Abcess

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

Accession

Addition of a test specimen,previously collected by a health care provider, to a laboratory specimen collection; recording of essential specimen identification data in a laboratory-maintained file in chronological order of laboratory specimen acquisition; assignment to the specimen of an identification code.

Abutment

A tooth or implant fixture used as a support for prosthesis.

Acid Etching

Use of an acidic chemical substance to prepare the tooth enamel and or dentin surface to provide retention for bonding.

Adhesion

State in which two surfaces are held together by chemical or physical forces or both with or without the aid of an adhesive. Adhesion is one aspect of bonding.

Adhesive

Any substance that joins or creates close adherence of two or more surfaces. Intermediate material that causes two materials to adhere to each other.

Adjunctive

A secondary treatment in addition to the primary therapy.

Administrative Costs

Overhead expenses incurred in the operation of a dental benefit program, exclusive of costs of dental services provided.

Administrator

One who manages or directs a dental benefit program on behalf of the program's sponsor.

Adult Dentition

The permanent teeth of adultood that either replace the primary dentition or erupt distally to the primary molars.

Adverse Selection

A statistical condition within a group when there is a greater demand for dental services and/or more services necessary than the average expected for that group.

Allogenic

Belonging to the same species, but genetically different.

Alloplastic

Refers to synthetic material often used for tissue augmentation or replacement.

Allowable Charge

The maximum dollar amount on which benefit payment is based for each dental procedure as calculated by the third party payer.

Alloy

Compound combining two or more elements having properties not existing in any of the single constituent elements. Sometimes used to refer to amalgam.

Alternate Benefit

A provision in a dental plan contract that allows the third party payer to determine the benefit based on an alternative procedure that is generally less expensive than the one provided or proposed.

Alternative Benefit Plan

A plan, other than a traditional (fee-for-service,freedom-of-choice) indemnity or service corporation plan, for reimbursing a participating dentist for providing treatment to an enrolled patient population.

Alternative Delivery System

An arrangement for the provision of dental services in other than the traditional way (e.g., licensed dentist providing treatment in a fee-for-service dental office).

Alveolar

Referring to the bone to which a tooth is attached.

Alveoloplasty

Surgical procedure for contouting supporting bone, sometimes in Preparation for prosthesis.

Amalgam

An allow used in direct dental restorations. Typically composed of mercury,silver, tin and copper along with other metallic elements added to improve physical and mechanical properties.

Analgesia

Loss of pain sensations without loss of consciousness.

Ancillary

Subordinate or auxiliary to something or someone else; supplementary.

Anesthesia

A patient's level of consciousness is determined by the provider and not the route of administration of anesthesia. State dental boards regulate the use of anesthesia techniques.

Anomaly

Anomaly

Anterior

Mandibular and maxillary centrals, laterals and cuspids. The designation of permanent anterior teeth in the Universal tooth numbering system include teeth 6 through 11 (maxillary), and 22 through 27 (mandibular); primary teeth in the Universal tooth numbering system are designated C through H (maxillary), and M through R (mandibular). Also refers to the teeth and tissues located towards the front of the mouth.

Anxiolysis

The diminution or elimination of anxiety.

Any Willing Provider

Legislation that requires managed care organizations (MCOs), such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any providers who are willing to meet the terms of the contract.

Apex

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

Apexification

The process of induced root development to encourage the formation of calcified barrier in a tooth with immature root formation or an open apex. May involve the placement of an artificial apical barrier prior to non-surgical endodontic obturation.

Apexogenesis

Vital pulp therapy performed to encourage continued physiological formation and development of the tooth root.

Apicoectomy

Amputation of the apex of a tooth.

Appeal

A formal request that an insurer review denied or unpaid claims for services or supplies provided. An appeal can be filed by a healthcare provider or a patient in an attempt to recover reimbursement from a third-party payer such as a private insurance company.

Arch, dental

The curved composite structure of the natural dentition and the residual ridge, or the remains thereof, after the loss of some or all of the natural teeth.

Arthrogram

A diagnostic X-ray technique used to view bone structures following injection of a contrast medium into a joint.

Assignment of Benefits

A procedure whereby a beneficiary/patient authorizes the administrator of the program to forward payment for a covered procedure directly to a treating dentist.

Audit

An examination of records or account to check their accuracy.A post-treatment record review or clinical examination to very information reported on claims.

Avulsion

Separation of tooth from its scoker due to trauma.

Benign

The mild or non-threatening character of an illness of the non-malignant character of neoplasm.

Benefits Plan Summary

The description of synopsis of employee benefits as required by ERISA that is to be distributed to employees.

Benefit Booklet

A booklet or pamphlet provided to the subscriber that contains a general explanation of benefits and related provisions of the dental program. Also known as a "Summary Plan Description."

Benefit

The amount payable by a third party toward the cost of various covered dental services or the dental service or procedure covered by the plan.

Beneficiary

A person who is eligible for benefits under a dental benefit contract.

Behavior Management

Techniques or therapies used to alter or control the actoins of a patient who is receiving dental treatment. Examples include use of a papoose board, education or anxiety relief techniques.

Barrier Membrane

Usually a thin, sheet-like usually non-autogenous material used in various surgical regenerative procedures.

Balance Billing

A provider's billing of a covered person directly for charges above the amount reimbursed by te health plan (i.e., difference between billed charges and the amount paid).Depending upon the contractual arrangements between the parties, this may or may not be allowed.

Bad Faith Insurance Practices

Term used to describe the failure of an insurance company to pay fair compensation for a valid claim.It includes failure to properly investigate a claim for benefits;and unreasonably and purposely delaying and/or withholding payment of a claim, or misrepresenting insurance policy provisions relating to coverage issues.

Bicuspid

A premolar tooth; a tooth with two cusps.

Bilateral

Occuring on, or pertaining to, both right and left sides.

Biologic Materials

Agents that alter wound healing or host-tumor interaction. Such materials Can Include cytokines, growth factor, or vaccines, but do not include any actual hard or soft tissue graft material. These agents are added to graft material of used alone to effect acceleration of healing or regeneratoin in hard and soft tissue surgical procedures. Also known as biologic response modifiers.

Biopsy

Process of removing tissue for histologic evaluation.

Birthday Rule

When a dependent child's parents both have dental coverage, this rule states that the "primary" program (the one that pays first) is the one covering the parent whose month and day of birth falls first in the calendar year. The birthday rule is the most common rule for determining primary vs. secondary coverage, but it may be superseded by a court order such as a divorce agreement.

Bitewing Radiograph

Interproximal radiographic view of the coronal portion of the tooth/teeth. A form of dental radiograph that may be taken with the long axis of the image oriented either horizontally or vertically, that reveals approximately the coronal halves of the maxillary and mandibular teet and portions of the interdental alveolar septa on the same image.

