Abscess
Acute or chronic, localized inflammation, with a collection of pus.
Abutment
A tooth or implant used to support a dental prosthesis.
Affordable Care Act
Enacted in March 2010, the federal Patient Protection and Affordable Care Act, commonly referred to as the ACA or “Obamacare,” provides the framework, policies, regulations and guidelines for implementation of comprehensive health care reform by the states. The Affordable Care Act will expand access to high-quality affordable insurance and health care.

Open Enrollment starts November 1, 2015 through January 31, 2016. Enrollment by December 15th will have effective date of January 1st. By January 15th, effective February 1st and so on. New for New York 2016 SHOP (small business) plans have coverage up to 100 full time employees (up from 50 max in 2015). Additionally in 2016, SHOP members can purchase a dental plan without medical plan. Finally, there is no premium increase for 2016 plans!
Alveolar
Referring to the bone to which a tooth is attached.
Alveoloplasty
A surgical procedure for recontouring alveolar structures, usually in preparation for a prosthesis.
Amalgam
A mixture of metals used in dental restorations (commonly referred to as a silver filling).
Analgesia
Loss of pain sensation without loss of consciousness.
Anesthesia
Partial or total absence of sensation to stimuli. There are three types of anesthesia:
General Anesthesia
A controlled state of unconsciousness, accompanied by a loss of ability to independently maintain airway and respond purposefully to physical stimulation or verbal command.
Intravenous Conscious Sedation
A depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and to respond appropriately to physical stimulation or verbal accompanied by a loss of ability to independently maintain airway and respond purposefully to physical stimulation or command.
Local Anesthesia
Elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of an anesthetic drug.
Anniversary Date
The day and month that the patients' insurance first became effective, and on which coverage renews.
Anterior
Refers to the teeth and tissues located in the front of the mouth - upper and lower incisors and canines.
Appeal
An urgent request by member for their dental insurer to approve a denied claim in order to complete treatment. Member provides written statement or evidence to support overturning original denied claim directly to dental insurer.
Apex
The tip or end of the root of a tooth.
Apicoectomy
Removal (amputation) of the apex of a tooth.
Arch
The curved structure of the natural dentition or the ridge remaining after the loss of some or all of the natural teeth.
Assignment Of Benefits
A clause in the policy that allows the insured person to direct the payment by the carrier to the dentist. The insured person does this by signing the assignment box on the claim form, or by signing a "signature on file" form.
Back Teeth
See Posterior Teeth
Benefit Year
Usually begins on the month of the year that the employer purchased the plan.
Benefits
The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan’s coverage documents.
Benign
The mild character of an illness or non-malignant character of a neoplasm.
Bicuspid
A tooth with two cusps, usually in front of a molar and referred to as a premolar.
Bilateral
Pertaining to both sides of the mouth.
Biopsy
Process of removing tissue for laboratory evaluation.
Birthday Rule
When a child is covered under both parent's plans, the plan of the parent who's birthday (month and day, not year) falls earlier in the calendar year is billed first.
Bitewing
An X-ray that shows the upper and lower teeth's biting surfaces on the same film. This x-ray shows the portion of the teeth above the gumline.
Bonding
The process by which two or more components are made into one by mechanical and/or chemical adhesion at their interface.
Bridge
There are two types of bridges:
Fixed Bridge
A prosthetic replacement of one or more missing teeth cemented or attached to the abutment teeth or implants adjacent to the space.
Removable Bridge
A prosthetic replacement of one or more missing teeth on a framework that can be removed by the patient.
Bruxism
Grinding of teeth.
Buccal
Facing the cheek.
Calendar Year
January 1st to December 31st.
Calculus
Hard deposits of mineralized plaque which are attached to the crowns and or roots of teeth; also referred to as tartar.
Canal
The narrow chamber inside the root of the tooth that contains the nerve and blood vessels.
Canines
See cuspids.
Capitation Plan
A plan where the dentist is contracted with the administrator to provide dental services to persons covered under the program in return for payment on a per-capita basis (per head).
Caries
Commonly used term for tooth decay.
Carrier
The party (usually an insurance company) that pays the claims and collects the premiums.
Carryover
If the deductible was paid during the last 3 months of the prior year, it can carry forward into the current year and not be paid again.
Cementum
Hard connective tissue covering the root portion of a tooth.
Claim
A request for payment that you or your health care provider submits to your health insurer after you receive items or services you think are covered.
