Glossary of Dental Insurance Terms
Delta Dental of Minnesota

Dental and Insurance terms

Delta Dental of Minnesota makes it easy to decode some of the confusion around dental insurance. Dentists and insurance providers use many terms to describe procedures, and we know it can be difficult to understand it all.

Below, we have put together explanations for some common dental jargon. For some of the more complicated terms, we have provided examples which may make it easier to understand in context.

Abrasion The abnormal wearing away of tooth substance by a mechanical process.

Abscess Acute or chronic, localized inflammation, with a collection of pus, associated with tissue destruction and, frequently, swelling, usually secondary to infection.

Abutment A tooth or teeth used to support and anchor a fixed or removable prosthesis.

Actisite A plastic fiber impregnated with the antibiotic tetracycline. Used by general practitioners or periodontists, it is placed in specific sites in the gums that have active periodontal disease to eliminate or reduce the disease-causing bacteria.

Alveolar bone The bone surrounding the roots of teeth.

Alveolectomy The shaping of the alveolar ridge of the jawbone by surgical procedures for the removal of bony prominences, usually in preparation for the construction of a prosthetic appliance.

Amalgam (Silver Filling) A metal alloy consisting of silver, tin, zinc, and copper combined with mercury and used as a restorative material for teeth.

Analgesia (Nitrous Oxide/laughing gas) loss of pain sensation without loss of consciousness.

Analgesic A mild remedy, such as aspirin, for relieving pain.

Anesthesia Absence of pain sensation.

General Anesthesia A controlled state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including loss of ability to independently maintain airway and respond purposefully to physical stimulation or verbal command.

Intravenous (IV) Sedation A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective reflexes and the ability to respond to stimulation or verbal commands.

Local Anesthesia (Novocaine) The loss of pain sensation over a specific area of the anatomy without loss of consciousness.

Anterior Teeth Front teeth.

Apicoectomy Surgical removal of the apex or tip of a root in order to remove diseased tissue.

Appliance A device worn by a dental patient during a course of treatment, but not as a substitute or reconstruction of oral or facial structures. For example, space maintainer, periodontal splints.

Attrition The normal loss of tooth substance resulting from friction caused by physiologic forces.

Basic Services Includes services such as silver fillings on back teeth, simple oral surgery, tooth-colored fillings on front teeth, periodontics, endodontics, sealants, and extractions (refer to your specific contract for coverage).

Bite (See Occlusion).

Bitewing X-ray A specific type of radiograph (X-RAY picture) which shows, simultaneously, an interproximal view of the coronal portion of upper and lower posterior teeth. Generally used to diagnose the presence of dental decay.

Bridge Fixed Partial Denture. A prosthesis replacing one or more missing teeth usually cemented or bonded to the abutment teeth adjacent to the space.

Bruxism Involuntary grinding of the teeth.

Calculus Hard deposits of mineralized dental plaque that is attached to crowns and/or roots of teeth.

Caries, Dental An infective disease that results in the destruction or decay of tooth substance. Also referred to as cavity or carious lesions.

Caries Susceptibility Test A test done to determine how likely someone is to develop tooth decay. The test is usually done by measuring the concentration of certain bacteria in the mouth.

Cavity/Cavities, Classification of:

One surface A carious lesion that involves a single surface of tooth.

Two surfaces A carious lesion that involves two adjacent tooth surfaces of an individual tooth.

Three surfaces A carious lesion that involves three adjacent tooth surfaces on an individual tooth.

“White” filling. A tooth-colored restorative material composed primarily of polymers (plastics) with filler materials composed of silica, quartz or ceramic particles. The polymer is usually cured with visible light or may be chemically cured. (Also, see Resin).

Coordination of Benefits (COB) A provision in an insurance contract that integrates benefits payable under more than one dental plan so that the insured person’s benefits from all sources do not exceed 100 percent of allowable dental expenses.

