Dentists use a lot of special words and phrases to describe parts of the mouth, problems and procedures. Your dentist can explain any term you don’t know, but in the meantime, here are some you can learn about:
Use this guide to familiarize yourself with the terms that you may find in your dental plan and make the most of your benefits.
Annual Maximum: The total dollar amount that a plan will pay for dental care for an individual member or family member (under a family plan) for a specified benefit period, typically a calendar year.
Assignment of Benefits: When a member authorizes the dental plan to forward payment for a covered procedure directly to a member’s dentist.
Balance Billing: When a participating dentist bills a member for amounts indicated as not billable to the patient by Delta Dental. Participating dentists agree to accept the fee approved by Delta Dental as payment in full and cannot bill a member for any difference.
Benefit Year: The 12-month period a member’s dental plan covers, which is not always a calendar year.
Certificate of Coverage: A booklet received from Delta Dental that explains a member’s benefits coverage in detail.
Claim/Claims Form: Information a dentist submits to the dental plan to get paid for services performed for a member. A dentist is responsible for the accuracy of all information on a claim form.
Coinsurance: The percentage of the costs of services paid by the patient. For example, a benefit that is paid at 80% by the plan creates a 20% coinsurance obligation for a member.
Contracted Fee: The fee for each single procedure that a dentist has agreed to accept as payment in full for covered services provided to a member.
Coordination of Benefits (COB): When a member has more than one dental plan, this is the process that the plans use to determine the amount that each will pay.
Copayment: The member’s share of payment for a given service. The copayment is usually expressed as a percentage of a dentist’s contracted fee, but can be expressed as a member’s preset share of payment for a given service.
Covered Service: A dental treatment for which payment is provided under the terms of a member’s dental plan.
Credentialing: A process designed to ensure a dentist is properly trained and licensed to treat members before becoming a part of a Delta Dental network. This includes the review of documentation pertaining to a dentist, including verification of licenses, specialty certification, malpractice insurance, infection control procedures, and OSHA requirements.
Deductible: A dollar amount that each member must pay toward covered services before Delta Dental’s benefits are paid. This is often referred to as the member’s out-of-pocket costs.
Dependents: Anyone other than the primary member that is covered by a dental plan. This could be a child or spouse.
Dual Coverage: When a member has coverage under two different dental plans. Primary and secondary carriers must coordinate the two plans.
Effective Date: The date the coverage under a dental plan begins.
Exclusions: Dental services that are not covered by a dental plan.
Explanation of Benefits (EOB): A paper or electronic document provided by Delta Dental detailing the dental treatments and services that were paid for on a member’s behalf. It is different from a bill.
Group: A company or organization that provides dental plans to its employees. The group works with Delta Dental to select the plan type, maximums, benefit levels, and member eligibility.
Fee Schedule: A list of charges for specific dental treatments used to reimburse dentists on a fee-for-service basis.
HIPAA: the “Health Insurance Portability and Accountability Act of 1996,” a Federal law intended to improve access to health coverage, limit fraud and abuse, protect personal health information, and control administrative costs. See the Administrative Simplification section of the Department of Health and Human Services’ web site for more information at http://aspe.os.dhhs.gove/admnsimp/
In-Network Dentist: A dentist who has agreed to be a part of Delta Dental’s network and accept pre-established fees for his or her professional dental services.
Limitations: Services that are limited or excluded from a dental benefit plan. A member is typically responsible for charges associated with plan limitations. These services are often referred to as optional services.
Lifetime Maximum: The maximum amount a plan will pay over the course of a lifetime. It may apply to an individual or a family and typically applies to specific treatments such as orthodontic treatment
Maximum Plan Allowance (MPA): The amount set by Delta Dental that a Delta Dental Premier dentist has agreed to charge for a service. For Premier dentists, Delta Dental will pay at the MPA or the actual billed amount-whichever is less.
National Provider Identifier (NPI): A unique identification number used to identify a health care professional as an alternative to their dental license number. Under HIPAA, all providers were required to have an NPI by May 23, 2007.
