Abscess
Acute or chronic localized inflammation, probably with a collection of pus, associated with tissue destruction and, frequently, swelling; usually secondary to infection.
Acute Periradicular/Acute Apical Abscess
An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and eventual swelling of associated tissues. May also be known as acute periapical abscess, acute alveolar abscess, dentoalveolar abscess, phoenix abscess, recrudescent abscess, secondary apical abscess.
Chronic Periradicular/Chronic Periapical Abscess
An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort and the intermittent discharge of pus through an associated sinus tract. May also be known as chronic alveolar abscess, chronic apical abscess, chronic dentoalveolar abscess, suppurative apical periodontitis, suppurative periradicular periodontitis.
Abutment
A tooth or implant fixture used as a support for a prosthesis.
Abutment Crown
Artificial crown attached to a tooth, root or implant body serving for the retention or support of a dental prosthesis.
Accession
Addition of a test specimen, previously collected by a health care provider, to a laboratory specimen collection; recording of essential specimen identification data in a laboratory-maintained file in chronological order of laboratory specimen acquisition; assignment to the specimen of an identification code.
Acid Etching
Use of an acidic chemical substance to prepare the tooth enamel and/or dentin surface to provide retention for bonding.
Adhesion
State in which two surfaces are held together by chemical or physical forces or both with or without the aid of an adhesive. Adhesion is one aspect of bonding.
Adhesive
Any substance that joins or creates close adherence of two or more surfaces. Intermediate material that causes two materials to adhere to each other.
Adjunctive
A secondary treatment in addition to the primary therapy.
Administrative Costs
Overhead expenses incurred in the operation of a dental benefit program, exclusive of costs of dental services provided.
Administrative Services Only (ASO)
An arrangement under which a third party, for a fee, processes claims and handles paperwork for a self-funded group. This frequently includes all insurance company services (actuarial services, underwriting, benefit description, etc.) except assumption of risk.
Administrator
One who manages or directs a dental benefit program on behalf of the program's sponsor.
Adult Dentition
The permanent teeth of adulthood that either replace the primary dentition or erupt distally to the primary molars.
Adverse Selection
A statistical condition within a group when there is a greater demand for dental services and/or more services necessary than the average expected for that group.
Allogenic
Belonging to the same species, but genetically different. See graft.
Alloplastic
Refers to synthetic material often used for tissue augmentation or replacement.
Allowable Charge
The maximum dollar amount on which benefit payment is based for each dental procedure as calculated by the third-party payer.
Alloy
Compound combining two or more elements having properties not existing in any of the single constituent elements. Sometimes used to refer to amalgam.
Alternate Benefit
A provision in a dental plan contract that allows the third-party payer to determine the benefit based on an alternative procedure that is generally less expensive than the one provided or proposed.
Alveolar
Referring to the bone to which a tooth is attached.
Alveoloplasty
Surgical procedure for recontouring supporting bone, sometimes in preparation for a prosthesis.
Amalgam
An alloy used in direct dental restorations. Typically composed of mercury, silver, tin and copper along with other metallic elements added to improve physical and mechanical properties.
Anesthesia
A patient's level of consciousness is determined by the provider and not the route of administration of anesthesia. State dental boards regulate the use of anesthesia techniques.
Analgesia
The diminution or elimination of pain.
Deep Sedation
A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired.
General Anesthesia
A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired.
Local Anesthesia
The elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.
Minimal Sedation
A minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command.
Moderate Sedation
A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway.
Anomaly
Deviation from the normal anatomic structure, growth, development or function; an abnormality.
Anterior
Mandibular and maxillary centrals, laterals and cuspids. The designation of permanent anterior teeth in the Universal/National tooth numbering system include teeth 6 through 11 (maxillary), and 22 through 27 (mandibular); primary teeth are designated C through H (maxillary), and M through R (mandibular). Also refers to the teeth and tissues located towards the front of the mouth.
Anxiolysis
The diminution or elimination of anxiety.
Apex
The tip or end of the root end of the tooth.
Apexification
The process of induced root development to encourage the formation of a calcified barrier in a tooth with immature root formation or an open apex. May involve the placement of an artificial apical barrier prior to nonsurgical endodontic obturation.
Apexogenesis
Vital pulp therapy performed to encourage continued physiological formation and development of the tooth root.
Apicoectomy
Amputation of the apex of a tooth.