Coordination of Benefits (Non-Duplication of Benefits) A provision in a dental insurance contract that relieves the insurer of liability for the cost of services covered under another plan. When subscribers have more than one dental plan, the plan that is secondary will pay no more than the amount it would have paid if it were the primary plan, less what the primary plan has paid.

Co-payment (Co-pay) The amount a person is responsible for paying toward the cost of his or her dental treatment after the insurance company has paid the predetermined percentage of the total treatment. Many dental insurance plans have a copayment policy and is often paid on a per visit or service basis.

Cosmetic Dentistry Any dental service performed primarily to improve appearance.

Crown, Artificial (Sometimes called a “Cap”) A fixed restoration (cannot be removed by the patient) covering the major part of the natural tooth, usually fabricated of various metals, including gold, porcelain, acrylic resin or combinations of these materials.

Crown/Core Buildup Building up the anatomical crown before restorative crown is placed.

Crown Lengthening A surgical procedure exposing more tooth for restorative purposes.

Curettage Scraping or cleaning the walls of a gingival pocket.

Cusp Pointed or rounded eminence on the chewing surface of a tooth.

Debridement, Full Mouth Removal of subgingival and/or supragingival plaque and calculus. This is a preliminary procedure and does not preclude the need for other procedures.

Deciduous A name used for the primary or baby teeth.

Deductible Most dental plans have a specific dollar deductible. It works like your car insurance deductible. During a benefit period, you will have to personally pay a portion of your dental bill before your insurance carrier will contribute to your bill. Your plan booklet will describe how your deductible works. Plans do vary on this point. For instance, some dental plans will apply the deductible to preventive treatments, and others will not.

Defective Margins Edges of restorations (fillings) that have become uneven through wear or chipping of the tooth or the filling material.

Demineralization The process of losing tooth enamel.

Dental Implant Biologically compatible material inserted into the bone to replace a missing tooth.

Dental Plaque (Bacterial plaque) A sticky substance which forms on the teeth. It is composed of mucoidal secretions containing bacteria and their products, dead tissue cells, and debris. This substance is toxic and is considered to be important in the initiation and progression of gingivitis (gum inflation) destructive periodontal disease, and dental caries (Cavity/Cavities).

Denture An artificial substitute for missing natural teeth and adjacent structures.

Complete denture A dental prosthesis which replaces the lost natural dentition and associated structures of the entire maxilla or mandible.

Immediate denture A dental prosthesis constructed for insertion immediately following the extraction of natural teeth.

Fixed partial denture (Bridge) A restoration of one or more missing teeth, permanently attached to natural teeth or roots, which furnish the primary support to the appliance, generally referred to as a bridge.

Removable partial denture A prosthetic appliance which artificially replaces missing teeth and associated structures in a partially edentulous jaw and which can be removed from the mouth and replaced at will.

Desensitizing agents Materials applied to teeth to reduce sensitivity for such reasons as temperature, touch, acids, biting, etc.

Diagnostic Services Procedures such as radiographs, clinical examinations, biopsies, blood tests, study models, and vitality tests which assist in determining the disease conditions present.

Dry mouth syndrome Decrease in production of saliva (also called Xerostomia).

Endodontics The discipline or specialty of dentistry concerned with the diagnosis and treatment of diseases of the pulp.

Erosion The loss of tooth structure from chemical (usually acidic) action; parts of the tooth’s surfaces are dissolved and lost. Exclusions Dental services not provided under a dental insurance plan.

Explanation of Benefits (EOB) A statement sent to subscribers by the insurance company explaining how the payment amount for a dental benefit claim was calculated. The statement outlines the procedures covered by the subscriber’s dental benefit plan and the amount that the insurer has paid toward the treatment.

Extraction Tooth removal.

Filed fees Approved fees that participating dentists have agreed to accept as the total fees for the specific services performed.

Filling Restoring lost tooth structure with metal, alloy, porcelain, or resin. (See Amalgam and/or Composite

Fissure sealant A material applied to teeth to seal the surface irregularities and prevent tooth decay. (See Sealant).

