Dental Glossary

Abscess
An infection of a tooth, soft tissue, or bone.

Abutment

A term with different meanings depending on the clinical scenario.

Implant case: the fixture that is placed between the implant body (aka implant post) and the restorative prosthesis (e.g., single crown; denture).

Natural tooth case: the tooth used as the support for one end of a denture.

Alternate benefit
A provision in a dental plan contract that requires the insurer to determine the benefit for a procedure based on a less expensive, professionally acceptable procedure. The most common example is a multi-surface, posterior composite restoration, which would be reimbursed as an amalgam. The provision does not limit treatment options. Sometimes referred to as LEAT or Least Expensive Alternate Treatment.

Amalgam
Material used to fill cavities in teeth. Dental amalgam is a mixture of silver, mercury, and other metals.

Anesthesia
Administered to patients to create temporary numbness in the mouth, allowing for dental work to be done without feeling pain.

Annual maximum
The most money a dental plan will pay for care within a benefit period. Once you reach the maximum amount, you pay any costs for the remainder of the benefit period.

Anterior teeth
The teeth toward the front of the mouth, which include the incisors and cuspids.

Apex
The anatomic area at the end of the tooth root.

Apicoectomy
The surgical removal of the apical portion of the tooth is performed through a surgical opening made in the overlying bone and gingival tissues. This procedure is often performed when an infection develops or persists after a root canal treatment.

Assignment of benefits
When a patient requests that Delta Dental pay the dentist directly.

Asymptomatic
No clinical symptoms of the disease in question.

Baby teeth
The first set of teeth; also known as primary or deciduous teeth.

Balance billing
When a dentist bills a member for amounts above Delta Dental's payment and the member's coinsurance amount (this total is the accepted fee). Contracted dentists agree to Delta Dental's accepted fee as full payment and will not balance bill for covered services. Out-of-network (non-contracted) dentists are not limited in the amount they may charge the member and thus may balance bill.

Basic cleaning
A routine professional teeth cleaning to remove plaque build-up, tartar, and stains. This is a regularly scheduled preventative treatment for individuals with healthy gum tissue.

Basic services
Dental services provided under the terms of the contract as specified in the description of benefits and copayments. Usually includes restorations (fillings), oral surgery (extractions), endodontics (root canals), and periodontal treatment. Also called class II, type B, or type II services.

Beneficiary
The person eligible for benefits under a plan; also known as the insured, enrollee, or member.

Benefit period
A specified period to incur covered benefits for them to be eligible for payment. This is also the specified period of time that your deductible (if any) and maximum (if any) is calculated. Also see benefit year.

Benefit year
The 12-month period a member’s dental plan covers, which is not always a calendar year. For example, a benefit year could run June-May instead of a calendar year (January-December). This is also known as a plan year. Also see benefit period.

Bicuspids
The teeth with two rounded points located between the cuspids and molars; also known as premolars.

Biopsy
The process of removing tissue for histologic evaluation, an important tool in the accurate diagnosis of cancer and other diseases.

Bitewing radiograph
An x-ray of the area of the mouth where the back teeth touch each other; useful in spotting early stages of tooth decay.

Bleaching
A technique to lighten the color of heavily stained teeth. Considered a cosmetic procedure.

Bonding
The technique to adhere a filling material to a tooth. Bonding materials may be used to repair chipped, cracked, misshapen, or discolored teeth or to fill in a gap between teeth.

Bone graft
A surgical procedure when bone is implanted in the jaw, usually in preparation for adding implants a few months later.

Bridge
Non-removable artificial teeth attached to adjoining natural teeth when one or a few teeth are missing. This is also known as a fixed partial denture.

Bruxism
Involuntary clenching or grinding of the teeth, often during sleep.

Calculus
A deposit of minerals coated with bacterial plaque that builds up on teeth; also known as tartar.

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
Breakdown of tooth structure due to acids produced by bacteria; also known as caries or tooth decay.