Bleaching

Process of lightening the teeth, usually using a chemical oxidizing agent and sometimes in the presence of heat. Removal of deep seated intrinsic or acquired discolorations from crowns of vital and non-vital teeth through the use of chemicals, sometimes in combination with the application of heat and light. Bleaching has been achieved through short and long term applications of pastes or solutions containing various concentrations of hydrogen peroxide and carbamide peroxide. Normally applied externally to teeth; may be used internally for endodontically treated teeth.

Bonding

Process by which two or more components are made integral by mechanical and/or chemical adhesoin at their interface.

Bounded Tooth Space

A space that has a tooth on each side.

Bruxism

The parafunctional grinding of the teeth.

Bundling of procedures

The systematic combining of distinct dental procedure codes by third-party payers that results in a reduced benefit for the patient/beneficiary.

By Report

A narrative description used to describe a service that does not have a procedure code or is specified in a code as "by report"; may be requested by a third-party payer to provide additoinal information for claims processing.

Cafeteria Plan

Employee benefit plan in which employees select their medical insurance coverage and other nontaxable fringe benefits from a list of options provided by the employer. Cafeteria plan participants may receive additional, taxable cash compensation if they select less expensive benefits.

Calculus

Hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.

Canal

A relatively narrow tubular passage or channel.

Canal, Root

Space inside the root portion of a tooth containing pulp tissue.

Canal, Mandibular

The passage that transmits vessels and nerves through thes jaw to branches that distributes them to the teeth.

Cantilever Extension

Part of a fixed prosthesis that extends beyond the abutment to which it is attached and has no additional support.

Capitatoin

A capitatoin program is one in which a dentist or dentists contract with the program's sponsor or administrator to provide all or most of the dental services covered under the program to subscribers in return for payment on a per-capita basis.

Caries

Commonly used term for tooth decay.

Case Management

The monitoring and coordination of treatment rendered to patients with specific diagnoses or requiring high cost or extensive services. May include complex treatment plans or discussion between multiple practitioners.A process of identifying patients with special health care needs, developing a healthcare strategy that meets those needs, and coordinating and monitoring the care, with the ultimate goal of achieving the optimum health care outcome in an efficient and cost-effective manner.

Cavity

Missing tooth structure. A cavity may be due to decay, erosion or abrasion. If caused by caries, also referred to as carious lesion.

Cement base

Material used under a filling to replace lost tooth structure.

Cememtum

Hard connective tissue covering the outer surface of a tooth root.

Centers for Medicare and Medicaid Services (CMS)

The federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), HIPAA, and Clinical Laboratory Improvement Amendments (CLIA) programs. CMS is part of the U.S. Department of Health and Human Services.

Cephalometric Image

A standardized, extraoral projection utilized in the scientific study of the measurements of the head.

Ceramic

Non-metal, non-resin inorganic refractory compounds processed at high temperatures (600 C/1112 F and above) and pressed, polished or milled - including porcelains, glasses, and glass-ceramics.

Claim

A request for payment under a dental benefit plan; a statement listing services rendered, te dates of services, and itemization of costs. The completed request serves as the basis for payment of benefits.

Claim Form

The paper form used to file for benefits under a dental benefit program.

Claimant

Person or authorized provider who files a claim for benefits. Patient or certificate holder who files a claim for benefits.

Cleft Palate

Congenital deformity resulting in lack of fusion of the soft and/or hard palate, either partial or complete.

Clenching

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

Closed Panel

A dental insurance benefit plan that requires the eligible patients to recieve their dental care from a specific dentist who has contractually agreed to the terms, payments and benefits of the plan. Usually only a limited number of dentists in an area are allowed to participate in thee types of plans.

Closed Reduction

The re-approximation of segments of a fractured bone without direct visualization of the bony segments.

Coinsurance

A provision of a dental benefit program by which the beneficiary shares in the cost of covered services, generally on a percentage basis. The percentage of a covered dental expense that a beneficiary must pay (after the deductible is paid). A typical coinsurance arrangement is one in which the third pary pays 80% of the allowed benefit of the covered dental service and the beneficiary pays te remainder of the charges fee. Percentages vary and may apply to table of allowance plans; maximum allowable benefit plans and direct reimbursement programs.

Complete Denture

A prosthetic for the edentulous maxillary or mandibular arch, replacing the full dentition. Usually includes six anterior teet and eight posterior teeth.

Complete Series

An entire set of radiographs. A set of intraoral radiographs usually consisting of 14 to 22 periopical and posterior bitewing images intended to display the corwns and roots of all teeth, periopical areas and alveolar bone.

Composite

A dental restorative material made up of disparate or separate parts (e.g., resin and quartz particles).

Compound Fracture

Break in bone that is exposed to external contamination.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Legislation relative to mandated benefits foa all types of employee benefit plans. The most significant aspects within this context are the requirements for continued coverage for employees and/or their dependents for 18 months who would otherwise lose coverage (30 months for dependents in the event of the employee's death).

Consultation

In a dental setting, a diagnostic service provided by a dentist where the dentist, patient, or other parties (e.g.,another dentist,physician, or legal guardian) discuss the patient's dental needs and proposed treatment modalities.

Contiguous

Adjacent; touching.

Contract

A legally enforceable agreement between two or more individuals or entities that confers rights and duties on the parties. Common types of contracts include: 1) Contracts between a dental benefit organization and an individual dentist to provide dental treatment to members of an alternative benefit plan. These contracts define the dentist's duties both to beneficiaries of the dental benefit plan and the dental benefit organizatoin, and usually define the manner in which the dentist will be reimbursed; and 2) ctonracts between a dental benefit organization and a group plan sponsor. These contracts typically describe the benefits of the group plan and the rates to be charged for those benefits.

Contract Dentist

Any dentist who has a contractual agreement with a dental benefit organization to render care to eligible persons.

Contract Fee Schedule Plan

A dental benefit plan in which participating dentists agree to accept a list of specific fees as the total fees for dental treatment provided.

Contract Practice

A dental practice or organization that has a contractual arrangement with an insurer for the provision of services under an insurance contract.

Contract term

Usually a 12-month period of time for which a contract is written and during which a group's deductibles, maximums and other provisions apply. This may or may not be the same as a calendar year. Also known as a benefit year.

Contributory Program

A dental benefit program in which the enrollee shares in the monthly premium of the program with the program sponsor (usually te employer). Generally done through payroll deduction.

Coordination of Benefits (COB)

A method of integrating benefits payable for the same patient under more than one plan. Benefits from all sources should not exceed 100% of the total charges.

Copayment

Beneficiary's share of the dentist's fee after te benefit plan has paid.

Coping

A thin covering of the coronal portion of the tooth usually without anatomic conformity. Custom made or pre-fabricated thimble-shaped core or base layer designed to fit over a natural tooth preparation, a post core, or implant abutment so as to act as a substructure onto which other components can be added to give final form to a restoration or prosthesis. It can be used as a definitive restoration or as part of a transfer procedure.

