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Dental

Dental

Dental

Vision

Dental Insurance plans / Vision Insurance plans Illinois

Dental Glossary
Dentists use a lot of terms to describe problems and procedures. They would be glad to explain any term you don’t know, of course, but here are a few:
A B C D E F G H I J L M N O P Q R S T U V W X Z

A
ABSCESSAcute or chronic localized inflammation with a collection of pus, associated with tissue destruction and, frequently, swelling.ABRASIONTooth wear caused by forces other than chewing, such as improper brushing.ABUTMENTA tooth or implant used to support an artificial device replacing teeth.ACID ETCHINApplying an acid to the tooth-enamel surface to provide retention for bonding.ALLOPLASTIC

Synthetic material used for tissue augmentation.

ALVEOLAR

The bone to which a tooth is attached.

ALVEOLOPLASTY

The recontouring of bone structures, usually in preparation for a prosthesis.

AMALGAM

A mixture of mercury, silver, tin, and copper used to fill cavities.

ANALGESIA

Loss of pain sensations without loss of consciousness.

ANESTHESIA

Removal of sensation. General anesthesia: a controlled state of unconsciousness. Local anesthesia: drug-induced elimination of sensation in one part of the body.

ANTERIOR

The teeth and tissues located towards the front of the mouth.

ANNUAL MAXIMUM

The most a dental plan will pay toward your dental care within a specific period, usually a calendar year.

APEX

The tip or end of the root end of the tooth.

APICOECTOMY

Amputation of a tooth apex (root tip).

ARCH, DENTAL

Upper or lower jaw.

AVULSION

Separation of tooth from its socket due to trauma; scientific term for “having a tooth knocked out.”

B

BAND

A metal ring orthodontists cement to a tooth as part of the bracing process.

BALANCE BILLING

The practice of billing a patient for the difference between what the dentist charges and the agreed-upon charge established by Delta Dental. In-network dentists cannot balance-bill patients.

BENEFIT LEVELS

Dental treatments are grouped into levels. The percentage covered by your dental plan often varies by benefit level. Most plans include the following benefit levels:

Preventive Services

Usually includes exams, cleanings, X-rays and fluoride treatments.

Basic Services

Usually includes procedures such as fillings, root canals, periodontal (gum) treatment and simple tooth extractions.

Major Services

Usually includes procedures such as crowns, dentures and implants.

Emergency Services

Dental services that are required immediately to avoid jeopardizing the patient’s health, or to relieve pain, swelling or bleeding.

Orthodontic Services

Treatment and procedures used to correct misaligned or crooked teeth. May include braces, retainers and other orthodontic appliances.

BENEFIT YEAR

The 12-month period your dental plan covers, which is not always a calendar year. For example, a benefit year could run June-May instead of January–December. This is also known as a plan year.

BICUSPID

A tooth with two cusps, usually a premolar tooth.

BILATERAL

Both sides.

BIOPSY

Process of removing tissue for evaluation.

BITEWING RADIOGRAPH

A side-view mouth X-ray.

BONDING

A composite resin that changes the shape or color of a tooth.

BRIDGE

A fixed partial denture replacing one or more missing teeth. Bridges can be fixed or removable.

BRUXISM

Grinding and/or clenching of teeth.

BUCCAL

Pertaining to or around the cheek.

C
CALCULUSHard mineralized plaque attached to crowns and/or roots of teeth.CANALThe space inside the root portion of a tooth containing pulp tissue; the passage which transmits vessels and nerves through the jaw.CANTILEVER EXTENSIONPart of a fixed prosthesis supported at one end only.CARIESTooth decay.CAVITY

Decay in tooth caused by caries; also referred to as carious lesion.

CEMENT BASE

Material used under a filling to replace lost tooth structure.

CEMENTUM

Hard connective tissue covering the tooth root.

CEPHALOMETRIC RADIOGRAPH

A full-head X-ray.