Class I, Class II, Class III

Many dental plans offer three classes of covered treatment. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.

Class I services: See diagnostic and preventive services.

Class II services: See basic services.

Class III services: See major services.

Co-Insurance
A type of coverage where the member pays a percentage of the cost for a procedure. For example, if the plan’s allowed amount for an office visit is $100 and the coinsurance is 20% (based on a benefit level of 80%), then the member pays 20% of $100, or $20.

Complete series (of radiographs)
A set of intraoral radiographs usually consisting of periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas, and alveolar bone crest.

Composite
A tooth-colored restorative material composed primarily of polymers (plastic) with filler materials composed of silica, quartz, or ceramic particles.

Comprehensive oral evaluation
A complete oral health check.

Coordination of benefits (COB)
When you are covered by more than one dental plan, the dental carriers follow a process to determine the order of payment and the amount each will pay. (Example: A child who is covered by both parents’ plans.)

Core buildup
The replacement of a part or all of the crown of a tooth whose purpose is to provide a base for the retention of an indirectly fabricated crown.

Covered service
Services for which payment is provided under the terms of the dental benefit contract. Even if a service is covered, you may still need to pay a deductible, co-payment, or co-insurance. Policies often contain a detailed list of what is and is not covered.

Crown (crown/jacket/cap)
An artificial tooth-shaped covering made of metal, porcelain, or porcelain fused to metal, used to restore teeth that have weakened from decay, are severely damaged, or chipped.

Crown lengthening
A surgical procedure that recontours gum tissue, and sometimes bone, to expose more of the tooth for a crown.

Cuspids
The teeth near the front of the mouth that come to a single point. Also known as eye teeth or canines.

DDS/DMD
DDS stands for Doctor of Dental Surgery. DMD stands for Doctor of Dental Medicine. A dentist.

Decay
The lay term for carious lesions in a tooth; decomposition of tooth structure.

Deciduous
A term used to describe the primary (baby) teeth.

Deductible
Like car insurance, this is the amount you must pay before your benefit plan begins to pay for your dental treatment. If you have a spouse and dependents enrolled in your plan, you may be subject to a family deductible instead of an individual deductible. Under most Delta Dental benefit plans, diagnostic and preventive services are often exempt from a deductible.

Demineralization
The process of losing tooth structure.

Dental care professional
A dentist, dental hygienist, dental assistant, or any other individual who is licensed or certified as required by a state and is performing dental services within the scope of that license or certification.

Dentin
The hard, dense, and bony tissue forming the bulk of a tooth under the enamel.

Denture
Removable artificial teeth in a plastic base that rests directly on the gums. A denture may be a complete or partial depending on the number of missing natural teeth.

Dependents
Anyone covered under a dental plan other than the primary subscriber (such as a spouse or child).

Diagnostic and preventive services
In the standard client contract, these procedures include oral evaluations, routine cleanings, x-rays, fluoride treatment, sealants and space maintainers.

Dual coverage
When you are covered by more than one dental benefits plan. Example: When you are covered by your spouse’s plan as well as your own. Also see coordination of benefits.

Effective date
The date the member can start using their dental benefits plan. Also called the eligibility date.

Eligibility date
The date enrollees are eligible for benefits under their plan. Often referred to as the effective date.

Enamel
Hard, calcium-rich surface covering a tooth.

Endodontics
Dental services that involve treatment of diseases or injuries that affect the root tip or nerve of the tooth.

Endodontist
A Dentist specializing in diseases of the tooth pulp, performing such services as root canals.

Enrollee
People who are covered under a Delta Dental plan. Enrollees includes both subscribers and their covered dependents. See beneficiary, member.

Exclusions
Dental services not covered under a dental benefits plan.

Explanation of benefits (EOB)
The notice that members and dentists receive after services have been provided and a claim has been processed. The EOB provides information about the fees charged, what procedures were provided, any adjustments made by the carrier, and the member’s coinsurance payment.