Member: An individual who has signed up for dental coverage from Delta Dental directly or through a Group.
Network: Consists of participating dentists who have signed up with Delta Dental to provide dental treatment within certain administrative guidelines at agreed-upon fees.
Open Enrollment: The period of the year during which employees or qualified individuals can enroll in or make changes to their benefits plan.
Out-of-Network Dentist: A dentist who has not signed up to participate in a Delta Dental network.
Protected Health Information (PHI): Personal information such as medical history, which is required to be stored securely by a health care entity.
Premium: The amount the member pays for dental benefits, which can be paid monthly, quarterly, or annually.
Pre-Treatment Estimate: A treatment plan usually submitted by a dentist for Delta Dental to review and provide an estimate of benefits before treatment starts. This can help a member budget for dental procedures and decide how to proceed with treatment.
Processing Policies: Internally developed policies used as a tool and guide to determine coverage for members. Processing policies are continually reviewed and updated to reflect current information. If a processing policy is applied to a billed serviced, it will be explained in your Explanation of Benefits (EOB).
Termination Date: The date a member’s dental coverage ends or when a member is no longer eligible for benefits.
Waiting Period: A period of time before a member is eligible to receive benefits for all or certain treatments. It typically applies to expensive services such as dentures or crowns.
Throughout the course of your dental health journey, you may find yourself in the care of various dental professionals who differ in background and specialties. Use this guide to better understand the different types of dental health professionals.
Dental Specialist: A dentist who has received postgraduate trainings in one of the recognized dental specialties: endodontics, orthodontics, oral surgery, pediatric dentistry, periodontics, and prosthodontics.
DDS: Doctor of Dental Surgery.
DMD: Doctor of Dental Medicine.
Endodontist: A dental specialist who treats diseases of the pulp and nerve of the tooth.
General Dentist: A primary dental care provider that performs preventive care as well as restorative procedures such as fillings, crowns, implants, and more.
Oral and Maxillofacial Surgeon: A dental specialist who is most commonly known to remove teeth but also treats diseases, injuries, defects, and deformities of the oral and maxillofacial regions.
Orthodontist: A dental specialist who straightens of moves misaligned teeth and/or jaw.
Pediatric Dentist: A dentist who specializes in the diagnosis, treatment, and management of the oral health needs of children.
Periodontist: A dentist who specializes in diagnosing, managing, and treating the tissue, gums, and bone that support the teeth.
Use this guide to gain an understanding of some of the most common dental procedures and treatments.
Abutment: A natural tooth or implanted tooth substitute used to support a removable partial denture or bridge work.
Acid Etching: A process that prepares tooth surface for bonding to fillings or sealants by toughening enamel with a weak acid solution.
Alveoloplasty: A surgical procedure that reshapes the jawbone.
Anesthesia: Medication administered to an individual prior to a procedure with the purpose of dulling pain or sedating the individual. Dentists most commonly use local anesthesia to numb the area where pain is likely to occur without changing the awareness of the individual undergoing the procedure.
Apicoectomy: A minor surgical procedure that removes the apex, or top, of the root of a tooth.
Band: A metal ring cemented around a tooth as part of orthodontic treatment. Bands can hold various attachments used to assist with tooth movement and alignment.
Basic Cleaning: A routine professional teeth cleaning to remove plaque build-up, tarter, and stains. This is a regularly scheduled preventative treatment for individuals with healthy gum tissue.
Biopsy: The process of removing tissue for histologic evaluation, an important tool in the accurate diagnosis of cancer and other diseases.
Bleaching: A cosmetic procedure that whitens teeth with a bleaching solution.
Bonding: A procedure in which a tooth-colored plastic material is applied with a special light, and ultimately “bonds” the material to the tooth to improve a person’s smile.
Bridge: An appliance that replaces missing teeth by securely attaching an artificial tooth to the natural teeth. This is also known as a fixed partial denture.
Cement Base: Material sometimes used to replace a missing tooth structure.
Composite: A filling material used to repair teeth. The most common type of filling.