Appeal
A formal request that an insurer review denied or unpaid claims for services or supplies provided. An appeal can be filed by a healthcare provider or a patient in an attempt to recover reimbursement from a third-party payer such as a private insurance company.
Arch, Dental
The curved composite structure of the natural dentition and the residual ridge, or the remains thereof, after the loss of some or all of the natural teeth.
Areas of Oral Cavity
A two digit numeric system used to report regions of the oral cavity to third party payers:
00 - Entire oral cavity | 01 - Maxillary arch | 02 - Mandibular arch | 10 - Upper right quadrant | 20 - Upper left quadrant | 30 - Lower left quadrant | 40 - Lower right quadrant
Arthrogram
A diagnostic X-ray technique used to view bone structures following injection of a contrast medium into a joint.
Assignment of Benefits
A procedure whereby a beneficiary/patient authorizes the administrator of the program to forward payment for a covered procedure directly to the treating dentist.
Audit
An examination of records or accounts to check their accuracy. A post-treatment record review or clinical examination to verify information reported on claims.
Autogenous
See graft. (Taken from one part of a patient's body and transferred to another)
Avulsion
Separation of tooth from its socket due to trauma. See evulsion.
Bad Faith Insurance Practices
The failure to deal with a beneficiary of a dental benefit plan fairly and in good faith; or an activity which impairs the right of the beneficiary to receive the appropriate benefit of a dental benefits plan or to receive them in a timely manner. Examples include: evaluating claims based on standards significantly at variance with community standards; failure to properly investigate a claim; unreasonably delaying/withholding payment.
Balance Billing
Billing a patient for the difference between the dentist's actual charge and the amount reimbursed under the patient's dental benefit plan.
Barrier Membrane
Usually a thin, sheet-like usually non-autogenous material used in various surgical regenerative procedures.
Behavior Management
Techniques or therapies used to alter or control the actions of a patient who is receiving dental treatment. Examples include use of a papoose board, education or anxiety relief techniques.
Beneficiary
A person who is eligible for benefits under a dental benefit contract. Also known as covered person, insured, or member.
Benefit
The amount payable by a third party toward the cost of various covered dental services or the dental service or procedure covered by the plan.
Benefit Booklet
A booklet or pamphlet provided to the subscriber that contains a general explanation of the benefits and related provisions of the dental benefit program. Also known as a Summary Plan Description.
Benign
The mild or non-threatening character of an illness or the non-malignant character of a neoplasm.
Bicuspid
A premolar tooth; a tooth with two cusps.
Bilateral
Occurring on, or pertaining to, both right and left sides.
Biologic Materials
Agents that alter wound healing or host-tumor interaction. Such materials can include cytokines, growth factor, or vaccines, but do not include any actual hard or soft tissue graft material. Also known as biologic response modifiers.
Biopsy
Process of removing tissue for histologic evaluation.
Birthday Rule
When a dependent child's parents both have dental coverage, this rule states that the primary program (the one which pays first) is the one covering the parent whose month and day of birth falls first in the calendar year. The birthday rule is the most common rule for determining primary v. secondary coverage.
Bitewing Radiograph
Interproximal radiographic view of the coronal portion of the tooth/teeth. A form of dental radiograph that reveals approximately the coronal halves of the maxillary and mandibular teeth and portions of the interdental alveolar septa on the same image.
Bleaching
Process of lightening of the teeth, usually using a chemical oxidizing agent and sometimes in the presence of heat. Removal of deep seated intrinsic or acquired discolorations from crowns of vital and non-vital teeth through the use of chemicals containing various concentrations of hydrogen peroxide and carbamide peroxide.
Bonding
Process by which two or more components are made integral by mechanical and/or chemical adhesion at their interface.
Bridge
See fixed partial denture.
Bruxism
The parafunctional grinding of the teeth.
Buccal
Pertaining to or toward the cheek (as in the buccal surface of a posterior tooth).
Bundling of Procedures
The systematic combining of distinct dental procedure codes by third-party payers that results in a reduced benefit for the patient/beneficiary.
By Report
A written description of the service provided that is prepared when the term "by report" is included in a procedure code nomenclature; may be requested by a third-party payer to provide additional information for claims processing.
Cafeteria Plan
Employee benefit plan in which employees select their medical insurance coverage and other nontaxable fringe benefits from a list of options provided by the employer. Cafeteria plan participants may receive additional, taxable cash compensation if they select less expensive benefits.