Core Buildup

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

Coronal

Refers to the crown of a tooth.

Cost Containment

Features of a dental benefit program or of the administration of the program designed to reduce or eliminate certain charges to the plan.

Cost Sharing

The share of health expenses that a beneficiary must pay, including the deductibles, copayments, coinsurance, and charges over the amount reimbursed by the dental benefit plan.

Coverage

Benefits available to an individual covered under a dental benefit plan.

Covered charges

Services and supplies that are reimbursed in whole or in part under the conditions of the dental benefit plan, subject to all the terms and conditions of the agreement or insurance policy. Charges are subject to any contractual agreements, exclusions and limitations. Any charges not covered by the plan are considered non-covered charges.

Covered Person

An individual who is eligible for benefits under a dental benefit program.

Covered Services

Services for which payment is provided under the terms of the dental benefit contract.

Cracked Tooth Syndrome

A collection of symptoms characterized by transient acute pain experienced when chewing.

Crown,abutment

Artificial crown serving for the retention or support of a dental prosthesis

Crown

That portion of tooth normally covered by, and including, enamel.

Crown, Artificial

Restoration covering or replacing the major part, or the whole of the clinical crown of a tooth.

Clinical Crown

That portion of a tooth not covered by tissues.

Crown Lengthening

A surgical procedure exposing more tooth for restorative puposes by apically positioning the gingival margin and removing supporting bone.

Culture and Sensitivity Test

Clinical laboratory test that identifies a microorganism and te ability of various antibiotics to control the microorganism.

Curettage

Scraping and cleaning the walls of a real or potential space, such as a gingival pocket or bone, to remove pathologic material.

Cusp

Pointed or rounded eminence on or near the masticating surface of a tooth.

Cuspid

Single cusped tooth located between the incisors and bicuspids.

Customary Fee

Te fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.

Cyst

Pathological cavity, usually lined with epithelium, containing fluid or soft matter.

Cyst, Odontogenic

Cyst derived from the epithelium of odontogenic tissue (developmental, primordial).

Cyst, Periopical

An apical inflammatory cyst containing a sac-like epithelium-lined cavity that is open to and continuous with the root canal.

Cytology

The study of cells, including their anatomy, chemistry, physiology and pathology.

Debridement

Removal of subgingival and/or supragingival plaque and calculus that obstructs the ability to perform an evaluation; removal of contused and devitalized tissue from a wound surface.

Decay

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

Deciduous

Having the propery of falling off or shredding; a term used tto describe the primary teeth.

Deductible

The amount of dental expense for which the beneficiary is reponsible before a third party will assume any liability for payment of benefits. Deductible may be an annual or one-time charge, and may bary in amount from program to program.

Dental Benefit Organization

Any organization offering a dental benefit plan. Also known as dental plan organization.

Dental Benefit Program

The specific dental benefit plan being offered to enrollees by the sponsor.

Dental Insurance

A plan that financially assists in the expense of treatment and care of dental disease and, in some cases, accidents to teeth.

Dental Prepayment

A method of financing the cost of dental services prior to receiving services.

Dental Service Corporation

A legally constituted, not-for-profit organization that negotiates and administers contracts for dental care. Delta Dental Plans and Blue Cross/Blue Shield Plans are such plans.

Dentin

Hard tissue that forms the buld of the tooth and develops fomr the dental papilla and dental pulp, and in the mature state is mineralized.

Dentition

The Teeth in the dental arch.

Denture

An artificial substitute for some or all of the natural teeth and adjacent tissues.

Denture Base

That part of a denture that makes contact with soft tissue and retains the artificial teeth.

Diagnostic Cast

Plaster or stone model of teeth and adjoining tissues; also referred to as study model. Primarily for use in extraoral examinations of relationships existing between oral tissues so as to determine how those relationships will effect form and function of a dental restoration or appliance being planned, or so as to determine whether subsequent pre-definitive impression tissue treatment or modification might be necessary in order to insure optimal performance of the planned restoration or appliance.

Diagnostic Imaging

A visual display of structural or functional patterns for the puspose of diagnostic evaluation. May be photographic or radiographic.

Diastema

A space,such as one between two adjacent teeth in the same dental arch.

Direct Pulp Cap

Procedure in which the exposed vital pulp is treated with a therapeutic material, followed with a base and restoration, to promote ealing and maintain pulp vitality.

Direct Reimbursement

A self-funded dental benefits plan that reimburses patients according to dollars spend on dental care not type of treatment received. It allows the patient complete freedom to choose any dentist.

Direct Restoration

A restoration fabricated inside the mouth.

Discectomy

Excision of the intra-articular disc of a joint.

Displaced tooth

A partial evulsion of a tooth; may be mesial, distal facial, lingual, or incisal.

Distal

Surface or position of a tooth most distant from the median line of the arch.

Downcoding

A process used by third-party payers to reduce the value of billed procedures by changing the codes submitted to ones of lower value.

Dressing

Medication, bandages or other therapeutic material applied to a wound.

Dry Socket

Localized Inflammation of the tooth socket following extraction due to infectoin or loss of blood clot; osteitis.

Dual Choice Program

A benefit package from which an eligible individual can choose to entroll in either an alternative dental benefit program or a traditional dental benefit program.

Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT)

A federally funded program that provides comprehensive health care for children through periodic screenings, diagnostic and treamment services.

Eduntulous

Without teeth.

Eligibility Date

The date an individual and/or dependents become eligible for benefits under a dental benefit contract. Often referred t oas effective date.

Employment Retirement Income Security Act (ERISA)

A federal act, passed in 1974, which established new standards and reporting/disclosure requirements for employer-funded pension and welfare benefit programs. To date, self-funded benefit plans operating under ERISA have been held to be exempt from most state insurance laws, although the courts have held that the states can regulate te medical care provided under such plans, as by requiring mandatory review of adverse HMO determinations.

Enamel

Hard calcified tissue covering dentin of the crown of tooth.

Endodontics

Endodontics is the branch of dentistry that is concerned with morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass te basic and clinical sciences including biology of te normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.

Endodontist

A dental specialist who limits his/her practice to treating disease and injuries of the pulp and associated periradicular conditions.

Enrollee

Individual covered by a benefit plan.

Eteral

Any technique of administratoin of an agent in which the agent is absorbed through the gastrointestinal tract or oral mucosa (e.g., oral,rectal,subgingual).

Entity

Something that exists as a particular and discrete unit. Persons and corporations are equivalent entities under the law.

Equilibration

Reshaping of the occlusal surfaces of the teeth to create harmonious contact relationships between the upper and lower teeth; also known as occlusal adjustment.

Established Patient

A patient who has received professional services from a dentist or another dentist of the same specialty who belongs to the same group practice, within the past three years, subject to state laws.

Evaluation

The patient assessment that may include gathering of information through interview, observation, exdamination, and use of specific tests that allows a dentist to diagnose existing conditions.