CERTIFICATE OF COVERAGE

A booklet you receive from Delta Dental that explains your benefits coverage in detail.

CLAIM/CLAIM FORM

Information the dentist submits to the dental plan to get paid for services performed on a patient.

CLEFT PALATE

Congenital deformity resulting in lack of fusion of the soft and/or hard palate.

CLENCHING

The clamping and pressing of the jaws and teeth together, frequently associated with psychological stress or physical effort.

CLOSED REDUCTION

The repositioning of a fractured bone without surgery.

COINSURANCE

A fixed percentage of a dental treatment cost that you share with your dental plan. For example, Delta Dental may pay for 80 percent of a given service, while you are responsible for 20 percent. Coinsurance kicks in after you meet your deductible.

COMPOSITE

A dental restorative material.

COMPOUND FRACTURE

A broken bone exposed to external contamination.

COORDINATION OF BENEFITS

Guidelines that determine how each dental plan pays when you are covered by more than one dental plan.

COPAYMENT

A set dollar amount you are required to pay your dentist for a service. An enrollee usually has a copayment or coinsurance, but not both. (Also known as “copay.”)

COPING

A thin covering of a tooth crown applied as part of a restoration.

CORONAL

The crown of a tooth.

COVERED SERVICE

A dental treatment or procedure paid for – either partially or fully – by your dental benefits.

CREDENTIALING

A process to ensure a dentist is properly trained to treat patients before being able to be a part of Delta Dental’s networks.

CROWN

A restoration that covers or “caps” a tooth to restore it to its normal shape and size. Anatomical crowns: The normal enamel covering of a tooth. Abutment crown: An artificial crown that supports a dental prosthesis. Artificial crown: A restoration that covers most or all of a tooth crown. Clinical crown: The part of a tooth not covered by supporting tissues.

CURETTAGE

Scraping or cleaning the walls of a cavity or gingival pocket.

CUSP

An extruded part of the chewing surface of a tooth.

CYST

A cavity containing fluid or soft matter.

D
DEBRIDEMENTRemoval of plaque, calculus and/or tissue.DECAYCarious lesions in a tooth resulting in decomposition of tooth structure.DECIDUOUSUsed to describe primary (baby) teeth.DEDUCTIBLEA set dollar amount you are responsible for before your dental plan begins to pay for covered services.DENTAL PROPHYLAXIS

Scaling and polishing procedure that removes plaque, calculus, and stains.

DENTIN

The part of the tooth beneath enamel and cementum.

DENTITION

The teeth in the dental arch. Permanent dentition refers to permanent teeth; deciduous dentition refers to deciduous (baby) teeth.

DENTURE

An artificial substitute for natural teeth and adjacent tissues.

DENTURE BASE

The part of a denture that contacts soft tissue and holds the artificial teeth.

DEPENDENTS

Anyone covered under a dental plan other than the primary subscriber. For example, a spouse or children.

DHMO (DENTAL HEALTH MAINTENANCE ORGANIZATION)

Also referred to as pre-paid plans, DHMOs require you to choose one dentist or dental facility for all of your oral health needs. These plans don’t have deductibles or maximums. An enrollee pays a fixed dollar amount (copayment) to the dentist at visits. Delta Dental’s DHMO plan is called DeltaCare® USA.

DIAGNOSTIC CAST

Plaster or stone model of teeth and adjoining tissues; also referred to as study model.

DIASTEMA

A space, often used to refer to a space between adjacent teeth.

DIRECT PULP CAP

Covering exposed tooth pulp with a dressing or cement.

DISCOUNT CARD/PLAN

An option for individuals and families that do not have dental benefits. Enrollees have access to dentists who have agreed to charge discounted fees for certain services. Patients pay the agreed-upon fee directly to the dentist. A discount card/plan is not insurance.

DISPLACED TOOTH

Partial loss of a tooth due to trauma.

DISTAL

Toward the back of the dental arch.

DRY SOCKET

Inflammation of the tooth socket following a tooth extraction.