Calculus
Hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.
Canal
A relatively narrow tubular passage or channel.
Root Canal
Space inside the root portion of a tooth containing pulp tissue.
Mandibular Canal
The passage which transmits vessels and nerves through the jaw to branches that distributes them to the teeth.
Cantilever Extension
Part of a fixed prosthesis that extends beyond the abutment to which it is attached and has no additional support.
Capitation
A capitation program is one in which a dentist or dentists contract with the programs' sponsor or administrator to provide all or most of the dental services covered under the program to subscribers in return for payment on a per-capita basis.
Caries
Commonly used term for tooth decay.
Case Management
The monitoring and coordination of treatment rendered to patients with specific diagnoses or requiring high cost or extensive services. A process of identifying patients with special health care needs, developing a healthcare strategy that meets those needs, and coordinating and monitoring the care to achieve optimum health care outcome in an efficient and cost-effective manner.
Cavity
Missing tooth structure. A cavity may be due to decay, erosion or abrasion. If caused by caries; also referred to as carious lesion.
Cement Base
Material used under a filling to replace lost tooth structure.
Cementum
Hard connective tissue covering the outer surface of a tooth root.
Centers for Medicare and Medicaid Services (CMS)
The federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), HIPAA, and the Clinical Laboratory Improvement Amendments (CLIA) programs. CMS is part of the U.S. Department of Health and Human Services.
Cephalometric Image
A standardized, extraoral projection utilized in the scientific study of the measurements of the head.
Ceramic
Non-metal, non-resin inorganic refractory compounds processed at high temperatures (600°C/1112°F and above) and pressed, polished or milled – including porcelains, glasses, and glass-ceramics.
Claim
A request for payment under a dental benefit plan; a statement listing services rendered, the dates of services, and itemization of costs. The completed request serves as the basis for payment of benefits.
Claim Form
A form, paper or electronic, used to report dental procedures to a third-party payer in order to file for benefits under a dental benefit program. The paper claim form was developed by the American Dental Association.
Claimant
Person or authorized provider who files a claim for benefits. Patient or certificate holder who files a claim for benefits.
Claims Payment Fraud
The intentional manipulation or alteration of facts or procedure codes submitted by a treating dentist resulting in a lower payment to the beneficiary and/or the treating dentist than would have been paid if the manipulation had not occurred.
Claims Reporting Fraud
The intentional misrepresentation of material facts concerning treatment provided and/or charges made, in that this misrepresentation would cause a higher payment.
Cleft Palate
Congenital deformity resulting in lack of fusion of the soft and/or hard palate, either partial or complete.
Clenching
The clamping and pressing of the jaws and teeth together in centric occlusion, frequently associated with psychological stress or physical effort.
Clinical Crown
That portion of a tooth not covered by tissues.
Closed Panel
A dental insurance benefit plan which requires the eligible patients to receive their dental care from a specific dentist who has contractually agreed to the terms, payments and benefits of the plan. Usually only a limited number of dentists in an area are allowed to participate in these types of plans.
Closed Reduction
The re-approximation of segments of a fractured bone without direct visualization of the boney segments.
Code on Dental Procedures and Nomenclature (Code)
A listing of dental procedure codes and their descriptive terms published by the American Dental Association (ADA); used for recording dental services on the patient record as well as for reporting dental services and procedures to dental benefit plans. The Code is printed in a manual titled Current Dental Terminology (CDT).
Coinsurance
A provision of a dental benefit program by which the beneficiary shares in the cost of covered services, generally on a percentage basis. The percentage of a covered dental expense that a beneficiary must pay (after the deductible is paid). A typical coinsurance arrangement is one in which the third party pays 80% of the allowed benefit and the beneficiary pays the remainder.
Complete Denture
A prosthetic for the edentulous maxillary or mandibular arch, replacing the full dentition. Usually includes six anterior teeth and eight posterior teeth.
Complete Series
An entire set of radiographs. A set of intraoral radiographs usually consisting of 14 to 22 periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas and alveolar bone crest.
Composite
A dental restorative material made up of disparate or separate parts (e.g. resin and quartz particles).
Compound Fracture
Break in bone which is exposed to external contamination.
Comprehensive Oral Evaluation
See evaluation.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Legislation relative to mandated benefits for all types of employee benefit plans. Most significant aspects are requirements for continued coverage for employees and/or their dependents for 18 months who would otherwise lose coverage (30 months for dependents in event of employee's death).