Fluoridation The adjustment of the fluoride content of a water supply as an aid in decreasing the incidence of dental caries.

Fluoride, Topical Application The direct application of a fluoride compound (sodium, stannous, acidulated phosphate) to the teeth as a measure for partially preventing the incidence of dental caries. Application is recommended for teeth at risk for disease.

Frenulectomy (Frenectomy) Excision or removal of the frenum.

Frenum Muscle fibers covered by a mucous membrane that attaches the cheek, lips and/or tongue to associated dental mucosa.

Full mouth series radiographs (Full mouth x-rays) A series of usually 14 periapical films plus bitewing radiographs.

General Anesthesia See Anesthesia.

Gingiva/gingival curettage Removal of inner tissue from a gum pocket.

Gingiva (E) The fibrous tissue, covered by mucous membrane, which immediately surrounds a tooth. The gums.

Gingivectomy The excision or removal of gingiva.

Gingivitis Inflammation of gingival tissue.

Gingivoplasty Surgical procedure to reshape gingivae to create a normal, functional form.

Graft A piece of tissue or synthetic material placed in contact with tissue to repair a defect or supplement a deficiency.

Hemisection Surgical separation of a multirooted tooth so that one portion remains and another portion is removed.

Identification (ID) Card A card provided to subscribers of Delta Dental of Minnesota dental plans that contains important information that should be given to their dentists when they (or their eligible dependents) receive treatment. The ID card is not proof of insurance.

Immediate denture (See Denture).

Impacted Tooth Commonly a tooth embedded in either the soft or bony tissues of the jaw in such a way that it has not erupted or has erupted only partially.

Initial placement The first delivery of a crown, bridge, or denture as opposed to a replacement.

Inlay A restoration (typically gold, porcelain or resin) processed outside the mouth and then connected or bonded to the tooth. It does not cover or replace any cusps.

Interproximal Between the adjoining surfaces of adjacent teeth.

IV Sedation (See Anesthesia).

Jump rebase A process of refitting a denture by replacing the denture base material without changing the occlusal relations of the teeth.

Limitations Restricting conditions such as age, period of time covered, and waiting periods under which a group or individual is insured.

Major Restorative Includes services such as restorative crowns, bridges (multiple crowns), and tooth-colored fillings for back teeth (refer to your specific contract for specific coverage or benefits).

Malocclusion Improper alignment of biting or chewing surfaces of upper and lower teeth.

Mandible Lower jaw.

Maxilla Upper jaw.

Maximum The maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period. Most insurance plans have an annual and/or lifetime dollar maximum. The patient is responsible for paying costs above the plan maximum.

Micro-fractures Very early fracture lines in teeth due to biting or grinding forces (also called “craze lines”). These “micro-fractures” are not associated with symptoms of discomfort or sensitivity.

Molars The 12 back teeth in the entire mouth (or the three back teeth in each quarter of the mouth if the wisdom teeth are counted).

Network Dentist Any dentist who has a contractual agreement with a carrier or dental service organization.

Novocaine (See Anesthesia).

Occlusal Pertaining to the contacting or biting surfaces of opposing teeth. Pertaining to the masticating surfaces of the posterior teeth. (See Cavities, Classification of).

Occlusal Adjustment Reshaping the occlusal surfaces of teeth to create harmonious contact relationships between the maxillary and mandibular teeth.

Occlusal Equilibration Modification of the biting surfaces of opposing teeth to develop harmonious relationships between the teeth themselves, the neuromuscular mechanism, the temporomandibular joints, and the structure supporting the teeth.

Occlusal Guard Removable dental appliance which is designed to minimize the effects of bruxism and other occlusal factors.

Occlusion Any contact between biting or chewing surfaces of upper and lower teeth.

Onlay A restoration that replaces or covers a cusp or cusps of the tooth.