DUAL COVERAGE

Coverage under two separate dental plans — for instance, if a child is covered by dental plans from both parents. Also see “Coordination of Benefits.”

E
EDENTULOUSWithout teeth.EFFECTIVE DATE
The date you can start using your dental benefits plan.ENAMELHard calcified tissue covering dentin of the crown of tooth.ENDODONTISTA dental specialist who treats disease and injuries of the tooth pulp. A patient who needs a root canal may be treated by an endodontist.ENROLLEEA person covered under a dental plan.

EQUILIBRATION

Reshaping the biting surfaces of teeth to create proper adjustment and alignment.

EVALUATION

Periodic oral evaluation: a regular dental checkup. Limited oral evaluation — problem-focused: an exam limited to a specific oral-health problem. Comprehensive oral evaluation: a thorough evaluation of hard and soft tissues. Detailed and extensive oral evaluation — problem-focused, by report: a detailed and extensive problem-focused evaluation.

EVULSION

Complete separation of the tooth from its socket due to trauma (avulsion). A knocked-out tooth.

EXCISION

Surgical removal of bone or tissue.

EXCLUSIONS

Dental services or procedures not covered by your dental plan.

EXPLANATION OF BENEFITS (EOB)

A document Delta Dental provides after a procedure. It contains a summary of the treatments you received, including the treatment cost, the portion covered by your dental plan, and the portion you may owe. An EOB is not a bill.

EXUDATE

A byproduct of inflammation or necrosis (death of tissue) containing fluid, cells, and/or other debris.

F

FACIAL

The surface of a tooth directed toward the face.

FEE SCHEDULE

A list of charges for specific dental treatments agreed to by both the dental plan and the dentist.

FILLING

The restoring of lost tooth structure using materials like metal, alloy, plastic, or cement.

FRACTURE

In dentistry, the breaking of a tooth.

FRENUM

Muscle fibers covered by a mucous membrane that attach the cheek, lips and/or tongue to associated structures.

FURCATION

The area of a multirooted tooth where the roots diverge.

G

GENERAL DENTIST

A primary dental care provider with a broad range of general oral health expertise. General dentists perform preventive care as well as many restorative procedures such as fillings, crowns, implants and more.

GINGIVA

The soft tissues overlying the crowns of unerupted teeth and encircling the necks of erupted teeth.

GINGIVECTOMY

The removal of gingiva.

GROUP

A company or organization that provides dental benefits to its employees or members. The group works with Delta Dental to select the plan type, benefit levels, maximums and member eligibility.

H

HEMISECTION

Surgical separation of a multirooted tooth so that one root and/or the overlaying portion of the crown can be surgically removed.

HETEROLOGOUS

Made up of tissue not normal to the part.

HIPAA

Stands for the “Health Insurance Portability and Accountability Act of 1996,” a federal law intended to improve access to health coverage, limit fraud and abuse, protect personal health information (PHI), and control administrative costs.

HYGIENIST

A licensed dental professional who assists or performs procedures such as screenings, X-rays and cleanings. The range of services hygienists can perform varies from state to state.

I

IMAGING, DIAGNOSTIC

Includes, but is not limited to, CAT scans, MRIs, photographs, and X-rays.

IMMEDIATE DENTURE

Prosthesis that is placed immediately after removing natural teeth.

IMPACTED TOOTH

An unerupted or partially erupted tooth that is blocked from surfacing by another tooth, bone, or soft tissue.

IMPLANT

A device placed surgically in bone as support for a prosthesis.

IMPLANTATION, TOOTH

Placement of an artificial or natural tooth into a socket.

INDIRECT PULP CAP

Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair.

INDIVIDUAL AND/OR FAMILY PLAN

Dental plans that individuals and their families can purchase directly from Delta Dental rather than through an employer.

INLAY

A dental restoration made outside of the mouth and then applied to a tooth.