Cleaning
See prophylaxis.
Cleft palate
A congenital deformity resulting in lack of fusion of the soft and or hard palate, may be either partial or complete.
Clenching
The clamping and pressing of the jaws and teeth together, frequently associated with psychological stress or physical effort.
Closed Panel
A plan where the covered patient only receives benefits if the services are provided by a dentist who is under contract with the dental benefit company or plan.
C.O.B.
See Coordination Of Benefits.
Complete Series
See Full Mouth X-rays.
Composite
A dental restorative material made up of separate parts (e.g. resin and quartz particles).
Coordination Of Benefits (C.O.B.)
This process becomes involved when the patient is covered by more than one plan. Coverage is then divided between the two plans using guidelines establisted by the National Association of Insurance Commissioners.
Copayment
A fixed amount (for example, $36) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Coronal
Refers to the crown of a tooth.
Crown
There are three types of crowns:
Anatomical Crown
That portion of the tooth normally visible and covered by enamel.
Artificial Crown
A restoration covering or replacing the major part of the anatomical crown.
Abutment Crown
An artificial crown serving for the retention or support of a dental prosthesis.
Crown Lengthening
A surgical procedure exposing more of the tooth for restorative purposes by repositioning the gingival margin and/or removing supporting bone.
Curettage
Scraping or cleaning the walls of a cavity or gingival pocket.
Cusp
A pointed or rounded eminence on or near the chewing surface of a tooth.
Cuspids
The third tooth from the center of the mouth to the back of the mouth. These are the front teeth that have one rounded or pointed edge used for biting. Also known as canines.
Cyst
A pathological cavity or space, containing fluid or soft matter.
Debridement
Removal of subgingival and/or supragingival plaque and calculus which obstructs the ability to perform an evaluation; removal of bruised and devitalized tissue from a wound surface.
Decay
The lay term for carious lesions in tooth; decomposition of tooth structure.
Deciduous
To fall off or shed; a name used for the primary (baby) teeth.
Deductible
The amount paid by the patient before the carrier starts to pay benefits.
Dental Health Maintenance Organization (DHMO)
A legal entity that accepts the responsibility of providing services at a fixed price. The enrollees in these plans must have dental care provided through designated doctors.
Dentin
That part of the tooth that is beneath enamel and cementum.
Dentition
The teeth in the dental arch.
Denture
An artificial substitute for natural teeth and adjacent tissues.
Dependent
Usually the spouse and children of the subscriber.
Diagnostic
Procedures performed by the dentist to evaluate the condition of the teeth and mouth.
Diastema
A space, such as one between two adjacent teeth.
Distal
Toward the back of a tooth or the dental arch (away from the midline).
D.H.M.O.
See Dental Health Maintenance Organization.
Dry Socket
Localized inflammation of the tooth socket, following an extraction, due to infection or loss of blood clot.
Edentulous
Without teeth.
Eligibility
A process used to determine if the patient is eligible for benefits. This should be done before the treatment begins.
Enamel
Hard calcified tissue covering the dentin on the crown of a tooth.
Endo
See Endodontics.
Endodontic
Relating to the pulp.
Endodontist
A dental specialist whose practice is limited to treating disease and injury to the pulp. Endodontists perform root canal therapy and other services related to the blood vessels and nerve tissue inside teeth.
Equilibration
Reshaping of the occlusal surfaces of teeth to create proper contact between the upper and lower teeth; also know as occlusal adjustment.
Essential Health Benefits
Health care service categories that must be covered by certain plans, starting in 2014. These service categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitation services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including dental and vision care. Insurance policies must cover these benefits in order to be certified and offered in the marketplace, and all Medicaid state plans must cover these services by 2014.
Exchange
The word “Exchange” is used in the federal health care law to describe the marketplace where individuals, families and small business owners in a state will access health insurance in 2014. In some states the exchange is run by the State in others it is run by the federal government.
Excision
Surgical removal of bone and/or tissue.
Exclusion
A service not covered by a dental policy.
Exostosis
Overgrowth of bone.
Facial
The surface of a tooth directed toward the face (including the buccal and labial surfaces).
Fee Schedule
A set amount paid by the insurance company that is unrelated to the doctor's fee.
Filling
A term used for the restoration of lost tooth structure with materials such as amalgams or plastic.
Fluoride
A gel or liquid that prevents decay.
F.M.X.
See Full Mouth X-rays.
Foramen
A natural opening into or through bone.
