Dentistry is Not Medicine – How the Dental Insurance Makes It Different?

The Undeniable & Insane Facts About Your Dental Insurance

Although the words “dental insurance” brings to mind the idea that you will be covered when facing a dental need, it really just is not true at all. Dental insurance policies do not operate in the same way that health insurance policies work. Most likely, it means that you are in for a surprise when you need expensive dental work. 


The Waiting Period

Most dental plans have some kind of a waiting period before the coverage will take effect. This is to prevent patients from waiting until they badly need dental care, buying insurance and expecting the insurance company to pay for it. The waiting period – if there is one, will usually be a minimum of six months, but may extend to a full year. Some more expensive plans do not have a waiting period. 

In addition to the waiting period, there is also another problem. Pre-existing conditions are often not covered by some plans. The exception may be if you had dental coverage up to the time of getting accepted by the new dental plan. 


Emphasis on Preventive Treatments

Dental insurance plans place an emphasis on prevention. The belief is that with the right preventive treatments that most major dental problems would not occur – in most people. Even though there may be a waiting period for other treatments, there is not one for preventive care and they will often pay 100 percent of the cost. There also are not any copays or deductibles for preventive care with in-network dentists. 


The Two-Tier System

Most dental plans split up the types of treatments into two different tiers. It is usually divided into Basic and Major treatments. Basic treatments include fillings, extractions, and x-rays. 

Major dental treatments include things such as root canals, crowns, and dentures. When getting this type of treatment, it is important to remember that most dental plans will only provide coverage up to $1,500 per year. Although this is considered a good amount, many dental treatments can run much higher than this. It must also be remembered that there is a co-pay and a deductible to be paid by you. 



As part of a standard Basic plan, most dental insurance policies will cover about 80 percent of the cost. The more complex dental tasks, those in the Major treatments category, are not covered as well – the coverage drops down to about 50 percent of the cost. Remember also that you cannot get these covered until after a year in most cases. 


The Reality

The truth about dental plans is that you are basically prepaying for your preventive dentistry. Since the cost of the average dental plan is going to be about $350 per year, this is about equal to the cost of two checkups and cleanings, and one set of dental x-rays. The problem with this is that a family dental plan may still only cover you for $1,500. 

If each member of your family gets a filling or two, that will about take care of your coverage for the year. Any major dental work, such as a root canal with a crown will largely come out of your own pocket. A crown will cost a minimum of $750, and a dental implant will start out around $1,500. 


The Reason for the Difference

When you wonder why dental insurance plans do not provide coverage in the same way as medical plans, it is because the insurance industry looks at dental coverage differently. It is practically considered a luxury. The two fields separated in 1840 when the University of Maryland refused to train doctors in the field of dentistry and oral surgery. This resulted in the new University of Maryland School of Dentistry, which was the world’s first such school.


Periodontal Disease

If you have a case of advanced periodontal disease and hope that dental insurance will cover it – you are in for a surprise. It will not cover it. Many Americans, about 50 percent of them, have this oral disease, and it is the main reason why Americans are losing their teeth. In the over 65 age group, about 70 percent of them have periodontal disease – and many of them cannot afford any dental coverage. 

Treating advanced periodontal disease is costly. Once it reaches the advanced stage, gums are receding, the structures holding your teeth in place are being destroyed and so is the jaw bone in that area. This causes the teeth to become loose and may even fall out. There are several treatments that are used, and many times multiple treatments are necessary. They include:

  • Medications
  • Scaling and rootplaning
  • Flap surgery
  • Gum graft surgery
  • Bone graft surgery
  • Laser treatment
  • Dental implants
  • And more. 


Preventing Periodontitis

Because dental insurance does not pay out a lot of money, the best way to save your teeth and smile is to take good care of them at home. Brushing them twice a day and flossing will usually prevent gum disease. This lets you keep your costs at the dentist office lower, and dental checkups will help spot problems early – which will also help prevent costly bills later.


Many dental plans are accepted at the offices of ToothHQ located in the Carrollton, Cedar Hill, Grapevine and Dallas TX  areas.  For more information, and to find out if your individual dental insurance is accepted, or to set up an appointment, you can call our office today at 214-731-0123