Having insurance to cover dental procedures you need or want can sometimes be challenging. As far as cosmetic dental procedures are concerned, things may be even more intricate. Even though insurance covers some cosmetic dental procedures, not all are.
Dental insurance plans generally focus on procedures considered medically necessary. This is contrary to cosmetic procedures—those that do not confer any medical benefits apart from enhanced tooth appearance. Of course, this does not imply that cosmetic dental treatments are not worth it. Not all insurance plans cover dental health. Fortunately, dental insurance can cover specific cosmetic procedures based on the particular plan.
Dental Procedures Considered Cosmetic
The most prevalent cosmetic dental procedures include the following:
- Gum contouring—removing excessive soft tissues that can cover parts of the teeth.
- Tooth shaping—modifying or adjusting the tooth’s shape to make it appear nicer, often by filing.
- Dental veneers—these are artificial covers for the visible teeth surfaces, usually porcelain-made.
- Teeth whitening—the chemical treatment of teeth that removes discoloration and stains.
Some dental insurance plans do not offer coverage for cosmetic dental procedures altogether, whereas others might lower your out-of-pocket costs without paying for the entire procedure. Dental Plus insurance plans are specialized plans that offer enhanced coverage, often including cosmetic dentistry.
Will Insurance Cover Cosmetic Dental Procedures?
To answer this question effectively, you must know whether a particular cosmetic procedure is restorative or elective.
Some Cosmetic Dental Procedures Are Restorative In Nature
Restorative dental procedures are virtually always covered by dental insurance. Restorations include things like crowns and fillings. It could also include dental implants based on the specific dental plan. A restorative dental procedure can be conducted in an aesthetically pleasing way, therefore constituting a crucial part of a smile makeover.
Porcelain crowns and composite fillings, for example, restore and safeguard teeth. However, they are also made of cosmetically pleasing material that improves tooth appearance afterward. Irrespective, they are a critical procedure utilized to achieve the best level of oral health.
Whenever your dental professional utilizes white dental restorations because of a physical injury to the teeth, chances are high that the treatment will be covered by dental insurance.
When Cosmetic Dental Procedures Are Elective
Elective dental procedures are procedures you opt to undergo, even if you do not need them for health reasons. For example, if your teeth are disease- or decay-free, but you do not like how they look, having the dentist enhance them would be considered an elective dental procedure.
Usually, dental insurance does not cover elective dental procedures. Some prevalent examples include teeth whitening and cosmetic veneers. However, there are exceptions to this rule. It could be that you have an irregularity on your front teeth that must be repaired, but a crown would be too aggressive on the entire tooth structure. Cosmetic bonding or veneers would be minimally invasive and act as a restorative dental procedure. Your dental professional may have to give photographs, X-rays, and notes to the dental insurer so they can cover the treatment.
Procedures Generally Covered By Insurance
Several dental procedures are considered cosmetic and restorative simultaneously and, therefore, are covered by insurance. If a procedure is conducted because it will positively impact the function and health of the jaw, gums, and teeth, insurance will likely pay for it. On the contrary, if a cosmetic procedure is conducted mainly to enhance a patient's smile, it will likely be deemed purely cosmetic, and dental insurance will not pay for it.
Usually, a patient can lose a tooth because of an accident or decay. When this occurs, their smile's aesthetic appearance is impacted, as is the mouth's functionality. Put otherwise; when a space is left where a tooth used to be, a patient might be less effective at eating, speaking, or chewing. Losing a tooth could also adversely affect a patient's general health.
A missing tooth could also damage the integrity of the jawbone underlying it. Should you lose your tooth, the jawbone beneath the area where the tooth was will start deteriorating and weakening. A patient will also often experience problems with their bite due to missing teeth. When gaps are present in teeth, the correct alignment will be lost, which could have significant health consequences regarding the patient’s capability to speak and eat.
Dental procedures that may be deemed cosmetic but also play a significant role in a patient's health include dental bridges, implants, fillings, and crowns.
Dental Implants
Dental implants are placed to replace missing teeth with human-made ones that look natural and restore a patient's complete smile so they can have full confidence. The artificial tooth (crown) is fixed to the bone by a small titanium post. The human-made tooth could be replaceable or permanent.
Implants are virtually indistinguishable from the adjacent original teeth. After the supporting tissue and bone fuse to the dental implant, they will be permanently secured in place.
Apart from filling in gaps, implants also assist in preserving the bone tissues in your jawbone, which may prevent you from losing more teeth with time.