Front Teeth
See Anterior Teeth.
Full Mouth X-RAYS (F.M.X.)
X-rays showing all the teeth. Includes 14 periapicals and 2 or 4 bitewings. Also known as a complete series.
Gender Rule
When a child is covered under both parent's plans, the father's plan is billed first.
General Anesthesia
Medication that relieves the sensation of pain on the whole body. General anesthesia renders you unconscious.
Gingiva
The soft tissue surrounding and supporting the teeth; otherwise know as the "gums".
Gingivectomy
The removal of gingival tissue.
Gingivitis
Inflammation of gingival tissue.
Gingivoplasty
Surgical procedure to reshape gingiva to create a normal, functional shape.
Graft
A piece of tissue or material placed in contact with tissue to repair a defect.
Hemisection
Surgical separation of a multirooted tooth so that one root and/or the overlaying portion of the crown can be surgically removed.
Immediate Denture
A denture constructed for placement immediately after removal of all remaining teeth.
Impacted
An unerupted or partially erupted tooth that is positioned against another tooth, bone or soft tissue so that complete eruption is unlikely.
Implant
A device specially designed to be placed surgically within or on the jaw bone as a means of replacing teeth.
Incentive Program
A dental plan where benefits start at a given percentage and the percentage increases each year if the patient visits the dentist annually for preventive treatment. However, if the patient fails to go to the dentist each year the percentage drops back to where it started.
Incisors
The central and lateral incisors, are the first and second teeth from the center of the mouth to the back of the mouth. These are the front teeth with flat edges for biting.
Inlay
A laboratory processed restoration made of metal, acrylic or porcelain. This filling does not involve the high points of the tooth (cusps).
In-Network Co-Insurance
The percent (for example, 20%) you pay of the allowed amount for covered dental care services to providers who contract with your insurance plan. In-network co-insurance usually costs you less than out-of-network co-insurance.
In-Network Co-Payment
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your insurance plan. In-network co-payments usually are less than out-of-network co-payments.
Interproximal
Between the adjoining surfaces of adjacent teeth.
Jaw
A common name for either the maxilla or the mandible.
Labial
Pertaining to or around the lip.
Least Cost Alternative
A clause in the policy that allows an insurance company to pay for the least expensive treatment.
Lesion
An injury or wound; area of diseased tissue.
Lingual
Pertaining to or around the tongue.
Local Anesthesia
Medication that relieves the sensation of pain in a localized area.
Malar
Pertaining to the cheek bone.
Malignant
Having the abnormal properties of dysplasia, invasion and metastasis.
Malocclusion
Improper alignment of biting or chewing surfaces of the upper and lower teeth.
Managed Care Plans
Plans that restrict the type, level and frequency of treatment; limit the access to care; and control the level of reimbursement for services. These are D.H.M.O.'s, Capitation plans, Closed Panel plans, PPO plans or other network based programs.
Mandible
Lower jaw.
Maxilla
Upper jaw.
Maximum
The maximum dollar amount of benefits a plan will pay toward the cost of dental care over a specific period of time (usually one year).
Medically Necessary
Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standard of medicine.
Mesial
Toward the front of a tooth or the dental arch (towards the midline).
Molar
A posterior tooth used for grinding; behind the premolars (bicuspids) on either side of the jaw, having a large crown and a broad chewing surface.
Mucous Membrane
The lining of the oral cavity; also called mucosa.
Nightguard
A removable acrylic appliance to minimize the effects of grinding (bruxism) or joint problems (T.M.J.). Usually worn at night to prevent grinding or relieve joint pain. Also known as an occlusal guard.
Network
Providers your plan has contracted with to provide dental services.
Obturator
A prosthesis that closes an opening in the palate.
Occlusion
Any contact between biting or chewing surfaces of the upper and lower teeth.
Onlay
A laboratory processed restoration made of metal, porcelain or acrylic that replaces one or more of the highest points of the tooth (cusps).
Open Enrollment
A designated period of time each year – usually a few months – during which insured individuals or employees can make changes in health insurance coverage.
Operculectomy
Removal of the operculum.
Operculum
The flap of tissue over an uneruped or partially eruped tooth.
Oral
Pertaining to the mouth.
Oral Surgeon
A dental specialist whose practice is limited to diagnosing and treating diseases, injuries, deformities and defects of the mouth.
Orthodontist
A dental specialist whose practice is limited to preventing and treating malocclusion of the teeth.
