I can’t begin to tell you how many times in my career as a dental hygienist I have been asked this question. However, I totally understand why people ask it. Dentistry and insurance can be confusing, a lot of health/ medical things can be. I can help explain it so you will have a better understanding of what’s happening at your next dental appointment.

Whoo hoo! You finally got dental insurance and you’re going to the dentist!

(Well, maybe you aren’t that excited but you know it’s something you need to do.)



Here is a common scenario for a lot of people. You finally get a job that offers dental coverage and you are so excited because the plan covers two dental cleanings a year! Finally, you can go to the dentist after several years of not going and get your teeth cleaned for “free”. You make your appointment , the hygienist takes x-rays and then she/he, along with the dentist, informs you that you can not have the “free” cleaning that your insurance said you could. They say that you require a “deep cleaning”. Now you’re angry at the dentist and the hygienist. You are sure they are pulling one over on you. Now you have to pay more out of pocket for this other cleaning. You wonder to yourself “What is going on?”

What is a “regular cleaning”?

Let me explain. Your dental insurance doesn’t care know or care what the condition of your mouth is in when they offer you this policy. They know if you read “two free cleanings a year” listed in the benefit schedule you are going to be persuaded to purchase the plan. In order to qualify for a “regular cleaning”, what is known as a dental prophylaxis in the world of dentistry, you must have healthy gums and bone surrounding your teeth. You also should have minimal tartar build- up.

DENTAL PROPHYLAXIS = prevention

The reason it is called a Dental Prophylaxis is because the word prophylaxis means “to prevent disease”. If you’re lucky and have a combination of good genetics and good home care you may qualify for a prophylaxis only. You can not have this cleaning if you already have a form of dental disease. At this point, we are past preventing gum disease ( hence the word prophylaxis) since you are already showing signs of the disease. Now we are at the point where the disease needs to be treated. You may not even realize your gums and bones are in this condition. Gum disease is often silent and some only see a little bit of bleeding here and there when brushing or flossing.

What is Gingivitis?

The beginning of gum disease is Gingivitis. Gingivitis is simply swollen and bleeding gums where only soft tissues are affected. Gingivitis is reversible by seeing your hygienist regularly for cleanings. It can also be prevented by using proper brushing (preferably a sonic toothbrush) and flossing techniques. The reason gingivitis occurs is because the plaque and tartar build-up sit at or below the gum-line. This causes irritation to the tissues. Depending on the severity and if it is mild or localized, your hygienist may still be able to remove the build-up in the amount time provided.

GINGIVITIS TREATMENT

The goal is to keep you comfortable and still allow the procedure to be filed to your insurance as a prophylaxis. The plan from here is for you to return every 6 months to repeat. If the build-up is too excessive and she/he needs extra time removing it, then you may need to return in a couple of weeks for a second cleaning. Usually, the first cleaning will not be completely covered by your insurance. Often times this first cleaning is referred to as a Full Debridement.

Periodontal Disease

The next step in gum disease is Periodontal Disease. Periodontal Disease is when the disease has moved beyond the gums. The infection has now started to deteriorate the bone, under your gums, that hold the teeth in.

PERIODONTAL PROBING

You know when the hygienist is going around with that tiny probe and gently poking your gums and calling out numbers like “3, 4, 4 – 4,5,5”? That is what she/he is doing to determine if you have bone loss under your gums. These are millimeter measurements that are being charted in your file. The hygienist and dentist use periodontal probings and dental x-rays to diagnose periodontal disease. If they determine you are at any of the stages of this disease they will most likely recommend a deep cleaning for you. This is called “Scaling & Root Planing”.

SCALING & ROOT PLANNING

Those probing depths usually will extend beyond 4 mm’s. You will need to be numbed in order to remain comfortable during the procedure. Usually, the procedure is broken up into several appointments. One quadrant of four of the mouth (upper left, lower right, etc) is cleaned at a time.