IN-NETWORK DENTIST

A dentist who has agreed to be part of a Delta Dental network. In-network dentists agree to accept pre-established fees for services.

INTENTIONAL REIMPLANTATION

The intentional removal, repair and replacement of a tooth into its socket.

INTERPROXIMAL

Between the adjoining surfaces of adjacent teeth.

INTRACORONAL

Within the crown of a tooth.

INTRAORAL

Inside the mouth.

J

JAW

A common name for either the maxilla or the mandible.

L
LABIALPertaining to or around the lip.LESIONAn injury or wound; area of diseased tissue.LIFETIME MAXIMUMThe maximum amount a plan will pay over the course of a lifetime. The lifetime maximum may apply to an individual or a family and usually applies to specific treatments such as orthodontia.LIMITATIONSConditions, such as age and period of time covered, that restrict a dental plan’s coverage for certain services.LINE ANGLE

Used to designate the junction of two tooth surfaces or two walls of a tooth-cavity preparation.

LINGUAL

Pertaining to or around the tongue.

M

MAINTENANCE, PERIODONTAL

Therapy for preserving the health of the periodontium.

MALAR

Pertaining to the cheek bone.

MALIGNANT

Cancerous.

MALOCCLUSION

Improper alignment of biting or chewing surfaces.

MANAGED FEE-FOR-SERVICE

A type of dental plan where participating dentists agree to fee schedules that can provide discounts for dental care. Delta Dental’s managed fee-for-service option is called Delta Dental Premier®.

MANDIBLE

Lower jaw.

MAXILLA

The upper jaw.

MAXIMUM BENEFIT

See “Annual Maximum.”

MAXIMUM PLAN ALLOWANCE (MPA)

The amount set by Delta Dental that a Delta Dental Premier® dentist has agreed to charge for a service.

MEMBER

See “Enrollee.”

MESIAL

Toward the midline of the dental arch.

MOLAR

Teeth back of the premolars (bicuspids) on either side of the jaw; grinding teeth, having large crowns and broad chewing surfaces.

MOULAGE

A wax or plaster cast-mold reproduction of the face.

N

NATIONAL PROVIDER IDENTIFIER (NPI)

A unique identification number used to identify a health care professional as an alternative to their dental license number.

NETWORK

Dentists who have signed up with Delta Dental to provide dental care at agreed-upon fees.

NON-AUTOGENOUS

A graft from a donor other than the patient.

NON-PARTICIPATING DENTIST

See “Out-of-Network Dentist.”

O

OBTURATOR

A prosthesis that closes an opening in the palate.

OCCLUSAL RADIOGRAPH

An X-ray where the film is held between the teeth.

OCCLUSION

Any contact between biting or chewing surfaces of maxillary (upper) and mandibular (lower) teeth.

ONLAY

A restoration made outside the mouth that replaces a tooth cusp or cusps.

OPEN ENROLLMENT

The period of time in which employees or qualified individuals can enroll in or make changes to benefit plans.

OPTIONAL SERVICES

Procedures not covered under the terms of a dental benefits contract. Delta Dental will review claims for optional services to determine what, if any, amount will be paid for the service.

ORAL

Pertaining to the mouth.

ORAL MAXILLOFACIAL RADIOLOGIST

A dental specialist who performs and reads diagnostic imagery (such as X-rays, CT scans and ultrasounds) used to examine bones in the skull and face, as well as dental structures.

ORAL PATHOLOGIST

A dental specialist trained to diagnose dental diseases.

ORAL SURGEON

A dental specialist trained to perform dental surgeries such as wisdom teeth removal, dental implants and more.

ORTHODONTIST

A dental specialist who treats the misalignment of the teeth and their surrounding structures, using appliances such as braces and retainers.

OSTEOPLASTY

Surgical procedure that modifies the bones in the jaws.

OSTEOTOMY

Surgical cutting of bone.

OUT-OF-NETWORK DENTIST

A dentist who has not signed up to participate with Delta Dental.