Orthognathic
The functional relationship between the maxilla and the mandible.
Out-of-Network
Health care providers who are not a part of your health plan. Health plans do not have to cover services provided by out-of-network doctors. Always check if your health care provider is “in-network” to avoid paying additional costs.
Out-of-Pocket Limit
The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums.
Overdenture
A prosthetic device that is supported by retained roots or implants.
Palate
The hard and soft tissues forming the roof of the mouth that separates the oral and nasal cavities.
Palliative
Treatment that temporarily relieves pain but is not curative.
Panorex
An x-ray taken outside of the mouth that shows all the teeth on one film.
Partial Denture
A prosthetic device that replaces the missing teeth with a framework that can be removed by the patient.
Pediatric Dentist
A dental specialist whose practice is limited to treating children; formerly known as a pedodontist.
Pedo
See Pedodontics.
Pedontics (PEDO)
The treatment of children's teeth.
Periapical
The area surrounding the end of the tooth root.
Pericoronal
Around the crown of a tooth.
Perio
See Periodontics.
Perio Charting
Measures the depth that the gums have detached from the side of the tooth.
Periodontal
Pertaining to the supporting and surrounding tissues of the teeth.
Periodontal Maintenance
Cleaning of the teeth following periodontal treatment, includes perio charting.
Periodontics (PERIO)
The treatment of diseases of the gum or bone (supporting structures).
Periodontist
A dental specialist whose practice is limited to the treatment of diseases of the supporting and surrounding tissues of the teeth.
Periodontitis
Inflammation and loss of the connective tissue of the supporting or surrounding structures of teeth.
Perio Pocket
The pocket that forms when the gums detach from the side of the tooth.
Perio Prophy
See Periodontal Maintenance.
Perio Recall
See Periodontal Maintenance.
Permanent First and Second Molars
The adult first and second molars, are the sixth and seventh teeth from the center of the mouth to the back of the mouth.
Permanent Molars
The adult first, second and third molars.
Permanent Dentition
See Permanent Teeth.
Permanent Teeth
The adult teeth. Also known as the permanent dentition.
Plaque
A soft sticky substance that accumulates on teeth composed largely of bacteria.
Pontic
The term used for the artificial tooth on a fixed bridge.
Post
An elongated metallic projection cemented within the prepared root canal, serving to strengthen and retain restorative material and/or a crown restoration.
Posterior
Refers to teeth and tissues toward the back of the mouth, (premolars, bicuspids and molars).
P.P.O.
See Preferred Provider Organization.
Preauthorization
See Predetermination.
Precert
See Predetermination.
Precertification
See Predetermination.
Precision Attachment
An interlocking device integrated into a fixed or removable prosthesis to help keep the prosthesis in place.
Pre D
See Predetermination.
Predetermination
A process used to determine the benefits available for dental services that are planned by the dentist: an estimate of the amounts payable by the plan if services are rendered when the patient is eligible.
Pre-Existing Condition
When benefits are allowed to treat a condition that was present when the patient first became insured.
Preferred Provider Organization (P.P.O.)
A network of dentists who have agreed to accept discounted fees for patients covered by a specific dental program.
Preventive
A procedure performed to prevent decay and gum disease. The procedures that are classified as preventive include prophylaxes, flouride treatment and the placement of sealants.
Primary Dentition
See Primary Teeth.
Primary Plan
When the patient is insured by two plans, the plan that is billed first is the primary plan. The order is determined by guidelines established by the National Association of Insurance Commissioners.
Primary Teeth
The baby teeth. Also known as the primary dentition or first set of teeth to erupt.
Prophy
See Prophylaxis.
Prophylaxis
A polishing procedure performed to remove coronal plaque, calculus and stains; often referred to as a cleaning.
Prosthesis
An artificial replacement of any part of the body; dental prosthesis is any device or appliance replacing one or more missing teeth.
Prosthetic
A fixed or removable appliance to replace missing teeth, such as a bridge, partial denture or full denture.
Prosthetic Replacement
The replacement of an existing bridge, partial or full denture.
Prosthodontics
Dealing with the replacement of missing teeth with prosthetic devices.
Prosthodontist
A dental specialist whose practice is limited to the restoration of the natural teeth and/or the replacement of missing teeth.
Provider
The dentist who renders treatment to the patient.
Provisional
A temporary or interim solution.
Pulp
The blood vessels and nerve tissue that occupies the pulp cavity of a tooth.