Consultation
In a dental setting, a diagnostic service provided by a dentist where the dentist, patient, or other parties discuss the patient's dental needs and proposed treatment modalities.
Contiguous
Adjacent; touching.
Contract
A legally enforceable agreement between two or more individuals or entities that confers rights and duties on the parties. Common types include contracts between dental benefit organizations and dentists, and between benefit organizations and group plan sponsors.
Contract Dentist
Any dentist who has a contractual agreement with a dental benefit organization to render care to eligible persons.
Contract Fee Schedule Plan
A dental benefit plan in which participating dentists agree to accept a list of specific fees for dental treatment provided.
Contract Term
Usually a 12 months period of time for which a contract is written and during which a group's deductibles, maximums and other provisions apply. This may or may not be the same as a calendar year. Also known as the benefit year.
Contributory Program
A dental benefit program in which the enrollee shares in the monthly premium of the program with the program sponsor (usually the employer). Generally done through payroll deduction.
Coordination of Benefits (COB)
A method of integrating benefits payable for the same patient under more than one plan. Benefits from all sources should not exceed 100% of the total charges.
Copayment
Beneficiary's share of the dentist's fee after the benefit plan has paid.
Coping
A thin covering of the coronal portion of the tooth usually without anatomic conformity. Custom made or pre-fabricated thimble-shaped core or base layer designed to fit over a natural tooth preparation, a post core, or implant abutment.
Core Buildup
The replacement of a part or all of the crown of a tooth whose purpose is to provide a base for the retention of an indirectly fabricated crown.
Coronal
Refers to the crown of a tooth.
Cosmetic Dentistry
Those services provided by dentists solely for the purpose of improving the appearance when form and function are satisfactory and no pathologic conditions exist.
Cost Containment
Features of a dental benefit program or of the administration of the program designed to reduce or eliminate certain charges to the plan.
Cost Sharing
The share of health expenses that a beneficiary must pay, including the deductibles, copayments, coinsurance, and charges over the amount reimbursed by the dental benefit plan.
Coverage
Benefits available to an individual covered under a dental benefit plan.
Covered Charges
Services and supplies which are reimbursed in whole or in part under the conditions of the dental benefit plan, subject to all the terms and conditions of the agreement or insurance policy. Any charges not covered by the plan are considered non-covered charges.
Covered Person
An individual who is eligible for benefits under a dental benefit program.
Covered Services
Services for which payment is provided under the terms of the dental benefit contract.
Cracked Tooth Syndrome
A collection of symptoms characterized by transient acute pain experienced when chewing.
Crown
Various definitions based on type:
Abutment Crown
Artificial crown serving for the retention or support of a dental prosthesis.
Anatomical Crown
That portion of tooth normally covered by, and including, enamel.
Artificial Crown
Restoration covering or replacing the major part, or the whole of the clinical crown of a tooth.
Clinical Crown
That portion of a tooth not covered by tissues.
Crown Lengthening
A surgical procedure exposing more tooth for restorative purposes by apically positioning the gingival margin and removing supporting bone.
Culture and Sensitivity Test
Clinical laboratory test which identifies a microorganism and the ability of various antibiotics to control the microorganism.
Curettage
Scraping and cleaning the walls of a real or potential space, such as a gingival pocket or bone, to remove pathologic material.
Current Dental Terminology (CDT)
The ADA reference manual that contains the Code on Dental Procedures and Nomenclature and other information pertinent to patient record keeping and claim preparation by a dental office; published biennially (e.g., CDT 2009-2010).
Current Procedural Terminology (CPT)
A listing of descriptive terms and identifying codes developed by the American Medical Association (AMA) for reporting practitioner services and procedures to medical plans and Medicare.
Cusp
Pointed or rounded eminence on or near the masticating surface of a tooth.
Cuspid
Single cusped tooth located between the incisors and bicuspids.
Cyst
Pathological cavity, usually lined with epithelium, containing fluid or soft matter.
Odontogenic Cyst
Cyst derived from the epithelium of odontogenic tissue (developmental, primordial).
Periapical Cyst
An apical inflammatory cyst containing a sac-like epithelium-lined cavity that is open to and continuous with the root canal.
Cytology
The study of cells, including their anatomy, chemistry, physiology and pathology.