Oral and Maxillofacial Surgery The discipline or specialty of dentistry concerned with operative procedures in and about the oral cavity and jaws.

Oral Hygiene Instruction May include instructions for home care (i.e. tooth brushing technique, flossing, use of special oral hygiene aids).

Oral Pathologist A dental specialist who recognizes, diagnoses, investigates and manages diseases of the oral cavity, jaws, and adjacent structures.

Oral Surgeon A dental specialist whose practice is limited to the diagnosis, surgical, and adjunctive treatment of diseases, injuries, deformities, defects and aesthetic aspects of the oral and maxillofacial regions.

Orthodontics The discipline or specialty of dentistry concerned with the diagnosis and treatment of malocclusion and misalignment of teeth.

Orthodontist A dental specialist whose practice is limited to the treatment of malocclusion or the correction of irregularly aligned teeth. This includes services such as comprehensive orthodontics and minor appliance therapy.

Orthognathic Functional relationship of jaws.

Osseous surgery A procedure modifying the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form. This may include the removal of supporting bone (ostectomy) and nonsupporting bone.

Overdenture A complete or partial removable denture supported by retained roots or dental implants to provide improved support and stability.

Overhang Excess filling material projecting beyond cavity margins.

Palliative (Emergency) Treatment Minor procedure for emergency treatment of dental pain.

Panorex/Panoramic Film A radiograph (X-ray) of both the upper and lower jaws, all the teeth and associated structures on one film.

Partial Denture (See Denture).

Pathology The branch of science that deals with disease in all its relations, especially with its origin and the functional and material changes it causes.

Pathosis A disease entity or pathologic condition. A dental cavity is a pathosis.

Patient Management Problems Adverse behavior by the patient connected to an episode of treatment or attempted treatment.

Pediatric Dentistry The discipline or specialty of dentistry concerned with the prevention, diagnosis and treatment of dental conditions and diseases in children.

Pedodontist A dental specialist whose practice is limited to treatment of children through adolescence.

Periapical X-ray (Single) A radiograph (X-ray) that shows the total tooth, including the apex (tip) of the root and surrounding tissue.

Periochip A tiny, bullet-shaped, biodegradable chip that is inserted under the gum into an isolated periodontal pocket. It releases the disease-killing chemical chlorhexidine over about a week’s time and subsequently resorbs.

Periodontal disease An infection of the structures surrounding and supporting the teeth. (gums)

Periodontal maintenance Therapy for preserving the state of health of the gums and tissues surrounding and supporting the teeth. Also known as a perio recall.

Periodontal scaling/root planing The removal of hard deposits, with metal scalers and curettes, on the root surfaces. The intent is to remove the diseased elements of the root surface, thereby permitting healing and potential reduction in depth of the periodontal pocket.

Periodontal Splinting The ligating, tying, or joining of periodontally involved teeth to one another to stabilize and immobilize the teeth.

Periodontal surgery Gum surgery that includes the treatment of the diseased teeth and their supporting structures.

Periodontics The discipline or specialty of dentistry concerned with the prevention, diagnosis and treatment of diseases of the soft and hard tissues supporting the teeth.

Periodontist A dental specialist whose practice is limited to the treatment of gum disease and the areas surrounding and supporting the teeth.

Plaque A soft, sticky substance that accumulates on teeth; it is composed largely of bacteria and food substances suspended in saliva.

Pontic An artificial tooth on a bridge (fixed partial denture). It replaces the lost natural tooth, restores its functions, and occupies the space previously filled by the natural tooth.

Post/Core An elongated projection fitted and cemented within the prepared root canal, serving to strengthen and retain restorative material and/or crown restoration.

Posterior Situated behind or toward the rear.

Posterior Teeth – Back teeth.

Pre-estimation of Benefits A request for an estimate of benefits that a subscriber can ask his or her dentist to complete if dental care will be extensive. This allows the subscriber to know in advance exactly what procedures are covered, the amount the insurance company will pay toward treatment and his or her financial responsibility. Under some plans, pre-estimation by the insurer is required before certain procedures can be provided.