Crown: A cover that is put over a tooth to help restore the tooth's normal shape, size, and function. These are typically applied when individuals have a cavity too large for filling, a cracked or weakened tooth, or want to conceal a discolored or poorly shaped tooth.
Crown Lengthening: A surgical procedure that recontours gum tissue, and sometimes bone, to expose more of the tooth for a crown.
Dental Prophylaxis: A scaling and polishing procedure used to remove plaque and stains.
Dental Prosthesis: An artificial device that replaces missing teeth.
Debridement: A procedure for removing calculus (tartar) and plaque.
Excision: The surgical removal of bone or tissue.
Extraction: The act of removing a tooth or portions of a tooth.
Fluoride Varnish: A liquid containing fluoride that is painted onto the teeth and hardens. It is used to prevent or reduce the risk of cavities.
Full-Mouth X-Ray: The combination of 14 or more periapical and bitewing films of the back teeth that reveals all of the teeth including the crowns, roots, and alveolar bone.
Gingivectomy: A surgical procedure for removing gingiva (gum tissue) in order to restore gum health.
Gingivoplasty: A surgical procedure for reshaping gingiva (gum tissue).
Graft: A piece of tissue or alloplastic material placed in contact with tissue in order to repair a deficiency.
Immediate Denture: A prosthesis constructed and placed immediately after the removal of natural teeth.
Implant: A device placed within or on the bone of the jaw or skull to support either a crown, bridge, denture, facial prosthesis, or to act as an orthodontic anchor.
Mouthguard: A removable plastic device worn over teeth and gums to protect from damage during sports.
Nightguard: A removable device worn over teeth at night to protect from damage due to clenching or bruxism.
Operculectomy: A procedure that removes the flap of tissue over an unerupted or partially erupted tooth.
Overdenture: A removable prosthetic device that covers and rests on one or more natural teeth, the roots of natural teeth, and/or dental implants.
Partial Denture: A prosthetic device used to replace missing teeth.
Preventative Dentistry: Procedures and services administered to prevent oral diseases.
Prophylaxis: A dental cleaning that consists of the removal of plaque, stains, and calculus by scaling and polishing.
Pulpectomy: A procedure that removes diseased pulp tissue.
Radiograph: An image produced by projecting radiation. Also called an X-ray.
Reline: A procedure used to resurface the side of a denture that is not in contact with the soft tissue of the mouth to ensure a secure fit.
Removable Partial Denture (Removable Bridge): A prosthetic replacement used to replace missing teeth. This device can be removed by the individual.
Retainer: A removable device worn in the mouth to prevent teeth from shifting. These devices can be fixed or removable.
Root Planing: A procedure performed on tooth roots to remove dentin, bacteria, calculus, and diseased surfaces.
Scaling: The removal of plaque, calculus, and staining from teeth.
Sealants: Plastic resin placed on the biting surfaces of molars in order to prevent bacteria from attacking the enamel.
Suture: A stitch used to repair an incision or wound.
Temporary Removable Denture: An interim prosthesis designed to be used for a limited period of time.
Veneer: Thin coverings placed over the front part of teeth made to look like natural teeth.
Do you want to better understand the areas of the mouth that your dentists are referring to when you're in the office? Use this guide to learn the most common terms.
Alveolar Bone: The bone structure that contains tooth sockets and supports the teeth.
Anatomical Crown: The visible part of a natural tooth covered by enamel.
Arch: An upper or lower denture.
Bicuspid: A premolar tooth or a tooth with two cusps.
Buccal: The cheek area.
Cementum: Hard connective tissue covering the tooth root.
Cusp: The pointed portion of the tooth.
Cuspid: A tooth with one cusp located between the incisors and premolars. It is also known as a canine tooth.
Deciduous Teeth: The first set of teeth a child gets, also known as primary teeth or baby teeth. There are 20 deciduous teeth which are usually all in place around age 2.
Dentin: The portion of the tooth found beneath the enamel and cementum. A hard, calcified material that makes up the bulk of the tooth.
Enamel: Hard calcified tissue covering dentin on the crown of the tooth.
