A simple lesson

Dental insurance benefits lead to misunderstandings about what is covered during dental hygiene procedures.

Aug 1st, 2005

Dental insurance benefits lead to misunderstandings about what is covered during dental hygiene procedures. Author of patient brochure offers suggestions on how to discuss frankly what is covered.

A debridement and a cleaning are not the same. Patients are often confused about the procedures, and staff is often perplexed about how to explain the differences. Misunderstandings about what a debridement entails, as well as problems concerning insurance coverage are common. Patients prefer tactful, non-technical language when it comes to addressing treatment. They also appreciate a frank discussion of the fees. Here is an excerpt from my new patient brochure, “What is a Debridement? Can’t I Just Have my Teeth Cleaned?”

To read the entire brochure, go to www.steppingstonestosuccess.com.

In summary, patients rely on the dental staff to help them understand their treatment needs. Right or wrong, they also often need help coming to terms with the limited nature of dental benefits. Hygienists and other team members help patients with needed procedures when they tactfully and succinctly explain what the treatment entails and whether or not there are insurance benefits. Written materials can support staff explanations.

Even offices that do not accept insurance payments find themselves faced with helping patients understand limitations. Successful practices are often the ones that do their best to help patients. Patients appreciate this and refer their friends. Everyone wins.

What causes heavy plaque and calculus?

While most people brush their teeth and take care of their mouths, sometimes their efforts may not be effective. Brushing quickly, using a worn brush, using a too-stiff brush, or inappropriate technique might be to blame. Some medical conditions or medicines may also cause more plaque and calculus to develop. Whatever the reason, the good news is that a debridement is the first step to health. As part of a patient’s care, we will show him or her how to brush effectively, as well as use floss and other tools. This will help prevent dense plaque and calculus from developing.

What are plaque and calculus?

Plaque is a soft, sticky substance that forms on teeth which is composed of bacteria and bacterial by-products, regardless of what foods are eaten. Calculus, also known as tartar, is a hard, mineralized deposit, somewhat like cement, that is formed from the plaque in the mouth and the minerals in saliva.

What is a debridement?

A debridement is a procedure to remove thick or dense deposits on the teeth. It is required when tooth structures are so deeply covered with plaque and calculus that the dentist and staff cannot check for decay, infections or gum disease. A debridement is not the same as a regular cleaning. It is usually a preliminary treatment when a person has very heavy plaque or calculus.

Explain the difference between a debridement and a regular cleaning.

A regular cleaning is a prophylaxis in dental terms. It is the removal of plaque, calculus, and stains from the tooth structures. A prophylaxis is accomplished by using dental instruments that scrape away deposits from the teeth. An electric device, called an ultra-sonic or sonic scaler, may be used. This deposit removal is performed on tooth structures that have not been affected by bone loss, periodontal disease or infection, typically the crowns of the teeth. A regular cleaning is recommended for persons who do not have dense deposits.

A debridement is recommended for persons who do have dense deposits. It is described by the ADA as the removal of heavy plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation, a preliminary procedure that does not rule out the need for additional procedures. Simply put, a debridement is necessary when dense plaque or calculus is present. Dental instruments and electric devices may be used, but the amount of time needed to complete the procedure, as well as the difficulty and extent of the procedure, are different.

Will my insurance pay for a debridement?

Many insurance plans provide for teeth cleaning twice a year. This payment has no relationship to what patients might really need. Many patients need debridement procedures, cleanings, periodontal treatment, fillings, implants, or other types of care more frequently than most plans will cover. Some insurance plans will pay a portion of the cost of a debridement. This may be before or after the patient has paid the deductible. Some plans will pay for a regular cleaning, and the patient is responsible for the balance. Very few plans cover the true fee of a debridement. The good news is that with the help of dental benefits, the amount a patient has to pay is reduced. Keep in mind that only after a debridement will the dentist get an accurate picture of a patient’s oral health. Further procedures to treat periodontal disease or other problems may be needed.

No dentist has ever told me that I need a debridement. Can’t I just have my teeth cleaned?

Many different conditions may arise throughout a person’s life, such as high cholesterol or high blood pressure. Oral problems are no different. Situations and circumstances change. While it may seem trivial to worry about heavy deposits on your teeth, it is now known that oral conditions may be implicated in several health disorders. Recent studies show a relationship between teeth and gum health and certain heart conditions and other systemic diseases. Dentists and hygienists are required to provide patients with the best information and treatment they know. It is not proper to perform inadequate treatment.

If my insurance plan will not pay for a debridement, why should I have it done?

While your insurance plan can help you pay for treatment you need, it was never designed to pay for everything. Most plans pay a minimum, regardless of what you need. It is a mistake to let benefits be your sole consideration for decisions about your dental condition. People who have lost their teeth often say they would pay any amount to get them back.

Carol Tekavec, CDA, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-2005. She is the designer of a dental chart and is a lecturer with the ADA Seminar Series. Contact her by phone at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com for more details about the new code handbook and her patient brochure, “My Insurance Covers This ... Right?”

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