Question: I have a dental PPO plan I got through my job. I need help understanding how my dental insurance states my coverages are one thing, but the numbers do not add up when a claim is filed. For example, I had a large filling and a crown not long ago. The filling coverages were to be at 80% paid. Which it was, so that was fine. However, the crown I got cost $1000.00, and my plan said that it paid out 50% of the cost of a crown. Straight forward math right, I should only have to pay $500.00, which was my co-payment of 50%. I then got the billing from the dental office stating the insurance company only paid $450.00, so my cost is $550.00. It is only $50.00 more, but this happens quite often. What should I do about this? 

Answer: In general, PPO plans to pay out a percentage of 80% for essential services such as fillings and 50% for major services such as crowns. But it does not just stop there. Usually, they will state that the percentage paid out is up to UCR (Usual, Customary, and Reasonable). Therefore, if the dentist you are going to is above the UCR rate for the company, you will have an additional charge. Also, some PPO plans will have two sets of coverage, one for network dentists and another for outside-network dentists. Outside-network dentists usually will have fewer benefits than inside-network providers. As to why you are paying more, I could not say which is the case for you. That will be something you should call your plan’s member services for. They can review your benefits and directly answer what is affecting your cost on claims. However, here is a tip you may want to keep in mind. Before starting any dental services, have your dental office submit to your insurance company as a quote only. That way, you will know the actual cost of dental care without worrying about additional expenses.

Question: I am 52 and have been fighting for years to keep my teeth. After years of having major dental services dealing with dental pain all the time and not counting the expense, I am tired of it all. I am considering pulling the teeth I have left and getting complete dentures. The dentist I am going to now does not want to pull my teeth, saying they do not need to be pulled and I should continue having dental care for them. Sure, once they’re pulled and I get dentures, there will be no more dental bills. I am looking for a dental insurance plan to let me have dentures if that is what I want and not say it is elective and not cover them. Please advise. 

Answer: I suggest reviewing dental discount plans. You would want the flexibility that a dental discount plan gives you. With a dental discount plan, your dental services will be up to you and the dentist within the plan. The company does not state what you can or can not have done. 

You get discounted savings for all your dental needs when the services are rendered. If you want dentures, you pay only the discounted cost for them as listed on the fee schedule. You would need to find a dentist in the plan willing to pull out teeth that may not have to be pulled. So make phone calls and ensure you have a dentist in the plan to work with you and your needs.

Also, here is something to think about. Even if you have complete dentures, you must see a dentist regularly for check-ups to ensure that your gums and mouth are healthy. Dentists can also evaluate the fit and function of your dentures and make any necessary adjustments. Additionally, regular dental check-ups can help detect potential oral health issues before they become more serious problems.

Your family oral health care is essential to maintain as your oral health has direct links to your overall health wellness. Therefore, a few ways to keep your and your family’s oral health are good at-home oral health care habits and seeing your dentist regularly. Studies also show that families that have dental insurance in place are more likely to see their family dentist regularly. In addition, dental insurance helps keep your family’s dental care costs lower and more affordable.

Regarding dental insurance for healthy families, it’s important to look for preventive care plans, such as regular cleanings, x-rays, and check-ups. Additionally, plans that cover orthodontia and basic and major restorative services can be beneficial for families with children who may need braces or other dental work. 

It’s also important to consider the network of providers available under a plan and any waiting periods or deductibles that may apply. By carefully evaluating the options and choosing a plan that meets your family’s needs, you can ensure everyone has access to the dental care they need to maintain good oral health.

You can call our member service line at 310-534-3444. Our team of experts can explain each plan’s various options and benefits and help you select the one that best fits your needs and budget.

It is essential to understand that your dental health starts at home.

Maintaining good oral hygiene is essential for having healthy teeth and gums. Here are some tips to help you achieve and maintain healthy teeth and gums:

1.  Brush your teeth twice a day: Brush your teeth at least twice a day with fluoride toothpaste to remove plaque and prevent cavities.
2. Floss daily: Flossing helps remove food particles and plaque between your teeth and the gum line.
3. Mouthwash: Use an antiseptic mouthwash to kill bacteria and freshen your breath.
4. Limit sugary and acidic foods: Sugary and acidic foods can erode tooth enamel and cause cavities. Limit your intake of these foods and drinks.
5.  Drink water: Drinking water after meals helps wash away food debris and prevent dry mouth, which can lead to bad breath and tooth decay.
6. Visit your dentist regularly: Regular dental checkups and cleanings are essential for maintaining healthy teeth and gums. Your dentist can detect and treat any dental problems early on.

By following these tips, you can have healthy teeth and gums and maintain good oral hygiene.

Early Childhood Cavities Prevention: Early Childhood Cavities, which includes Baby Bottle Tooth Decay, is an infectious disease that can be prevented. By ages 12 to 19, 23% of children from low-income families have untreated cavities in their permanent teeth, twice that of children from higher-income households.

Early Childhood Cavities Prevention (ECCP) is a nationwide campaign to increase awareness about the importance of preventive oral health care in infants’ first years.

Baby Bottle Tooth Decay: Preventing dental disease is never too early. Primary (baby) teeth are important because they act as placeholders for permanent teeth and aid in proper speech development, nutrition, and self-esteem. Cavities can occur in children less than a year old.

What is BBTD: BBTD, or Baby Bottle Tooth Decay, is a dental condition that can occur in young children when their teeth are consistently exposed to sugary drinks, such as milk or juice, especially at bedtime. The sugars in these drinks can cause decay and cavities in young children’s teeth, leading to pain, infection, and the need for dental work to repair the damage. It is important to avoid giving sugary drinks to young children at bedtime and encourage them to drink water instead. Additionally, it is important to establish good dental hygiene habits early on, such as brushing and flossing regularly and scheduling regular check-ups with a dentist.