Gingiva: Soft tissues that lay over the crowns of unerupted teeth, also known as gum tissue.
Interproximal: Between the teeth.
Intraoral: Inside the mouth.
Labial: The area of or around the lip.
Lingual: Of or near the tongue.
Lingual Surface: The side of the tooth facing the tongue.
Mandible: The lower jaw.
Maxilla: The upper jaw.
Molar: The teeth that are posterior to the premolars on either side of the jaw and have broad chewing surfaces.
Occlusal: The relationship between the upper and lower teeth as they come in contact with each other.
Operculum: A flap of gingival tissue over the crown of an erupting tooth.
Oral: Of the mouth.
Palate: The hard and soft tissue formed at the roof of the mouth that separates the oral and nasal cavities.
Pulp: Connective tissue containing nerve tissue and blood vessels that occupy the pulp cavity inside of the tooth.
Quadrant: One of the four equal sections in which the dental arches are divided, typically referred to as the upper and lower right and upper and lower left quadrants.
Root: The portion of the tooth that is located in the socket which is attached by the periodontal apparatus.
Root Canal: The chamber within the root of the tooth that contains pulp.
Sublingual: Under the tongue.
Submandibular Glands: Salivary glands located beneath the tongue.
Temporomandibular Joint (TMJ): The connecting hinge between the base of the skull and the lower jaw.
Unerupted: Teeth that have not penetrated into the oral cavity.
Wisdom Teeth: The last teeth to come in during the mid to late teenage years. They are also called third molars.
Developing a dental condition is common. Below is a list of the most regularly diagnosed dental conditions so that if problems do arise, you have somewhere to look for guidance, and can seek the treatment you need.
Abscess: Localized buildup of pus in an area of infection, usually around the tooth or in the gums, that can ultimately destroy oral tissue.
Abrasion: Tooth wear caused by forces other than chewing such as improper brushing or holding objects between the teeth.
Avulsion: When a tooth is knocked out of its socket due to trauma.
Bone Loss: A decrease in the amount of bone that supports a tooth or implant.
Bruxism: An unconscious habit of grinding or clenching the teeth.
Calculus: A hard deposit of mineralized material sticking to the crowns and/or roots of teeth. This substance cannot be brushed off and is removed during a professional cleaning
Caries: Tooth decay. Tooth surfaces are slowly destroyed by acid-producing bacteria.
Cavity: An area of the tooth that is damaged by caries, abrasion, or erosion.
Cleft Palate: A birth defect that occurs when the tissues that make up the roof of the mouth do not join together completely.
Decay: The decomposition of the tooth structure.
Dry Mouth: A condition caused by lack of saliva and moisture in the mouth. If untreated, it can lead to increased levels of tooth decay and infections.
Dry Socket: Severe pain inside and around the tooth socket which can occur one to three days after a tooth extraction. This issue usually requires post-operative care.
Erosion: The wearing down of tooth structure, caused by chemicals and acid.
Fracture: The breaking of a tooth.
Gingivitis: Inflammation of gingival tissue.
Impacted Tooth: A partially erupted tooth positioned against another tooth, bone, or soft tissue, making complete eruption unlikely.
Lesion: An area of diseased tissue.
Malocclusion: Improper alignment of the upper and lower teeth.
Peri-implantitis: An infection that develops around an implant which can lead to bone loss.
Periodontal Abscess: An infection of the gum pocket that can destroy soft and hard tissues.
Periodontitis: The inflammation and loss of the connective tissue of the supporting structure of teeth.
Plaque: A soft and sticky substance that builds up on teeth due to bacteria buildup.
Pulpitis: Inflammation of the dental pulp.
Recession: When the gums pull away from the teeth, often exposing the root.
Looking for more information or looking for individual dental insurance? Brush up on more dental terminology:
If you have additional questions or require further support, contact your dentist or connect with your local Delta Dental.
American Dental Association – Glossary
Journal of Prosthetic Dentistry – Glossary of Prosthodontic Terms – Ninth Edition – 2017
American Academy of Periodontology – Glossary of periodontal terms