Pulp Cavity
The space within a tooth, which contains the pulp.
Pulpitis
Inflammation of the dental pulp.
Pulpotomy
Removal of a portion of the pulp.
Quadrant
One of the four equal sections into which the dental arches can be divided; begins at the midline of the arch and extends back to the last tooth (right and left sides of both arches).
Qualified Health Plan
An insurance product that is certified by a marketplace, provides Essential Health Benefits, follows established limits on cost-sharing (like deductibles, copayments and out-of-pocket maximum amounts) and meets other requirements. A Qualified Health Plan will have a certification by each marketplace in which it is sold.
Radiograph
X-ray.
R.C.T.
See Root Canal Therapy.
Reline
Process of resurfacing the tissue side of a denture with new material.
Rescission
The retroactive cancellation of a health insurance policy. Insurance companies will sometimes retroactively cancel your entire policy if you made a mistake on your initial application when you buy an individual market insurance policy. Under federal law, rescission is illegal except in cases of fraud or intentional misrepresentation of facts as prohibited by the terms of the plan or coverage.
Resin Filling
See Composite Filling.
Restorative
Procedures performed to restore missing or decayed teeth.
Retainer
Appliance to stabilize the teeth following orthodontic treatment.
Retrograde Filling
A method of sealing the root canal by filling it from the root apex.
Root
The anatomic portion of the tooth that is covered by cementum and is located in the socket of bone.
Root Canal
The chamber within the root of the tooth that contains the pulp.
Root Canal Therapy
Treating disease of and injuries to the pulp usually by removing the pulp from the canal of the tooth and replacing it with a filling material.
Root Planing
A procedure designed to remove calculus from the root surfaces of teeth.
Scaling
The removal of plaque, calculus and stain from teeth.
Sealant
A clear application of acrylic placed over the biting surface of the tooth to prevent decay.
Secondary Plan
When a patient is insured by two plans, the plan that is billed second is the secondary plan. The order is detemined by guidelines established by the National Association of Insurance Commissioners.
Sialodochoplasty
A surgical procedure for the repair of a defect and/or restoration of a portion of a salivary gland duct.
Sialolithotomy
A surgical procedure by which a stone within a salivary gland or its duct is removed.
Signature on File
When the patient signs a statement in the dental office, but does not sign the actual claim form being submitted. The statement in question may authorize the dentist to receive information about the patient, or may assign benefits to the dentist.
Single Film
See Periapical.
Special Enrollment
The opportunity for people who experience a life-changing event, such as the loss of a job, death of a spouse or birth of a child, to sign up immediately in an employer’s health plan, even if it is outside of the plan’s specified enrollment period.
Splint
A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured or traumatized.
Stomatitis
Inflammation of the membranes of the mouth.
Subscriber
The person who carries the dental plan.
Suture
A stitch used to repair an incision or wound.
Tartar
See Calculus.
TMJ
Temporomandibular joint - the hinge between the lower jaw (mandible) and base of the skull (temporal bone).
Temporomandibular Joint Disfunction
Abnormal TMJ functioning also refers to symptoms arising in other areas secondary to the disfunction.
Third Molar
See Wisdom Tooth.
Torus
A bony elevation or outgrowth of bone.
Trismus
Limited ability to open the mouth, usually due to inflammation.
U.C.R.
See Usual, Customary and Reasonable.
Unerupted
Tooth or teeth that have not penetrated into the mouth.
Uniclaim
A universal claim form that can be used instead of waiting for the patient to bring in their form. Some insurance companies may not accept uniclaims.
Unilateral
One-sided.
Usual, Customary and Reasonable (U.C.R.)
The dentists fee that is usually charged, customary in a given area, and reasonable because of special circumstances (difficulty).
Veneer
A layer of tooth colored material attached to the surface.
Virgin Teeth
Teeth that have no decay or fillings.
Waiver of Deductible
When the deductible does not apply to certain procedures (usually diagnostic & preventive).
Wax-Up
A wax form that is a model of an object to be fabricated.
Wisdom Tooth
The third molar, or eighth tooth from the center of mouth to the back of the mouth. Wisdom teeth are often impacted (obstructed from erupting) and have to be extracted.
X-ray
Radiograph.
Xerostomia
Decreased salivary secretion that produces a dry and sometimes burning sensation of the mouth.
Zygomatic Bone
Quadrangular bone on either side of face that forms the cheek prominence.