Primary Dentition First set of teeth; also known as deciduous or “baby” teeth.

Prophylaxis The removal of calculus (tartar), dental plaque, and stains from the teeth (above the gum line).

Prosthesis (Dental) An artificial replacement of a lost part of the natural dentition or oral cavity.

Prosthetic Repairs & Adjustments Includes services such as denture repair and adjustment, rebasing and relining, and dental bridge repair.

Prosthodontics The discipline or specialty of dentistry concerned primarily with providing artificial replacements for missing teeth.

Prosthodontist A dental specialist whose practice is limited to the restoration of natural teeth and/or the replacement of missing teeth with artificial substitutes.

Pulp The “inside” part of a tooth that contains blood vessels, nerves and other cells. It makes the tooth a “living” tissue.

Pulp Cap Exposed or nearly exposed pulp is covered with a dressing to protect the pulp from additional injury and promotes healing and repair.

Pulp Exposure Treatment Treating the pulp or “nerve” that has been uncovered, generally in the process of removing tooth tissue destroyed by decay, in an attempt to promote healing and therefore make root canal treatment unnecessary.

Pulpotomy Removal of the top part of the pulp. For permanent teeth, it is the first step in root canal treatment.

Radiograph (See X-ray).

Rebase (Reline) A process of refitting a denture by resurfacing or replacing denture base material without changing the occlusal relations of the teeth.

Recontouring The reshaping of any surface of a natural or artificial tooth.

Reline To resurface the tissue side of a denture with new material so that it will fit more accurately (see Rebase).

Resins “White” fillings composed of several types of “plastic” materials.

Restoration (Prosthetic Restoration, Appliance) Broad terms applied to any amalgam, inlay, crown, bridge, partial denture, or complete denture which restores or replaces lost tooth structure, teeth or other oral tissues.

Root Canal Therapy (R.C.T.) The nerve of the tooth is removed from the canal inside the root and replaced with an inert filling material.

Root planing A definitive treatment procedure involving the cleaning and shaping of the root surface of teeth.

Scaling A dental procedure performed to remove calculus (tartar), soft deposits (plaque), and stains from the teeth.

Sealant A resin material bonded to the biting surface of a tooth to prevent decay. (See Fissure Sealant).

Sedative Filling Temporary restoration intended to relieve pain.

Space maintainer An appliance constructed for the purpose of preventing adjacent and opposing teeth from moving into the space left by teeth lost prematurely.

Splint A device used to support, protect, or immobilize teeth that have been loosened, replanted, fractured or traumatized. Also refers to devices used in the management of temporomandibular joint (TMJ) disorders.

Stainless steel crown A preformed steel crown used for the restoration of badly broken-down primary teeth and first permanent molars. Also used for temporary restoration of badly damaged teeth.

Subscriber A person, usually an employee, who represents a single or family unit in a dental program. (Also called Enrollee).

Superstructure A structure constructed on or over another structure. For example, a removable denture that fits snugly onto the protruding implant abutments.

Temporary/Interim Denture A dental prosthesis that is planned to be used for a short interval of time, generally during a healing period following surgery.

Temporomandibular Joint (TMJ) The connecting hinge mechanism between the mandible (lower jaw) and the base of the skull (temporal bone).

TMJ disorder The term given to a condition characterized by facial pain and restricted ability to open/move the jaw.

Veneer A covering (porcelain or resin) for the front of a tooth, usually done to improve esthetics.

Vertical dimension The vertical height of the face, in particular the distance from the tip of the nose to the point of the chin, with the teeth in occlusion acting as stops or at an equivalent distance if the teeth are not present.

Vestibuloplasty A surgical procedure done to facilitate the placement of a prosthesis.

Xerostomia Decrease in production of saliva.

X-ray A diagnostic radiograph produced on a photographic plate, film, or paper by the action of roentgen rays.