You want to practice proper hygiene during the dental implant placement period and after the procedure ends to remove food debris and plaque from the site.
Dental Crowns
Dental crowns enhance a smile's appearance by covering up a decayed or damaged tooth with a natural-looking cap customized to resemble the surrounding tooth enamel’s color. They are generally an option when a tooth is severely weakened or decayed. Dental crowns are custom-made to resemble the color and shape of the natural teeth, enhancing tooth function and appearance.
Dental Bridges
The dental bridge placement procedure involves pontics (prosthetic teeth) being secured to the surrounding dental implants or natural teeth to replace missing teeth. Apart from enhancing tooth functionality, dental bridges improve a patient's smile.
Dental Fillings
Dental fillings are malleable materials used for filling holes in teeth. The procedure prevents cavity progression after tooth removal, restoring function. Therefore, apart from filling a cosmetic procedure, they are also considered restorative and, hence, covered by insurance.
Often, a hole develops on the outer part of the tooth because of trauma or a cavity. Thus, it must be filled to stop it from worsening, resulting in bacteria buildup that can spread to the internal part of the tooth. Should the cavity spread up to the interior part of the tooth, it may necessitate a more invasive procedure, like a root canal.
Determining whether you require dental fillings is easy. Once you begin experiencing tooth sensitivity to hot or cold drinks or foods at the same part of the tooth, it may be a strong sign that you require dental fillings. You may also have to undergo dental filling treatment if you feel pain whenever biting or realize the tooth is fractured, chipped, or rough.
Once you see a dental professional for a dental filling, they will examine the tooth to establish what has caused the issue and, if need be, take X-ray images. Before starting the filling procedure, the dental professional will administer local anesthesia, numbing your tooth. They will drill and extract the decayed material. This process often takes only minutes.
Once the procedure is over, the tooth will remain numb for some more hours. You may not experience significant risks, but you want to contact your dentist soon if you have any complications.
Inlays and Onlays
Inlays and onlays are also called indirect fillings. They are an option when a tooth has moderate to mild decay or inadequate tooth structure to support dental fillings. Inlays are placed directly on tooth surfaces if the tooth cusps are not damaged. But when the cusp or a more substantial part of the tooth is damaged, your dental professional may utilize an onlay to conceal the tooth’s whole surface.
Onlays and inlays were conventionally made of gold. However, generally, they are made from a composite of ceramic or porcelain material in a dental lab and fixed to teeth using adhesive dental cement. Inlays and onlays provide support, strengthening teeth, restoring their shape, and avoiding further deterioration or decay.
Several cosmetic dentists indeed perform these procedures. Apart from the cosmetic aspects of what the procedures offer, there are health benefits that usually motivate dental insurers to cover them. It is not unusual for insurance to cover crowns, bridges, and implants based on the specific reason why a patient is having the procedures conducted.
If you are unsure whether a given cosmetic dental procedure will be paid for by insurance, consult your insurer or dental professional before starting treatment. Determine what procedures your insurer covers and inquire whether specific circumstances would make the involved procedure restorative instead of elective. If the procedure you wish to undergo receives coverage, then this is the best time to undergo that procedure eventually.
Dental Procedures Not Covered Under Insurance
If you have a dental procedure and are wondering about what your dental insurer covers and does not cover, then you may first need to know what dental procedures are cosmetic and what are restorative or medically necessary. In certain cases, the answer to this concern is straightforward, while others have gray areas. Put otherwise; some dental procedures considered cosmetic for a patient in a specific situation might not be cosmetic for a patient in a different situation.
Even though a particular procedure might not enhance a patient's look, it might also critically contribute to their overall health. These are kinds of procedures that insurance might cover even if they significantly enhance the patient's appearance.
Teeth Whitening
The whitening or bleaching of teeth is a prevalent procedure that is always deemed cosmetic. It can be adopted at home with over-the-counter (OVC) whitening products and in the office. Teeth whitening could be achieved through any of these methods:
- Toothpaste combined with teeth-whitening ingredients.
- Bleaching trays or strips.
- Bleaching with the assistance of LED light.
- Laser whitening.
This procedure is deemed purely cosmetic because it only enhances a smile's aesthetic appearance. Tooth whiteness does not do any job or enhance a patient's health. Instead, it enhanced a patient's cosmetic look. Therefore, the teeth whitening procedure is always deemed a purely cosmetic procedure. If you wish to undergo it, you should be ready to pay for the cost from your pocket. Insurance will not reimburse you for teeth whitening.