PERIODONTAL MAINTENANCE

After the series of cleanings, you may be placed on a 3-4 month interval cleaning schedule. This is so the hygienist can help maintain the bone level where it is. This will help prevent the current bone disease from progressing. These maintenance cleanings will now be considered Periodontal Maintenance. Your insurance will probably only cover a portion of the fee each visit. However, some insurance companies have begun to cover these type of cleanings more over the past years. If your periodontal disease is at an advanced stage you may be referred to a periodontist for more invasive procedures. Such as surgical bone grafting. (not as scary as it sounds)

DO WHAT BENEFITS YOU

So, to summarize. Your dental hygienist and dentist aren’t actually the ones that decide the type of cleaning you will have. The condition of YOUR gums and YOUR bone level is what’s doing the deciding. They are only translating the condition of those gums to you. So, I hope you are better able to understand if you are told you can not have the “regular” cleaning your insurance promises. That cleaning isn’t the one that will benefit you. That cleaning is for people who’s pockets are around 3mm and below. Would you really want the hygienist to just clean 3mm’s deep on a 6mm pocket? This would be leaving all that buildup and infection below, just so you could get the cleaning for free? I’m sure you wouldn’t and a good ethical hygienist wouldn’t want that for you either.

ASK FOR AN EXPLANATION

Don’t be afraid to ask to see your probing chart. Ask for a thorough explanation of your x-rays that show the bone loss and where the tartar can be seen deep under the gums. Circled in yellow = bone level Circled in red= plaque under gums. Note: gums and soft tissue do not show on an x-ray

An experienced and skilled dental hygienist will be able to explain these details to you.

So how do I afford this deep cleaning if my insurance won’t cover all of it?



A challenging part of dentistry has always been fighting not to let the dental insurance dictate the treatment my patients need. Dental insurance should be seen as a coupon, in a sense, to a treatment that you need. Something to help with that NEEDED dental expense. Don’t ever let it decide what is best for the health of your mouth. I completely understand how expensive dentistry can be and how some just simply can not afford it. However, so many offices now offer payment plans and dental memberships. This can provide discounted treatments in addition to your dental insurance. If you have a Flex Spending Account you can now use it to purchase a BURST sonic toothbrush. This will make a huge difference in the health of your gums.

BURST Discount link

What can I really do to change my dental condition in addition to seeing the hygienist regularly?

I am most excited about the new affordable dental products on the market. Your home care can make all the difference in the type of cleaning you will need. The new BURST sonic toothbrush is one of the best I’ve seen. You can finally get an excellent toothbrush for just $39.99. Sonic toothbrushes are the closest thing you can do to flossing, although nothing takes the place of flossing.

A SONIC TOOTHBRUSH IS BEST

A sonic brush produces an insane amount of bubbles that go beneath the gums. The bubbles go into those pockets, and destroy the plaque. It actually cleans beyond where the bristles end, unlike a manual toothbrush. I absolutely love it and believe in it so much for the health of my patient’s gums and teeth. I decided to sign up to be an Ambassador for the company! The cherry on top is that this brush will actually whiten your teeth. This is due to the Binchotan Charcoal that is infused into the bristles in nano-sized particles. It is non-abrasive and gentle to teeth and gums.

BURST TOOTHBRUSH DISCOUNT CODE AACTUU

I now can can offer my $30 discount code to anyone that wants one! Go to burstoralcare.com and use promo code AACTUU at checkout or Click Here To Get $30 off a BURST Whitening Toothbrush . Choose between Rose Gold, White or Black brush!

Your Health Depends On It

Please know how much the condition of your mouth can affect your overall health. Invest in your health. Your teeth are worth that investment even if you don’t realize it. The bacteria that causes Gum Disease has been linked to all kinds of disease. Such as, Alzheimer’s disease, heart disease, preterm births, some forms of pancreatic cancer and infertility in both men and women!

Don’t sell yourself short by giving up if you don’t qualify for the “free cleaning”. Make that investment in your oral health. Make that investment in you! Don’t let an insurance company determine your worth!