OVERDENTURE

Prosthetic device supported by retained teeth roots or implants.

P

PALATE

The hard and soft tissues forming the roof of the mouth.

PALLIATIVE

Action that relieves pain.

PANORAMIC RADIOGRAPH

An X-ray that shows the entire upper and lower mouth and jaw on a single film.

PARTIAL DENTURE

A prosthetic device that replaces missing teeth, designed to be removed by the patient.

PARTICIPATING DENTIST

See “In-Network Dentist.”

PATIENT

An individual who has established a professional relationship with a dentist for the delivery of dental care.

PEDIATRIC DENTIST

A dental specialist who treats children; formerly known as a pedodontist.

PERIAPICAL

The area surrounding the end of the tooth root.

PERIAPICAL RADIOGRAPH

An X-ray made by placing film inside the mouth.

PERICORONAL

Around the crown of a tooth.

PERIODONTAL

Pertaining to the supporting and surrounding tissues of the teeth.

PERIODONTAL DISEASE

Inflammation of the gingival tissues and/or periodontal membrane.

PERIODONTAL POCKET

A deepened gingival fissure; a feature of periodontal disease.

PERIODONTIST

A dental specialist who treats diseases of the supporting and surrounding tissues of the teeth. Patients with periodontal (gum) disease are treated by a periodontist.

PERIODONTITIS

Inflammation and loss of the connective tissue of the surrounding structure of teeth.

PERIRADICULAR

Surrounding a portion of the root of the tooth.

PLAN YEAR

See “Benefit Year.”

PLAQUE

A soft sticky substance, composed largely of bacteria, that accumulates on teeth.

PONTIC

The artificial tooth on a fixed partial denture (bridge).

POST

A metallic projection cemented within a prepared root canal to strengthen and retain restorative material.

POSTERIOR

Teeth and tissues towards the back of the mouth – i.e., premolars and molars.

PPO (PREFERRED PROVIDER ORGANIZATION)

A dental plan in which participating dentists agree to fee schedules that provide deeper discounts and lower out-of-pocket expenses. Delta Dental’s PPO options are called Delta Dental PPOSM and Delta Dental PPO plus Premier.

PRE-DETERMINATION

See “Pre-Treatment Estimate.”

PRE-ESTABLISHED FEE

The amount set by Delta Dental that an in-network dentist has agreed to charge for a service.

PREMEDICATION

The use of medications prior to dental procedures.

PRE-TREATMENT ESTIMATE

A treatment plan usually submitted by a dentist for Delta Dental to review and provide an estimate of benefits before treatment starts. Pre-treatment estimates can help you budget for dental procedures. They can also help you and your dentist decide how to proceed with a treatment. This is sometimes referred to as Pre-Authorization.

PREMIUM

The amount the enrollee pays for dental benefits, usually paid monthly, quarterly or annually.

PRIMARY DENTITION

The first set of teeth.

PROCESSING POLICIES

Clinical guidelines to validate that a dental treatment or procedure meets the criteria set by your dental plan. Processing policies may change occasionally. If a processing policy is applied to a billed service, it will be explained on the Explanation of Benefits (EOB).

PROPHYLAXIS

A scaling and polishing procedure that removes plaque, calculus and stains.

PROSTHESIS

Artificial replacement of any part of the body. Dental prosthesis: any device or appliance replacing one or more missing teeth and/or associated structures. Types of prostheses include: definitive prosthesis — a prosthesis to be used over an extended period of time; fixed prosthesis — non-removable tooth-borne dental prosthesis; interim prosthesis — a provisional prosthesis designed for use over a limited period of time; removable prosthesis — dental prosthesis designed to be removed and reinserted by the patient.

PROSTHODONTIST

A dental specialist who restores natural teeth and replaces missing teeth with artificial substitutes, like implants or dentures.

PROTECTED HEALTH INFORMATION (PHI)

Personal information about a patient, such as a Social Security number and medical history, which is required to be stored securely by health care entities such as a doctor, dentist, health clinic or health insurer.