Evulsion

Separation of the tooth from its socket due to trauma.

Excision

Surgical removal of bone or tissue.

Exclusions

Dental services not covered under a dental benefit program.

Exclusive Provider Organization (EPO)

A type of preferred provider organization under which employees must use providers from the specified network of dentists to receive coverage; there is no coverage for care received from a non-network provider except in an emergency situation.

Exfoliative

Refers to a thin layer of epidermis shed from the surface.

Exostosis

Overgrowth of bone.

Expiration date

In dentistry, te date on which the dental benefit contract expires; the date an individual ceases to be eligible for benefits.

Explanation of Benefits

A written statement to a beneficiary from a third-party payer after a clai has been reported, indicating the benefit/charges covered or not covered by the dental benefit plan.

Extended Care Facility

A facility such as a nursing home that is licensed to provide 24-hour nursing care service in accordance with state and local laws. Several levels of care may be provided- skilled, intermediate, custodial, or any combination.

Extension of Benefits

Extension of eligibility for benefits for covered services, usually designed to ensure completion of treatment commenced prior to the expiration date. Duration is generally expressed in terms of days.

Extraoral

Outside the oral cavity.

Extracoronal

Outside the crown of a tooth.

Extraction

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

Exudate

A material usually resulting from inflamamation or necrosis that contains fluid, cells, and/or other debris.

Facial

The surface of a tooth directed toward the cheeks or lips (i.e., the buccal and labial surfaces) and opposite the lingual surface.

Family Deductible

A deductible that is satisfied by combined expenses of all covered family members. For example, a program with $25 deductible may limit its application to a maximum of three deductibles, or $75 for the family, regardless of the number of family members.

Fascial

Related to a sheet or band of fibrous connective tissue enveloping, separating or binding together muscles, organs and other soft tissue structures of the body.

Fee-for-service

A method of paying practitioners on a service-by-service rather than a salaried or capitated basis.

Fee Schedule

A list of the charges established or agreed to by a dentist for specific dental services.

Filling

A lay term used for the restoring of lost tooth structure by using materials such as metal, allow, plastic, or porcelain.

Fixed Partial Denture

A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teet or implant replacements.

Flexible Benefits

A benefit program in which an employee has a choice of credits or dollars for distribution among various benefit options, e.g., health and disability insurance, dental benefits, childcare, or pension benefits.

Flexible Spending Account

Employee reimbursement account primarily funded with employee designated salary reductions. Funds are reimbursed to the employee for health care (medical and/or dental), dependent care, and/or legal expenses, and are considered a nontaxable benefit.

Fluoride

A chemical compound that prevents cavities; makes the tooth surface stronger so that teeth can resist decay.

Foramen

Natural opening into or through bone.

Fracture

The breaking of a part, especially of a bony structure; breaking of a tooth.

Franchise Dentistry

Refers to a system for marketing a dental practice, usually under a trade name, where permitted by state laws. In return for a financial investment or other consideration, participating dentists may also receive benefits of media advertising, a national referral system, and financial and management consultation.

Freedom of Choice

A provision in a dental benefit program that permits the insured to choose any licensed dentist to provide his or her dental care and receive full benefits under the program.

Frenum

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

Furcation

The anatomic area of a multirooted tooth where the roots diverge.

Gate Keeper System

A managed care concept used by some alternative benefit plans, in which enrollees select a primary care dentist, usually a general practitioner or pediatric dentist, who is responsible for providing non-specialty care and managing referrals, as appropriate, for specialty and ancillary care.

Genetic Test

Laboratory technique used to determine if a person has a genetic condition or disease or is likely to get the disease.

Gingiva

Soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted.

Gingivectomy

The excision or removal of gingiva.

Gingivitis

Inflammation of gingival tissue without loss of connective tissue.

Gingivoplasty

Surgical procedure to reshape gingiva.

Glass Ionomer

Polyelectrolyte cement in which the solid powder phase is a fluoride containing aluminosilicate glass powder to be mixed with polymeric carboxylic acid. The cement can be used to restore teeth, fill pits and fissures, lute and line cavities. It is also known as glass polyalkenoate cement, ionic polymer cement, polyelectrolyte cement.

Gold Foil

Thin pure gold leaf that is self adhering when condensed into a cavity. One of the oldest restorative techniques, it is compacted or condensed into a retentive cavity form.

Graft

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

Graft, Allo

Graft of a tissue between genetically dissimilar members of the same species. Donors may be cadavers, living related or living unrelated individuals. Also called allogenic graft or homograft.

Graft, Autogenous

Taken from one part of a patient's body and transferred to another.

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.

Health Maintenance Organization (HMO)

A legal entity that accepts responsibility and financial risk for providing specified services to a defined population during a defined period of time at a fixed price. An organized system of health care delivery that provides comprehensive care to enrollees through designated providers. Enrollees are generally assessed a monthly payment for ealth care services and may be required to remain in the program for a specified amount of time.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

A federal law that requires all health plans, including ERISA, health care clearinghouses and any dentist who transmits health information in an electronic transaction, to use a standard format and the ADA procedure codes. Providers' paper transactions are not subject to this requirement.

Healthcare Provider Taxonomy

The code that identifies the type of health care provider involved in furnishing services to beneficiaries.

Hemisection

Surgical separation of a multi-rooted tooth.

Histopathology

The study of disease processes at the cellular level.

Hold Harmless Clause

A contract provision in which one party to the contract promises to be responsible for liability incurred by the other party. Hold harmless clauses frequently appear in the following contexts: 1) Contracts between dental benefit organizations and an individual dentist often contain a promise by the dentist to reimburse the dental benefit organization for any liability the organization incurs because of dental treatment provided to beneficiaries of the organization's dental benefit plan. This may include a promise to pay the dental benfit organization's attorney fees and related costs; and 2) Contracts between dental benefit organization and a group plan sponsor may include a promise by the dental benefit organizatoin to assume responsibility for disputes between a beneficiary of the group plan and an individual dentist when the dentist's charge exceeds the amount the organization pays for the service on behalf of the beneficiary. If the dentist takes aciton against the patient to recover the difference between the amount billed by the dentist and the amount paid by the organization, the dental benefit organization will take over the defense of the claim and will pay any judgements and court costs.

Hyperplastic

Pertaining to an abnormal increase in the number of cells in an organ or a tissue with consequent enlargement.

Imaging, diagnostic

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

Immediate Denture

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

Impacted Tooth

An unerupted or partially erupted tooth that is positioned against another tooth, bone, or soft tissue so that complete eruption is unlikely.

Implant

Material inserted or grafted into tissue.

Implant, Dental

A device specially designed to be placed surgically within or on the madibular or maxillary bone as a means of providing for dental replacement.

Implant, endosteal(endosseous)

Device placed into the alveolar and basal bone of te mandible or maxilla and transecting only one cortical plate.