Extraction
The process or act of removing a tooth or tooth parts.

Filling
Replacement of missing or damaged tooth structure with artificial materials; usually made of metals (a mix of silver, liquid mercury, and other metals), resin (plastic), or porcelain.

Fixed partial denture (also called a bridge)
A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment, natural teeth, or their implant replacements.

Fluoride
A chemical agent applied to teeth to prevent cavities (tooth decay). Topical fluoride in the dental office can be foam, liquid, or varnish.

Full mouth x-ray
See complete series (of radiographs)

General dentist
A dentist who provides a full range of services for all age groups.

Gingiva
The gums, which are the soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted.

Gingivectomy
A surgical procedure for removing gingiva (gum tissue) to restore gum health.

Gingivitis
An inflammation of the gums surrounding the teeth caused by a buildup of plaque or food particles.

Guided tissue regeneration (GTR)
A surgical procedure that uses a barrier membrane placed under the gingival tissue and over the remaining bone support to enhance regeneration of new bone.

HIPAA
Stands for "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.

Imaging, diagnostic
This would include, but is not limited to, CAT scans, MRIs, photographs, radiographs, etc.

Immediate denture
Prosthesis constructed for placement immediately after the removal of the remaining natural teeth.

Impacted tooth
A tooth blocked from coming up through the gums by another tooth, bone, or soft tissue.

Implant (dental)
A support used to replace a natural tooth and root or to support a bridge or denture that is surgically anchored into the jawbone.

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

Inlay
A dental restoration (filling) shaped in the form of a cavity and then inserted and secured with cement.

In-network/out-of-network dentist

Services provided in a plan either by a contracted or non-contracted dentist.

• In-network dentists have agreed to participate in a plan and to provide treatment according to certain requirements and to accept contracted fees as full payment.
• Out-of-network dentists are not held to these requirements.

Depending on the plan, benefit levels could differ depending on whether the member visits an in-network or out-of-network dentist.

Laminate veneer
A thin plastic or porcelain shell applied to the front of a tooth to restore, strengthen, or improve its appearance.

Lifetime maximum
The maximum amount a plan will pay over the course of a lifetime for a specific dental service, such as orthodontia (braces).

Limitations/Exclusions
Limitations are usually related to a specific time or frequency — for example, a plan may cover only two cleanings in a 12-month period or one cleaning every six months. Exclusions are services not covered by a plan.

Limited oral evaluation
A visit to assess a specific dental problem.

Maintenance, periodontal
Removal of plaque, tartar, and stains above and below the gums for patients who have had therapy for gum disease.

Major services
A category of services that include procedures such as crowns, dentures, and implants. Co- payments or coinsurance are typically higher for these services. Also called Class III, Group III or Type C or Type III services.

Malocclusion
When the upper and lower teeth don’t line up to bite and chew properly.

Maximum/annual maximum/maximum benefit
The maximum payment Delta Dental will make within a given time period. Some plans have no maximum. Some maximums apply to the lifetime of the benefit plan; others apply to a particular time period (calendar year, benefit year, etc.) or to particular services (such as a separate maximum for orthodontic benefits).

Member
An individual who has signed up for dental coverage from Delta Dental directly or through a Group.

Molars
Teeth in the back of the mouth with a broad chewing surface for grinding food.

Mouthguard
A removable plastic device worn over teeth and gums to protect from damage during sports.

Network
Dentists who have signed up with Delta Dental to provide dental care at agreed-upon fees and certain administrative guidelines. The Delta Dental Premier, Delta Dental PPO, and EPO programs all have distinct dentist networks. Although network and panel are synonymous, network is the preferred term.

Nightguard
An acrylic appliance worn while sleeping to prevent damage caused by teeth clenching or grinding (also known as bruxism).

Non-billable
No payment is made by Delta Dental, and no payment is collectable from the patient by a participating dentist.

