and gingivitis germs that brushing and flossing do not catch. We recommend using a mouthwash with the ADA Seal of Acceptance.
• Chewing sugar-free gum helps produce saliva, which battles cavities. The gum also neutralizes plaque, strengthens enamel, and removes remaining food. It is especially important to chew gum after eating or drinking.

It’s easy to put the toothbrush down in order to take care of matters you feel are more urgent, but remember, a good oral health routine at home is the best way to prevent periodontal disease. “Periodontal disease is the most common cause of tooth loss in adults. An estimated 75 percent of Americans reportedly have some form of periodontal disease,” said the ADHA. Periodontal disease also is linked to more serious illnesses such as diabetes and stroke.

Also, remember to keep regular visits with our office. Dr. Smith, Dr. Ogletree, and Dr. Douglas can help you learn more about proper care for your teeth and gums.

Sleep apnea is a disorder in which breathing stops and starts repeatedly throughout the night. It’s most common among middle-aged adults, and the most prevalent symptom is loud snoring.

Sleep apnea occurs when the muscles in the back of your throat relax to the point where they inhibit your natural breathing. It can cause your breathing to stop for anywhere from ten to twenty seconds. In the worst cases, it can even stop your breathing for up to a few minutes.

In addition, people who suffer from sleep apnea wake up feeling tired and unrested. The condition may even lead to depression, high blood pressure, irritability, and memory loss. It puts you at a greater risk for heart attack and lowers oxygen levels in your brain.

All of this sounds scary, but the good news is that sleep apnea can be treated! One of the most common ways Dr. Smith, Dr. Ogletree, and Dr. Douglas can treat sleep apnea is by creating an oral device for you to wear while you sleep.

The device brings your jaw forward, which keeps the airway open and lowers the incidence of snoring. Another method is to use a continuous positive airway mask, often referred to as a CPAP. The mask fits over the mouth and forces oxygen through the throat while you sleep.

If you’re unsure about whether you may suffer from sleep apnea, visit our Tyler, TX office and let Dr. Smith, Dr. Ogletree, and Dr. Douglas know. We can determine the appropriate treatment if any is needed. Don’t risk losing another night’s sleep over something we can easily treat!

From the clinical perspective, dentistry is similar around the world. Dentists, like Dr. Smith, Dr. Ogletree, and Dr. Douglas, go to school, obtain a license, and work hard to prevent and treat tooth decay, gum disease, oral infections, throat or oral cancer, tooth loss, and other conditions that might limit a person’s ability to smile, bite, chew, or speak. The quality of dental care, however, and the payment method for dental services varies between nations.

Dentistry throughout the World

Developed countries have more dentists per capita than do developing nations, according to the World Health Organization. There is one dentist for every 150,000 people in Africa, for example, as compared to about one dentist for every 2,000 citizens of an industrialized nation. The lack of dentists in developing nations means that dental care is restricted to pain management and emergency care.

Dentistry often reflects the cultural views of a nation. Some cultures acknowledge only the functional aspect of teeth, so dentists focus on preventing tooth decay, gum disease, and tooth loss. Other cultures emphasize aesthetic appearances, so dentists there provide cosmetic procedures in addition to essential oral care.

Each nation imposes its own education and licensure requirements for dentists but most require some college before four years of dental school. The graduate must then pass local or national exams to practice in that region. European schools and standards are similar to the United States.

From the business perspective, dentistry varies between nations. In the United States, a dentist presents to the patient one bill that includes all of the treatment costs, such as the dentist, his assistant, tools, and labs. This allows the dentist to charge a single, easy-to-pay fee for individual procedures, and gives him an opportunity to mark up items and make a profit.

Across much of Europe, a dentist presents two bills to her patient – one for the dentist and another for the lab. This approach may stem from a cultural belief that profiting from healthcare is unethical and that healthcare should be available to consumers at actual cost; public dental clinics and subsidies ensures all citizens have access to dental care, regardless of ability to pay. In most cases, the government is both overseer and provider of dental care.

While the role of the dentist is nearly the same in every country – to ensure the oral health of the citizens – dental care is different in each nation. Regardless, you can rest assured that the care you receive at our Tyler, TX office is held to the highest standard.