Impant, eposteal(subperiosteal)

Subperiosteal implant that conforms to the superior surface of an edentulous area of alveolar bone.

Implant, transosteal(transosseous)

Device with threaded posts penetrating both te superior and inferior cortical bone plates of the mandibular symphysis and exiting through the permucosa.It may be intraoral or extraoral.

Implantation,tooth

Placement of an artificial or natural tooth into an alveolus.

Incentive Program

A dental benefit program that pays an increasing share of te treatment cost, provided that the covered individual utilizes the benefits of the program during each incentive period (usually a year) and receives the treatment prescribed. For example, a 70%-30% copayment program in the first year of coverage may become an 80%-20% program in the second year if te subscriber visits the dentist in the first year as stipulated in the program. Most frequently there is a corresponding percentage reduction in the programs copayment level if the covered individual fails to visit the dentist in a given year (but never below the initial copayment level).

Incisal

Pertaining to the biting edges of the incisor and cuspid teeth.

Incisal Angle

One of the angles formed by the junction of the incisal and the mesial or distal surfaces of an anterior tooth; called the mesioincisal and distoincisal angle respectfully.

Incision and Drainage

Te procedure of incising a fluctuant mucosal lesion to allow for the release of fluid from the lesion.

Incisor

A tooth for cutting or gnawing; located in the front of the mouth in both jaws.

Indemnity Plan

A non-network dental plan that reimburses the member or dentist at a certain percentage of charges for services rendered, often after a deductible has been satisfied. Indemnity plans typically place no restrictions on which dentist a member may visit. Indemnity plans are also referred to as "fee-for-service" plans.

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 via formation of secondary dentin.

Indirect Restoration

A restoration fabricated outside te mout.

Individual Practice Association (IPA)

A legal entity organized and operated on behalf of individual participating dentists for the primary purpose of collectively entering into contracts to provide dental services to enrolled populations. Dentists may practice in their own offices and may provide care to patients not covered by the contract as well as IPA patients.

Inlay

An indirect intracoronal restoration; a dental restoration made outside of the oral cavity to correspond to the form of the prepared cavity, which is then luted into the tooth.

Insured

Person covered by the program.

Insurer

The party in an insurance contract that promises to pay a benefit if a specified loss occurs. Usually an insurance company.

Intentional Reimplantation

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

Interproximal

Between the adjoining surfaces of adjacent teeth in the same arch.

Intracoronal

Referring to "within" the crown of a tooth.

Intraoral

Inside the mouth.

Jaw

A common name for either the maxilla or the mandible.

Keratin

A protein present in all cuticular structures of the body, such as hair, epidermis and horns.

Keratinized Gingiva

The oral surface of the gingiva extending from the mucogingival junction to the gingival margin. In gingival health, the coronal portion of the sulcular epithelium may also be keratinized.

Labial

Pertaining to or around the lip.

Laminate Veneer

A thin covering of the facial surface of a tooth usually constructed of tooth colored material used to restore discolored,damaged, misshapen or misaligned teeth.

Least Expensive Alternative Treatment (LEAT)

A limitation in a dental benefit plan that will only allow benefits for the least expensive treatment when there are multiple treatment options for a specific condition. Also referred to as Least Expensive Professionally Acceptable Alternative Treatment (LEPAAT). LEAT does not determine treatment, but does determine level of benefits available.

Lesion

An injury or wound; area of diseased tissue.

Liability

An obligation to pay an amount in money, goods, or services to another party.

Limitations

Restrictive conditions stated in a dental benefit contract, such as age, length of time covered, and waiting periods, that affect an individual's or group's coverage. The contract may also exclude certain benefits or services, or it may limit the extent or conditions under which certain services are provided.

Line Angle

An angle formed by the junction of two planes; used to designate the junction of two surfaces of a tooth, or of two walls of a tooth cavity preparation.

Lingual

Pertaining to or around the tongue; surface of the tooth directed toward the tongue; opposite of facial.

Locus

A site or location.

Maintenance, periodontal

Therapy ofr preserving the state of health of the periodontium.

Malar

Pertaining to the cheek bone.

Malignant

Having the properties of dysplasia, invasion, and metastasis.

Malocclusion

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

Managed Care

Health plans that integrate the financing and delivery of health care services to covered individuals by means of some or all of the following: arrangements wit selected providers to furnish services to members; defined criteria for the selection of health care providers; significant financial incentives for members to use contracted providers; procedures associated with the plan, subject to limitations and exclusions; and formal programs for quality assurance and utilization review.

Mandible

The lower jaw.

Maryland Bridge

Fixed partial denture featuring conservative retainers that are resin bonded to abutments.

Maxilla

The upper jaw.

Maximum Allowable Benefit (MAB)

The maximum dollar amount a dental program (also known as a 'dental benefit plan') will pay toward the cost of a dental care incurred by an individual or a family in a specified period, usually a calendar year, as specified in the program's contract provisions. Benefit plan administrators and plan sponsors (e.g., employer) determine the MAB, which may be a portion of the dentist's fee or what the administrator considers "customary" or "reasonable." Although these limits are called "customary," they may not reflect the dentist's actual fees. May be referred to as the Table of Allowances or, in some cases, UCR.

Maximum Fee Schedule

A compensation arrangement in which a participating dentist agrees to accept a prescribe sum as the total fee for aone or more covered services.

Medicaid

A federal assistance program established as Title XIX under the Social Security Act of 1965 that provides payment for medical care for certain low income individuals and families. The program is funded jointly by the state and federal governments and administered by states.

Medically Necessary Care

The reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies,appliances and devices) as determined and prescribed by qualified, appropriate health care provieders in treating any condition, illness, disease, injury, or birth developmental malformations. Care is medically necessary for the purpose of: controlling or eliminating infection, pain, and disease; and restoring facial configuration or function necessary for speech, swallowing or chewing.

Medicament

Substance or combination of substances intended to be pharmacologically active, specially prepared to be prescribed, dispensed or administered by authorized personnel to prevent or treat diseases in humans and animals.

Medicament,topical

Pahmacological substance especially prepared to be applied on tissues of the oral cavity.

Medicare

A federal insurance program enacted in 1965 as Title XVIII of the Social Security Act that provides certain inpatient hospital services and physician services for all persons age 65 and older and eligible disabled individuals. The program is administered by the Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA).

Member

An individual enrolled in a dental benefit program.

Mesial

Nearer the middle line of the body, or the surface of a tooth nearer the center of dental arch.

Microabrasion

Mecanical removal of a small amount of tooth structure to eliminate superficial enamel discoloration defects.

Microorganisms

A minute living organism, such as a bacterium, fungus, year, virus or rickettsia.

Molar

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

Moulage

A positive reproduction of a body part formed on a cast from a negative impression.

Mouthguard

Individually molded device designed primarily to be worn for the purpose of helping prevent injury to te teeth and their surrounding tissues. Sometimes called a mouth protector.