Non-covered services
Dental services not listed as a benefit. If the enrollee receives a non-covered service, the dental plan will not pay for them. The dentist will bill the member.

Non-duplication of benefits
In dual coverage cases, some customers have a non-duplication of benefits contract provision. This term describes the way the secondary carrier calculates its portion of the payment. The secondary carrier calculates what it would have paid if it were the primary plan and subtracts what the other plan paid. If the primary payment were greater than or equal to what the secondary coverage would have paid, the secondary program will make no payment. See dual coverage.

Non-participating dentist
Any dentist who does not have a contractual agreement with Delta Dental to provide dental services to enrollees of a Delta Dental benefit plan. See out-of-network dentist.

Occlusion
How the upper and lower teeth come together.

Onlay
A restoration that extends over the cusps of the tooth (but does not cover the entire tooth).

Open enrollment
The period of the year during which employees or qualified individuals can enroll in or make changes to their benefits plan.

Oral and maxillofacial surgery
Oral and maxillofacial surgery is the specialty of dentistry that includes the diagnosis, surgical, and adjunctive treatment of diseases, injuries, and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Oral surgeon
A dentist specialist who removes impacted teeth and repairs fractures of the jaw and other damage to the bone structure around the mouth.

Orthodontist
A dentist specialist who corrects misaligned teeth and jaws, usually with braces.

Out-of-network dentist
An out-of-network dentist is a dentist who does not have a network contract with Delta Dental. For a given plan, an out-of-network dentist refers to a dentist who is not bound by a Delta Dental contract to follow specific fee requirements when treating patients covered under applicable plans.

Overdenture
A type of removable denture that rests directly on your gums and is usually secured by implants placed into your upper and/or lower jaw.

Palliative
Action that relieves pain but is not curative.

Panoramic radiograph
An extraoral projection whereby the entire mandible, maxilla, teeth, and other nearby structures are portrayed on a single image, as if the jaws were flattened out.

Partial denture
Usually refers to a prosthetic device that replaces missing teeth.

Participating dentist/Delta Dental dentist
These words refer to dentists who contract with Delta Dental and abide by certain administrative guidelines, such as charging Delta Dental enrollees no more than the pre-approved fees. Always use the word participating in its entirety; do not shorten to par.

Pediatric dentist
A dentist specialist who treats children from birth through adolescence.; formerly known as a pedodontist.

Pediatric dentistry
Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Periapical radiograph
A radiograph made by the intraoral placement of film, phosphorous plate, emulsion or digital sensor, for disclosing the apices of the teeth.

Peri-implantitis
An infectious disease-causing inflammation around the gum and bone of a dental implant.

Periodic oral evaluation
A routine checkup to assess current oral health.

Periodontal disease
Gum disease affecting the gums and supporting structures of the tooth.

Periodontal maintenance
Treatment for preserving the state of health of the gums and bone surrounding and supporting the teeth.

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.

Periodontics
Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Periodontist
A dentist specialist who treats diseases of the gums, tissues and bones that support and surround the teeth.

Permanent dentition
Refers to the permanent (“adult”) teeth in the dental arch that replace the primary dentition.

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

Post and core
An anchor placed in the tooth root following a root canal to strengthen the tooth and help hold a crown in place.

Pre-treatment estimate (also called pre-determination, or pre-estimate)
A treatment plan usually submitted by a dentist for Delta Dental to review and provide an estimate of benefits before treatment starts. This can help a member budget for dental procedures and decide how to proceed with treatment.

Preventive services
See diagnostic and preventive services.

Primary dentition
The first set of teeth (baby teeth) also deciduous.

Prophylaxis
A dental cleaning that consists of the removal of plaque, stains, and calculus by scaling and polishing.

Prosthesis

An artificial replacement.

Dental prosthesis: Any device or appliance replacing one or more missing teeth and/or, if required, associated structures. (This is a broad term which includes abutment crowns and abutment inlays/onlays, bridges, dentures, obturators, gingival prostheses.)