How can you tell if your baby has dental caries?

I have a 14-month-old son, and his teeth are in good shape. I know this because we just came back from his dentist. However, in the waiting room, I heard the dentist talking to another mother and telling her that her baby had dental caries. My understanding of carries is limited, but it is terrible tooth decay. The mother said she did not see any signs of her baby’s teeth being bad.

So, are there signs? Or can your child be ok one day and have carries the next? I did not want to ask my dentist since I did not want him to know I heard him talking to the other lady. Any information would be good.

Reply: Dental caries, or tooth decay, can sometimes be challenging to detect in its early stages. However, here are a few signs that your child may have dental caries:

1. Discolored spots or white, brown, or black spots on the teeth

2. Sensitivity to hot or cold temperatures or sugary foods

3. Pain or discomfort in the teeth or gums

4. Bad breath

5. Difficulty eating or chewing

It’s important to note that dental caries may not show any signs or symptoms, so it’s important to take your child to the dentist regularly for checkups. The dentist can detect any early signs of tooth decay and provide treatment before it progresses.

My dentist stated that I would need to pull a tooth and that my back tooth was too damaged for a crown. I never had a tooth pulled, so I am a little worried. Will it hurt? What type of care do I need to have afterward? 

Reply: Feeling apprehensive about a tooth extraction is natural, especially if it’s your first time. However, the procedure is generally safe and routine and should not cause significant concern. The dentist will usually numb the area around the tooth before extracting it, so you should not feel any pain during the procedure. Afterward, you may experience discomfort or swelling, but this can be managed with over-the-counter pain medication and ice packs.

To ensure a smooth recovery, following the aftercare instructions provided by your dentist is essential. This may include avoiding certain foods and drinks, taking prescribed medication, and cleaning the extraction site. If you have any concerns or questions, be sure to contact your dentist for clarification and guidance. They are there to help you through the process and ensure a positive dental experience.

My daughter already has two cavities. I am still determining why I have her brush her teeth after breakfast and dinner. Although they are her baby teeth, I do not want her to continue getting cavities. What should I do about this? The dentist says to have her floss more. The truth is, right now, she does not floss. Getting her to brush is hard enough.

Does anyone advise on how to get her to floss?

Reply: Taking care of our teeth from a young age is essential to avoid dental problems later in life. Flossing is one of the best ways to prevent cavities, but getting children to do it regularly can be challenging. Here are a few tips that may help.

1. Make it fun: Encourage your child to floss by making it a fun activity. Play their favorite music or sing a song while they floss.

2. Use the right tools: Choose a floss appropriate for your child’s teeth. You can use a floss pick or a flosser that is designed for children.

3. Be gentle: Teach your child to be gentle when flossing. Flossing too aggressively can damage the gums.

4. Start early: It is recommended to start flossing your child’s teeth when they have two teeth that touch.

5. Lead by example: Show your child how to floss by doing it yourself. Children often learn by watching others.

6. Make it a routine: Incorporate flossing into your child’s child’s routine. Make it a habit so they continue to floss as they grow older.

Remember always to supervise your child while they floss to ensure they do it correctly. If you have any concerns, consult your child’s child for further advice.

When a baby cuts a tooth, can that tooth come through rotten? My friend’s baby is just getting her teeth in, and her teeth are already getting nasty. She does not know why this is happening. Can her baby just be born with bad teeth? If so, can they be fixed? I want to get her some information that may be helpful to her.

Reply: This may be useful if your friend asks for help finding information. A baby’s teeth can come in rotten, but it is uncommon. Most often, this is due to poor oral hygiene and bacteria buildup on the teeth. If your friend’s baby is experiencing this issue, she must take the baby to a pediatric dentist as soon as possible. The dentist can assess the situation and recommend the best course of action.

Sometimes, the baby’s teeth may need to be extracted and replaced with dental implants or crowns. Other times, a simple cleaning and improved oral care routine may be enough to fix the problem. Regardless of the solution, your friend must act quickly to prevent further decay and damage to her baby’s teeth.

Aside from poor oral hygiene and bacteria buildup, there are other reasons why a baby may have dental decay on incoming baby teeth. One of the common reasons is the consumption of sugary foods or drinks, which can lead to tooth decay. Additionally, some medications can cause dry mouth, leading to a higher risk of cavities. Another reason could be a lack of fluoride in the water or toothpaste, essential for strong and healthy teeth. Moreover, certain medical conditions or genetic factors may also contribute to dental decay. It is necessary to consult a pediatric dentist to determine the underlying cause of the problem and receive appropriate treatment.

My baby daughter’s teeth are just coming in, but they look yellow, which concerns me. I have started brushing her teeth daily, but the yellow does not seem to go away. My question is, do most babies have yellow teeth when they start coming in and turn white? 

Reply:  It is important to note that the yellowish tint on your baby’s teeth may be caused by various factors such as poor oral hygiene, medications, or even genetics. Regular brushing of your baby’s teeth is a good start, but it is also recommended to avoid giving sugary drinks or foods that can lead to tooth decay.

In addition, taking your baby to a pediatric dentist can help identify potential dental issues early on. The dentist can also advise properly caring for your baby’s teeth and gums and recommend any necessary treatments.

Overall, while it is common for baby teeth to appear yellow when they first come in, it is fessential to prioritize your baby’s dental health and seek professional advice when needed.