Sam Morgan | Piedmont Periodontics Blog

by Sam Morgan, Practice Administrator

Recently, I had a patient that had been in for a consultation over one year ago call to schedule his procedure. The patient had been diagnosed with progressive Periodontal Disease and severe bone loss. Since the patient was already missing several teeth, the doctor recommended a more aggressive treatment plan that included Osseous Procedure and then, after a period of healing, the placement of Implants.

Much to my amazement, the patient only had interest in placing the implants. I explained that the doctor would not place implants with out a healthy environment that would support osseointegration, giving the patient and his implants the chance for success. As I discussed the situation with the patient in more detail, he explained to me all of the research he had done on the recommended Osseous Procedure. He was concerned because there was no guarantee of success.

My response was that he was absolutely correct, but I took it one step further. I explained to the patient that he has Periodontal Disease and that there is no “cure” for the disease. I compared Periodontal Disease to Heart Disease, Diabetes, HIV or a diagnosed Mental Disease. There is no “cure” for any of these, only the ability to manage or attempt to manage the disease. Every human being is unique and the circumstances surrounding Periodontal Disease for that individual will more than likely be different from another individual. It could be genetic, it could be caused from poor hygiene, or it could be linked to another disease such as Diabetes.

I also explained that usually, we see a patient for a procedure like Osseous and then we see them 2-4 times per year for Periodontal Maintenance Procedures. A strong majority of our patients who maintain a strong regimen between our office and their primary dentist don’t revisit more drastic procedures. A person who has been diagnosed with Periodontal Disease is really no different than an individual who has had a heart attack and now has must visit their cardiologist for testing and monitoring on a routine basis.

Unfortunately, I believe this patient — like many others — will let fear keep him from receiving the care he so desperately needs to keep his mouth healthy and keep his teeth. We believe in preventative care and the least invasive treatment for any patient. Our ultimate goal is to help our patients keep their teeth and keep them as comfortable as possible while providing the care needed.

If you have been told you have Periodontal Disease or you suspect you may have symptoms, seek a professional to help you understand your options and what the future may look like for you and your teeth.

by Sam Morgan, Practice Administrator

If you don’t work in healthcare — or even if you do — you may not understand your dental insurance. I know I didn’t understand any of my benefits when I worked in the corporate world.

It is very commonplace and normal to think that if you have dental insurance, you should be covered for your normal hygiene maintenance procedures and any needed surgeries. Unfortunately, this is not the case. So, let’s take a few minutes to review some dental insurance basics:

Dental insurance is really a dental benefit that is allotted to you each year. These benefits usually run on a calendar year but sometimes run on different 12 month cycle.
We call dental insurance a dental benefit because, unlike most health plans, there is a defined or limited amount of benefit available to you each year.
Coverage for dental benefits under companies, plans, and groups will vary. Dental benefits are most commonly covered at a percentage of the fee charged by your dental professional. For instance, Sally may have 80% coverage with Company A for a cleaning while Bill has 60% coverage for the same cleaning under Company B.
Routine cleanings, exams, and x-rays are all covered at different levels within dental insurance companies. You should be aware of frequency limitations in the number of times per year (or any defined time period) that these services can be performed.
To find out exactly what may — or may not — be covered and at what percentage it is covered, you may want to request that your dental professional file a Pre-Authorization or Pre-Determination prior to a procedure. This is a recommendation based on procedure code and your dental insurance company requirements.
You should receive an Explanation of Benefits (EOB) each time your dental Insurance is billed for a procedure. If you don’t receive this information, you should contact your dental insurance company for a copy. If you have any trouble understanding your EOB, I recommend that you contact your dental professional for help understanding the document.
Common language you may hear in a dental office, on the phone with your dental insurance company, or see on a Explanation of Benefits includes

Dentist = Provider
Insurance Company = Carrier
ADA Code = Dental Code, a four digit number that follows a D (e.g., D0120)
EOB = Explanation of Benefits
Maxed Out = patient has utilized all of their benefits for the year
Frequency = number of times a procedure may be performed within a defined time period

The bottom line is that insurance is constantly changing, and it can be very complicated to understand. However, it is important to understand your benefits. Ask questions of your carrier and your provider. Don’t be embarrassed if you don’t understand or even if you need it explained more than once.

Each year, you may go through Open Enrollment at work. Take that opportunity to speak with your HR department and your dental professional about the options available to you.

Tag Archives: Sam Morgan

Periodontal Disease and Long Term Care

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