Mucous Membrane

Lining of te oral cavity as well as other canals and cavities of te body; also called "mucousa."

Necessary Treatment

A necessary dental procedure or service as determined by a dentist, to either establis or maintain a patient's oral health. Such determinations are based on the professional diagnostic judgement of the dentist, and the standards of care that prevail in the professional community.

Non-autogenous

A graft from donor other than patient.

Noncontributory Program

A method of payment for group coverage in which the sponsor pays the entire montly premium for the program.

Nonparticipating Dentist

Any dentist who does not have a contractual agreement with a dental benefit organization to render dental care to members of a dental benefit program.

Obturator

A disc or plate that closes an opening; a prosthesis that closes an opening in the palate.

Occlusal

Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth or opposing occlusion rims.

Occlusal Radiograph

An intraoral radiograph made with the film being held between the occluded teeth.

Occlusion

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

Odontogenic

Refers to tooth-forming tissues.

Odontoplasty

Adjustment of tooth length, size, and/or shape; includes removal of enamel projections.

Onlay

An indirect restoration made outside the oral cavity that overlays a cusp or cusps of the tooth, which is then luted to the tooth.

Open Enrollment

The annual perio in which employees can select from a choice of benefit programs.

Open Panel

This type of dental benefit plan allows covered patients to receive care from any dentist and allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans.

Open Reduction

Reapproximation of fractured bony segments accomplished through cutting the adjacent soft tissues and bone to allow direct access.

Operculectomy

Removal of the operculum.

Operculum

The flap of tissue over an unerupted or partially erupted tooth.

Oral

Pertaining to the mouth.

Oral and Maxillofacial Pathologist

A dental specialist whose practice is concerned with recognition, diagnosis, investigation and management of diseases of the oral vacity, jaws, and adjacent structures.

Oral and Maxillofacial Pathology

Oral patology is te specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.

Oral and Maxillofacial Radiologist

A dental specialist whose practice is concerned with the production and interpretation of images and date produced by all modalities of radiant energy used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region.

Oral and Maxillofacial Surgeon

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

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.

Orthodontics and Dentofacial Orthopedics

Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuro muscular and skeletal abnormalities of the developing or mature orofacial structures.

Orthodontist

A dental specialist who practice is limited to the interception and treatment of malocclusion and other neuro muscular and skeletal abnormalities of the teeth and their surrounding structures.

Orthognathic

Functional relationship of maxilla and mandible.

Orthotic Device

Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable partds of the body.

OSHA

Abbreviation for Occupational Safety and Health Administration. Federal agency in the US responsible for making and enforcing employee safety regulations.

Osteoplasty

Surgical procedure that modifies the configuration of bone.

Osteotomy

Surgical cutting of bone.

Overdenture

A removable prosthetic device that overlies and may be supported by retained tooth roots or implants.

Palate

The hard and soft tissues forming the roof of the mouth that seperates the oral and nasal cavities.

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.

Parafunctional

Other than normal function or use.

Parenteral

A technique of administration in which the drug bypasses te gastrointestinal tract (e.g., intramuscular [IM], intravenous [IV], intranasal [IN],submucosal[SM],subcutaneous[SC], intraocular[IO]).

Partial Denture

Usually refers to a prosthetic device that replaces missing teeth.

Patient

An individual wo has established a professional relationship wit a dentist for te delivery of dental health care. for matters relating to communication of information and consent tis term includes the patient's parent, caretaker, guardian, or other individual as appropriate under state law and the circumstances of te case.

Payer

A self-insured employer, insurance company, governmental agency or other party responsible for payment of health care claims of covered persons.

Pediatric Dentist

A dental Specialist whose practice is limited to treatment of children from birth through adolescence, providing primary and comprehensive preventive and therapeutic oral health care; 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.

Peer Review

An evaluation of the quality and conduct of an individual's work by the individual's professional equals (peers) in order to resolve questions or disputes regarding the quality, or conduct of the work. Peer review, when applied to dentistry, is a process, consistently structured and implemented by organized dentistry, in which a dentist's professional equals (peers) resolve questions or disputes (regarding the quality or appropriateness of care provided by the dentist or the fairness of the fee the dentist charged in an individual case) by retrospectively evaluating the quality or appropriateness of care in relation to professional norms or criteria or evaluating the fee charged in relation to the dentist's usual fee for te given complexity and level of care provided.

Peer Review Organization (PRO)

An organization established by an amendment of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), to provide for the review of medical services furnished primarily in a hospital setting and/or in conjunction with care provided under the Medicare and Medicaid programs. In addition to their review and monitoring functions, these entities can invoke sanctions, penalties, or other corrective actions for noncompliance in organization standards.

Percentile

The number in a frequency distribution below which a certain percentage of fees will fall. For example, the 90th percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level at which 90%of dentists charge that amount or less, and 10% more.

Periapical

The area surrounding the end of the tooth root.

Periopical Radiograph

A radiograph made by the intraoral placement of film for disclosing the apices of the teeth.

Point of Service

A health plan allowing the member to choose to receive a service from a participating or non-participating provider, with different benefit levels associated with the use of participating providers.

Pontic

The term used for an artificial tooth on a fixed partial denture (bridge).

Porcelain/Ceramic

Refers to those non-metal, non-resin inorganix refractory compounds processed at high temperatures (600C/1112F and above) and pressed, polished or milled - including porcelains, glasses, and glass-ceramics.

Post

Rod-like component designed to be inserted into a prepared root canal space so as to provide support for a superstructure built upon it.

Posterior

Refers to teeth and tissues towards the back of the mouth (distal to the canines); maxillary and mandibular premolars and molars.

Preauthorization

Statement by a third-party payer indicating that proposed treatment will be covered under the terms of the benefit contract.

Precertification

Confirmation by a third-party payer of a patient's eligibility for coverage under a dental benefit program.

Precision attachment

Interlocking device, having a male component integrated into a removable prosthesis that fits precisely into a female component embedded in the body of abutment teeth or implant abutments, to stabilize or retain the prosthesis when it is seated in the mouth.

Predetermination

A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan and notifies the dentist and patient of one or more of the following: patient's eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums.

Pre-existing Condition

Oral health condition of an enrollee that existed before his/her enrollment in a dental program.

Preffered Provider Organization (PPO)

A formal agreement between a purchaser of a dental benefit program and a defined group of dentists for the delivery of dental services to a specific patient population, as an adjunct to a traditional plan, using discounted fees for cost savings.

Prefiling of Fees

The submission of a participating dentist's usual fees to a service corporation for the purpose of establishing, in advance, that dentist;s usual fees and the customary ranges of fees in a geographic area to determine benefits under a usual, customary, and reasonable dental benefit program.

Premedication

The use of medications prior to dental procedures.

Premium

The amount charged by a dental benefit organization for coverage of a level of benefits for a specified time.