The Snap-On Smile
The Snap-On Smile is another dental procedure that is purely cosmetic when talking about insurance coverage. The Snap-On Smile is a dental plate worn every time on the upper or lower arches, even when drinking or eating, and it is used to assist patients in dealing with missing, crooked, stained, or chipped teeth. It does not enhance tooth functionality and is thus deemed a cosmetic procedure not covered by insurance.
Dental Bonding
Another cosmetic dental procedure is dental bonding, performed to enhance the appearance of gapped, uneven, or smaller-than-other teeth. This dental procedure is not covered by insurance because it conceals aesthetic problems and makes the teeth look better. Generally, it does not enhance tooth functionality, so it is not deemed restorative.
The dental bonding procedure involves the dental professional drilling out the tooth decay. Then, the dentist will apply the composite material to the tooth’s surface, sculpt it into the correct shape, and cure it using a higher-intensity light. Dental bonding effectively conceals the tooth’s problem, making it appear healthy. It is among the least costly cosmetic dental procedures.
Although dental bonding is considered purely cosmetic, it may be conducted to fix structural problems like cracked, damaged, chipped, or decayed teeth. In this case, insurance may cover the cost of the procedure.
Dental Braces
Most patients wonder whether dental braces are deemed restorative, but unfortunately, they are considered purely cosmetic. Indeed, dental braces can significantly enhance teeth function and health. However, insurers still do not pay for this form of treatment. This could be because patients generally place dental braces to enhance their aesthetic appearance instead of improving their health. In any case, such orthodontic procedures are generally not covered under insurance.
Dental Veneers
Veneers are artificial coverings fixed to the front surface of a tooth to enhance its appearance while keeping its appearance natural. These coverings are very thin and made from different materials. Their primary function is to enhance the appearance of teeth that cannot be otherwise enhanced. Veneers may alter the tooth's size, shape, or color to match the natural teeth in the patient's mouth. They may be resin- or porcelain-made.
Veneers are usually an entirely elective procedure. However, if the tooth has worn down, dental veneer placement can assist in repairing the tooth structure and preventing further damage. Insurance usually pays for the treatment when veneers are placed to repair the tooth structure and prevent further damage.
Gum Contouring or Gingival Sculpting
Gums play an essential role in smile aesthetics. Gum contouring, or gingival sculpting, reshapes the gum line to achieve an aesthetically pleasing and more balanced smile. It is usually conducted to address uneven gum lines or gummy smiles.
Gingival sculpting is generally not covered under insurance. However, this procedure is not always purely cosmetic. Certain cases require the procedure to be conducted for a patient's gum disease treatment.
What to Do If Your Plan Does Not Cover a Cosmetic Dental Procedure
If you wish to undergo a certain cosmetic dental procedure but your plan does not cover it, you can follow any of the following steps:
- Firstly, discuss the lack of dental coverage with your dental professional to see whether you can receive a negotiated rate that will be affordable.
- Secondly, you could compare various insurance plans available in your area to determine whether any cover the cosmetic procedure you wish to undergo.
- Thirdly, if no insurance plan covers the procedure you wish to undergo, explore an affordable discount dental program to determine whether your desired treatment is one of the services you can receive at a discounted rate from a participating dentist.
- Lastly, if the above three options do not work, you could delay the cosmetic procedure while saving for its treatment cost.
How Dental Insurance Plans Work
Regardless of your dental insurance provider, most dental insurance plans pay a percentage of the cost of procedures that are medically necessary or preventive. Cleanings and check-ups, which can prevent you from catching gum disease or cavities, might be fully covered twice a year. Insurance may cover dental fillings, crowns, or other procedures that correct damaged teeth by fifty to eighty percent.
It is worth repeating that insurance may not cover most cosmetic dental procedures because they are elective, meaning they are not necessary for your dental and oral health. You could have a healthy smile that will last you a lifetime without a cosmetic procedure, such as porcelain veneers or teeth whitening.
Find a Professional Cosmetic Dental Professional Near Me
Before budgeting for a cosmetic procedure, you want to know whether insurance will help you pay for it or if you need to pay for everything out of your pocket. Knowing this information will help you better plan treatment that meets your needs without compromising. The best person to ask about insurance coverage for cosmetic procedures is your cosmetic dentist.
At Tarzana Dental Care, we strive to ensure parents walk out of our facility with attractive smiles. If you seek information regarding insurance coverage for a particular cosmetic procedure or wish to undergo any of the procedures, contact us at 818-708-3232 for a dental examination.