Fixed prosthesis: Non-removable dental prosthesis which is solidly attached to abutment teeth, roots or implants.

Fixed-removable prosthesis: Combined prosthesis, one or more parts of which are fixed, and the other(s) attached by devices which allow their detachment, removal and reinsertion by the dentist only.

Interim prosthesis: A provisional prosthesis designed for use over a limited period of time, after which it is to be replaced by a more definitive restoration.

Removable prosthesis: Complete or partial prosthesis, which after an initial fitting by a dentist, can be removed and reinserted by the patient.

Prosthodontics
Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation, and maintenance of the oral function, comfort, appearance, and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.

Prosthodontist
A dentist specialist who replaces missing natural teeth with artificial materials, such as a bridge or denture.

Protected Health Information (PHI)
Personal information such as medical history, which is required to be stored securely by a health care entity.

Provider
A dentist or other dental care professional, or clinic that is accredited, licensed, or certified to provide dental services in their state, and is providing services within the scope of that accreditation, license, or certification.

Pulp
Blood vessels and nerve tissue inside a tooth.

Pulpectomy
A procedure that removes diseased pulp tissue.

Pulpotomy
Partial removal of the pulp or nerve.

Quadrant
One of the four equal sections into which the dental arches can be divided; it begins at the midline of the arch and extends distally to the last tooth.

Radiograph
An image produced by projecting radiation. Also called an x-ray.

Reimbursement levels
Many dental plans offer three classes of covered treatment. Each class provides specific types of treatment and typically covers those treatments at a certain percentage. Class I procedures are typically diagnostic and preventive and are usually covered at the highest level to encourage patients to seek preventive care. Class II includes basic procedures — such as fillings and extractions — which are reimbursed at a slightly lower percentage. Class III is for major procedures — such as crowns and dentures — which are reimbursed at yet a lower percentage.

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

Remineralization
The process whereby calcium, fluoride, and an antimicrobial mouth rinse are combined to reduce the bacteria and bond with the tooth to strengthen and rebuild the enamel. Remineralization helps reduce the likelihood of needing to have a tooth filled.

Resin/composite
Tooth-colored filling material used primarily for front teeth.

Restoration
These replace missing or damaged tooth structure with artificial materials such as a filling or crown.

Retainer
Removable device used to stabilize teeth following orthodontic treatment.

Root
The tooth structure that connects the tooth to the jaw.

Root canal therapy (RCT)
The pulp or nerve of the tooth is removed from the canal inside the root and replaced with an inert filling material.

Root planing
Scraping the roots of a tooth to remove bacteria and tartar.

Scaling
The removal of the hard deposits on teeth, called calculus or tartar.

Sealant
A thin plastic material used to cover the biting surface of a child’s tooth to prevent tooth decay.

Seat date
The date a crown, veneer, inlay, onlay or bridge is actually cemented into place or the date a removable prosthesis is delivered.

Supernumerary teeth
An extra tooth or teeth in addition to the regular number of teeth; also known as hyperdontia.

Tartar
A deposit of minerals coated with bacterial plaque that builds up on teeth; also known as calculus.

Termination date
The date your dental benefits coverage ends or the member is no longer eligible for benefits.

TMJ
Abbreviation for the temporomandibular joint, the ball-and-socket joint connecting the lower jaw to the skull.

Veneer
Thin covering made of porcelain or composite material covering natural teeth, usually to improve appearance.

Waiting period
A period of time before a member is eligible to receive benefits for all or certain treatments. It typically applies to expensive services such as dentures or crowns.

Wisdom teeth
The set of molars that grow in during the late teens or early twenties; these may be impacted or grow in crooked and require removal.

Xerostomia
Dry mouth caused by salivary glands that aren’t working properly.

X-ray
An image taken of bones, teeth and restorations made with a minimal amount of radiation, also known as a dental radiograph.