Prepaid Dental Plan

A method of financing the cost of dental care for a defined population, in advance of receipt of services.

Prevailing Fee

Term used by some dental benefit organizatoins to refer to the fee most commonly charged for a dental service in a given area.

Preventive Dentistry

Aspects of dentistry concerned with promoting goodoral health and function by preventing or reducing the onset and/or development of oral diseases or deformities and the occurrence of oro-facial injuries.

Primary Dentition

The first set of teeth.

Primary Payer

The third party payer determined to hav einitial responsibility in a benefit determination.

Prophylaxis

Removal of plaque, calculus and stains from the tooth structures. It is intended to control local irrational factors.

Prosthesis

Artificial replacement of any part of the body.

Prosthesis,Definitive

Prosthesis to be used over an extended period of time.

Prosthesis,Dental

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

Prosthesis,Fixedr

Non-removable dental prosthesis that is solidly attached to abutment teeth, roots o

Prosthesis,Fixed-Removable

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

Prosthesis,Interim

A provisional prosthesis designed for us over a limited eriod of time, after which it is to be replaced by a more definitive restoration.

Prosthesis,Removable

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

Provisional

Formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration.

Public Health Dentist

A dentist whose practice is limited to the science and art of preventing and controlling dental diseases and promoting dental health through organizaed community efforts.

Public Health Dentistry

Dental public health is athe science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.

Pulp

Connective tissue that contains blood vessels and nerve tissue that occupies the pulp cavity of a tooth.

Pulp Cavity

The space within a tooth that contains the pulp.

Pulpectomy

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

Pulpitis

Inflammation of the dental pulp.

Pulpotomy

Removal of a portion of the pulp, including the diseased aspect, with the intent of maintaining the vitality of the remaining pulpal tissue by means of a therapeutic dressing.

Purchaser

Organization or entity, often employer or union, that contracts wit the dental benefit organization to provide dental benefits to an enrolled population.

Pericoronal

Around the crown of a tooth

Periodontal

Pertaining to the supporting and surrounding tissues of the teeth.

Periodontal Disease

Inflammatory process of the gingival tissues and/or periodontal membrane of the teeth, resulting in an abnormally deep gingival sulcus, possibly producing periodontal pockets and loss of supporting alveolar bone.

Periodontal Pocket

Pathologically deepened gingival sulcus; a featureof periodontal disease.

Periodontics

Periodontics is the specialty of dentistry that 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 dental specialist whose practice is limited to the treatment of diseases of the supporting and surrounding tissues of the teeth.

Periodontitis

Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth with loss of attachment.

Periodontium

Tissue complex comprising gingival, cementum, periodontal ligament, and alveolar bone that attaches, nourishes and supports the tooth.

Periradicular

Surrounding a portion of the root of the tooth.

Permanent Dentition

Refers to the permanent or adult teeth in the dental arch.

Pin

A metal rod, cemented or driven into dentin to aid in retention of a restoration.

Plaque

A soft, sticky substance that accumulates on teeth and is composed largely of bacterial derivatives.

Quadrant

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

Quality Assessment

The measure of te quality of care provided in a particular setting.

Quality Assurance

The assessment or measurement of the quality of care and the implementation of any necessary changes to either maintain or improve the quality of care rendered.

Radicular

Pertaining to the root.

Radiographic/Surgical Implant Index

An appliance, designed to relate osteotomy or fixture position to existing anatomic structures.

Radiograph

An image or picture producted on a radiation sensitive film emulsion or digital sensor by exposure to ionizing radiation.

Reasonable and Customary (R&C) Plan

A dental benefit plan that determines benefits based only on "Reasonable and Customary" fee criteria.

Reasonable Fee

The fee charged by a dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances, and therefore may differ from the dentist's "usual" fee or the benefit administrator's "customary" fee.

Rebase

Process of refitting a denture by replacing the base material.

Recalcification

Procedure used to encourage biologic root repair of external and internal resorption defects.

Reimbursement

Payment made by a third party to a beneficiary or to a dentist on behalf of the beneficiary, to offset expenses incurred for a service covered by the dental benefit plan.

Reimplantation,tooth

The return of a tooth to its alveolus.

Reinsurance

Insurance for third-party payers to spread their risk for losses (claims paid) over a specified dollar amount.

Relative Value System

Coded listing of professional services with unit values to indicate relative complexity as measured by time, skill, and overhead costs. third-party payers typically assign a dollar value per unit to calculate provider reimbursement.

Reline

Process of resurfacing the tissue side of a removable prosthesis with new base material.

Removable Partial Denture

A removable partial denture (removable bridge) is a prosthetic replacement of one or more missing teeth that can be removed by the patient.

Resin,acrylic

Resinous material of the various esters of acrylic acid, used as a denture base material, for trays or for other restorations.

Retail Store Dentistry

Refers to dental services offered within a retail, department or drug store operation. Typically, space is leased from the store by a separate administrative group that, in turn, subleases to a dentist or dental group providing the actual dental services. the dental operation generally maintains the same hours of operation as the store and appointments often are not necessary. Considered to be a type of practice, not a dental benefit plan model.

Retainer,Orthodontic

Appliance to stabilize teeth following orthodontic treatment

Retainer,Prosthodontic

A part of a fixed partial denture that attaches a pontic to the abutment tooth, implant abutment, or implant.

Retrograde Filling

A method of sealing the root canal by preparing and filling it from the root apex.

Retrospective Review

A post-treatment assessment of services on a case-by-case or aggregate basis after the services have been performed.

Revision

The act of revising; second or more surgical procedure for correction of a condition.

Risk Pool

A portion of provider fees or capitation payments withheld as financial reserves to cover unanticipated utilization of services in an alternative benefit plan.

Root

Anatomic portion of the tooth that is covered by cementum and is located in the alveolus (socket) where it is attached by the periodontal apparatus; radicular portion of the tooth.

Root, residual

Remaining root structure following the loss of the major portion (over 75%) of the crown.

Root Canal

The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp.

Root Canal Therapy (RCT)

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

Root Planning

A definitive treatment procedure designed to remove cementum and/or dentin that is rough, may be permeated by calculus, or contaminated with toxins or microorganisms.

Rubber Dam

A barrier technique used to prevent the passage of saliva or moisture, or to provide an isolated operative field.

Salivary Gland

Exocrine glands that produce saliva and empty it into the mouth; these include the parotid glands, the submandibular glands and the sublingual glands.

Scaling

Removal of plaque,calculus, and stain from teeth.

Schedule of Benefits

A listing of dental services and the maximum benefit amounts an insurer will pay for a given service. Specificity will vary by benefit plan.

Sealant

A resinous material designed to be applied to the occlusal surgaces of posterior teet to prevent occlusal caries.

Second-Opinion Program

An opinion about the appropriateness of a proposed treatment provided by a practitioner other than the one making the original recommendation; some benefit plans require such opinions for selected services.