PROVIDER

See “Dental Professionals.”

PROVISIONAL

A temporary prosthesis or individual tooth restoration.

PULP

The connective tissue containing blood vessels and nerves that occupies the pulp cavity of a tooth.

PULP CAVITY

The space within a tooth containing the pulp.

PULPECTOMY

Complete removal of pulp tissue from the root-canal space.

PULPITIS

Inflammation of the pulp.

PULPOTOMY

Surgical removal of a portion of the pulp with the aim of saving the remaining pulp.

Q

QUADRANT

One of four equal sections into which the dental arches are divided.

R

RADICULAR

Pertaining to the root.

RADIOGRAPH

X-ray.

REBASE

Refitting a denture by replacing the base material.

REIMPLANTATION, TOOTH

The return of a tooth to its socket.

RELINE

The process of resurfacing the tissue side of a denture with new material.

RETAINER

A device used to stabilize teeth.

ROOT

The portion of the tooth that is covered by cementum and located in the alveolus (socket).

ROOT CANAL

The chamber within the root of the tooth that contains the pulp.

ROOT-CANAL THERAPY

The treatment of disease and injuries of the pulp and associated conditions.

ROOT PLANING

A procedure designed to remove microbial flora, bacterial toxins, calculus, and diseased cementum or dentin on the root surfaces and in the pocket.

S

SCALING

Removal of plaque, calculus, and stains from teeth.

SIALODOCHOPLASTY

Surgical procedure to repair and/or restore a portion of a salivary-gland duct.

SIALOGRAPHY

X-rays of the salivary ducts and glands.

SIALOLITHOTOMY

Surgical procedure to remove a stone within a salivary gland or its duct.

SPECIALIST

A dentist who concentrates on one discipline, such as pediatric dentistry, orthodontia or prosthodontics.

SPLINT

A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured, or traumatized.

STOMATITIS

Inflammation of the mouth membranes.

STRESS BREAKER

Part of a tooth-borne and/or tissue-borne prosthesis designed to relieve the abutment teeth and their supporting tissues from stress.

STUDY MODEL

Plaster or stone model of teeth and adjoining tissues; also referred to as diagnostic cast.

SUBSCRIBER

A person who has signed up for dental coverage from Delta Dental. If family coverage is offered, additional people covered will be listed as the subscriber’s spouse or dependents.

SUTURE

A stitch used to repair an incision or wound.

T

TEMPORARY REMOVABLE PARTIAL DENTURE

An interim prosthesis.

TEMPOROMANDIBULAR JOINT (TMJ)

The hinge between the mandible (lower jaw) and base of the skull (temporal bone).

TEMPOROMANDIBULAR JOINT DYSFUNCTION

Abnormal functioning of the TMJ.

TERMINATION DATE

The date your dental benefits coverage ends or you are no longer eligible for benefits.

TISSUE CONDITIONING

Material placed in contact with tissues for a limited time to help the tissues heal.

TRANSPLANTATION, TOOTH

Transfer of a tooth from one socket to another, either in the same or a different person.

TRISMUS

Restricted ability to open the mouth, usually due to inflammation.

U

UNERUPTED

Tooth/teeth that have not penetrated into the oral cavity.

UNILATERAL

One-sided.

VENEERA layer of tooth-colored material attached to the tooth surface. Veneers may be made of porcelain, ceramic, composite, or acrylic resin.

VOLUNTARY

A dental benefits plan offered through an employer where employee participation is optional. Employers usually don’t help cover the cost of the plan but still allow employees to enjoy pre-tax savings on premiums through payroll deduction.

W

WAITING PERIOD

A period of time before you are eligible to receive benefits for all or certain dental treatments.

X

X-RAY

Radiograph.

XEROSTOMIA

Decreased salivary secretion that produces a dry and sometimes burning sensation and/or tooth decay.

Z

ZYGOMATIC BONE
A cheekbone.

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