Sedative Filling

A temporary restoration intended to relieve pain.

Self-Funded Plan

a benefit plan in which the plan sponsor bears the entire risk of utilization. Some plans may be partially self-funded, if the sponsor employs indemnified stop-loss insurance to protect against the risk of unanticipated higher utilization. Third-party administrators may provide claims processing and other administrative services, without bearing any of the risk of utilizatoin of the plan.

Self Insurance

Setting aside of funds by an individual or organization to meet anticipated dental care expenses or its dental care claims, and accumulation of a fund to absord fluctuations in the amount of expenses or claims. The funds set aside accumulated are used to provide dental benefits directly instead of purchasing coverage from an insurance carrier.

Semi-precision attachement

A device or which one component is fixed to an abutment or abutments and the other is integrated into a fixed or removable prosthesis in order to stabilize and/or retain it.

Service Corporations

Dental benefit organizations established under not-for-profit satate statutes for the purpose of providing health care coverage, e.g., delta dental Plans, Blue Cross and Blue Shield Plans.

Sialodochoplasty

Surgical procedure for the repair of a defect and/or restoration of portion of a salivary gland duct.

Sialography

Inspection of the salivary ducts and glands by radiograph after the injection of a radiopaque medium.

Sialolithotomy

Surgical procedure by which a stone within a salivary gland or its duct is removed, either intraorally or extraorally.

Site

A term used to describe a single area, position, or locus. For periodontal procedures, an area of soft tissue recession on a single tooth or an osseous defects in edentulous tooth positions.

Space Maintainer

A passive appliance, usually cemented in place, that holds teeth in position.

Splint

A device used to suport, protect, or immobilize oral structures that have been loosened, replanted, fractured or traumatized. Also refers to devices used in the treatment of temporomandibular joint disorders.

Stp,atotos

Inflammation of the membranes of the mouth.

Stop-loss

A general term referring to that category of coverage that provides insurance protection (reinsurance) to an employer for a self-funded plan.

Stress Breaker

That part of a tooth-borne and/or tissue-borne prosthesis designed to relieve the abutment teeth and their supporting tissues from harmful stresses.

Study Model

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

Supernumerary Teeth

Extra erupted or unerupted teeth that resemble teet of normal shape.

Suture

Stitch used to repair incision or wound.

Table of Allowances

A list of covered services with an assigned dollar amount that represents the total obligation of the plan with respect to payment for such service, but does not necessarily represent the dentist's full fee for that service. also known as schedule of allowances, indemnity schedule.

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

Legislation (Public Law 97-248) affecting health maintenance organizations and te Medicare and Medicaid programs. Provides regulations for the development of HMO risk contracting with the Medicare program and, through amendment, established new provisions for the foundation and operation of peer review organizations.

Temporary Removable Denture

An interim prosthesis designed for use over limited period of time.

Temporomandibular Joint (TMJ)

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

Temporomandibular Joint Dysfunction (TMD)

Abnormal functioning of temporomandibular joint; also refers to symptoms arising in other areas secondary to the dysfunction.

Therapeutic

Of or pertaining to therapy or treatment; beneficial. Therapy has as its goal the elimination or control of a disease or other adnormal state.

Third Party

The party to a dental benefit contract that may collect premiums, assume financial risk, pay claims, and/or provides other administrative services. Also known as administrative agent, carrier, insurer, underwriter.

Third-Party Administrator (TPA)

Claims payer wo assumes responsibility for administering health benefit plans without assuming any financial risk. Some commercial insurance carriers and Blue Cross/Blue Shield plans also have TPA operations to accomodate self-funded employers seeking administrative services only (ASO) contracts.

Third-Party Payer

An organization other than the patient (first party) or health care provider (second party) involved in the financing of personal health services.

Tissue Conditioning

Material intended to be placed in contact with tissues for a limited period, with the aim of assisting the return to a healthy condition.

Title XIX

Portion of the Social Security Act that provides for federal grants to the states for medical assistance programs, commonly known as Medicaid.

Tomography

An X-ray technique that produces a film representing a detailed cross section of tissue structures at a predetermined depth.

Torus

A bony elevation or protuberance of bone.

Tracheotomy

A surgical procedure to create an opening in the tracheo (windpipe) to aid in breathing.

Transitional

Relating to a passage or change from one position, state, phase or concept to another.

Transitional Dentition

Refers to a mixed dentition; begins with the appearance of the permanent first molars and ends with the exfoliation of te deciduous teeth.

Transplantation

Surgical placement of biological material from one site to another.

Transplantation of Tooth

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

Transseptal

Through or across a septum.

Trismus

Restricted ability to open the mouth, usually due to inflammation or fibrosis of te muscles of mastication.

Tuberosity

A protuberance on a bone.

Unerupted

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

Unilateral

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

Upcode

Reporting a more complex and/or higher cost procedure that was actually performed. Also known as overcoding.

Usual,Customary and Reasonable (UCR) Plans

A dental benefit plan that determines benefits based on "Usual, Customary, and Reasonable" fee criteria.

Usual Fee

The fee that an individual dentist most frequently charges for a given dental service.

Utilization

The extent to which the members of a covered group use a prgram over a stated period of time; specifically measured as a percentage determined by dividing the number of covered individuals who submitted one or more claims by the total number of covered individuals. Also, an expression of the number and types of services used by the members of an covered group over a specified period of time.

Utilization Management

A set of techniques used by or on behalf of purchasers of health care benefits to manage the cost of health care prior to its provision by influencing patient care decision-making through case-by-case assessments of the appropriateness of care based on accepted dental practices.

Utilization Review,statistically based

A system that examines the distribution of treatment procedures based on claiums information. In order to be reasonably reliable the application of such claims analyses of specific dentist should include data on type of practice, dentist's experience, socioeconomic characteristics, and geographic location.

Vertical Bitewing

A dental x-ray film with a central projection on which the teeth can close, holding it in a vertical position for the radiographic examination of several upper and lower teeth simultaneously.

Vertical Dimension

The certical height of the face with the teeth in occlusion or acting as stops.

Vestibuloplasty

Any of a series of surgical procedures designed to increase relative alveolar ridge height.

Viral Culture

A collection of specimen for the purpose of incubating a virus for indentification.

Waiting Period

The period between employment or enrollment in a dental program and the date when a covered person becomes eligible for a given benefit.

Wax Pattern

A wax form that is the positive likeness of an object to be fabricated.

Worker's Compensation

A benefit paid to an employee wo suffers a work-related injury or illness.

Xerostomia

Decreased salivary secretion that produces a dry and sometime sburning sensation of the oral mucosa and/or cervical caries.

X-ray

Radiograph .

Yeast

A general term for fungus occuring as unicellular, nucleated organism that usually reproduces by buddin. Some yeasts may reproduce by fission, many producing mycelia or pseudomycelia.

Zygomatic Bone

Quadrangular bone on either side of face that forms the cheek prominence.