A smile is one of the features that helps people form their first impression of you. And since you only have one chance to make a first impression, the smile must be perfect. Consequently, like many people, you may need to improve your smile with cosmetic dental procedures to make an excellent first impression.
But will dental insurance pay for cosmetic dentistry? You might be surprised to know that the answer is sometimes yes. Continue reading to understand how and when to optimize your dental insurance benefits to pay for cosmetic procedures.
What Makes a Procedure Cosmetic or Restorative?
Whereas restorative dental procedures are medically necessary, insurance providers deem cosmetic dental procedures elective. Consequently, insurance pays for medically required dental treatments differently than cosmetic dentistry. Usually, insurance will cover all or some restorative dental treatments but will not pay for elective procedures. But most cosmetic dental procedures, like porcelain crowns, dental implants, and tooth veneers, can be conducted for cosmetic and restorative reasons.
So, what makes a dental treatment restorative and not cosmetic?
Insurance providers deem a treatment restorative if it is:
- Medically necessary because of disease or decay.
- Medically necessary because of injury or accident.
- Used for unaesthetic reasons, like altering the mechanics of the patient’s bite or replacing missing teeth.
A procedure is elective or cosmetic if:
- There is no medically necessary reason for conducting the procedure or altering the tooth.
- The underlying tissue or tooth is not decayed, impaired, or injured.
- The procedure is conducted only to enhance the aesthetics of the patient’s smile.
Usually, dental insurance does not cover cosmetic dental treatments that have no medical necessity. However, various situations narrow the distinction between medically required dental procedures and purely cosmetic treatments.
For example, a patient sometimes requires a dental procedure because they were in an accident. However, should the wish for the ultimate results be aesthetically appealing, will that be termed cosmetic or restorative dentistry? The answer is both.
Since the patient medically needs to replace teeth, the treatment will qualify as restorative dentistry. But why would that imply that the patient cannot have an attractive cosmetic outcome, too? Dental insurance providers might cover cosmetic dental procedures if they are medically necessary.
The Procedures Covered By Insurance
First, before discussing what cosmetic procedures are covered by dental insurance, this is how dental insurance works: Regardless of who your dental insurance provider is, most plans pay only a percentage of the cost of treatments that are either medically necessary or preventive.
Cleanings and checkups, which can prevent you from catching gum disease or cavities, could be paid for fully twice a year. Insurance might cover dental fillings, crowns, and other treatments that correct damaged teeth up to fifty to eighty percent.
Many cosmetic dental procedures might not be paid for by dental insurance only because they are elective. That means these procedures are unnecessary for your dental and oral health. For example, you could have a healthy smile lasting an entire lifetime even if you do not undergo a cosmetic dental treatment like porcelain veneers or teeth whitening.
However, specific cosmetic procedures may be partly covered by dental insurance. Particular treatments enhance your smile’s appearance while restoring your dental health. If a cosmetic dental procedure is necessary to correct injured gum (periodontal) tissue or dental tissue, dental insurance should cover the treatment at least partially.
Some of the cosmetic dental procedures that dental insurance can cover include the following:
Dental Crowns
A cosmetic dentist can insert crowns to restore injured, missing, broken, or diseased teeth. Crowns improve your smile’s appearance by covering up the affected tooth. They are customized to match the color of the tooth enamel, so the restored tooth will appear more naturally-looking.
Inlays and Onlays
Also referred to as indirect dental fillings, inlays, and onlays, they are made in a dental lab. They are utilized when a tooth has inadequate structure to hold a filling in place or has mild to moderate decay. The dentist places the inlay directly on the tooth surface if the cusps are undamaged. But if the tooth cusp or a more substantial part of the tooth is damaged, the dentist can use an onlay to cover the entire tooth surface.
Inlays and onlays were once gold-made, but nowadays, they are generally molded in a dental lab from ceramic, porcelain, or composite material and affixed to the affected tooth using adhesive dental cement. These appliances provide anchorage to restore a tooth’s shape, strengthen it, and prevent further deterioration or decay.
Dental Implants
Dental implants replace missing teeth, restoring your smile to one you can be fully confident of. Apart from filling in gaps, implants assist in preserving the bone tissue in the jaw, preventing you from losing more teeth.
The dental implant placement procedure replicates how original teeth are secured to your jaw and gums by their roots and into their sockets. It entails surgically replacing missing tooth roots with metal screw posts.
Once the implant is placed, you can attach a dental bridge or crown over it to fill the space left by the missing teeth you want to replace. Dental implants feel and work like original teeth compared to bridges or removable dentures.
Dental implants are deemed cosmetic since they assist in completing your smile by working as the tooth root for a single dental crown or an entire set of dental crowns forming a bridge. Implants are also fully functional and, therefore, medically necessary, as they make dental crowns work and feel like the original teeth.
Routine Check-Ups
Routine dental check-ups can also be cosmetic because the procedure entails teeth cleaning. Nevertheless, it is often a preventive procedure as it minimizes the likelihood of tooth decay.
Dental professionals recommend seeking dental checkups a minimum of two times a month. But if you have undergone any cosmetic treatment, you need dental check-ups within a brief period. On average, dental check-ups cost approximately $288 and entail different activities like examination, cleaning, and X-rays.
Dental Veneers
Veneers are thin, strong shells that conform to the teeth’s front surfaces. They can be placed to cover a wide array of cosmetic dental problems. For example, they can be placed to conceal the visible surfaces of cracked, chipped, injured, broken, stained, or discolored teeth.
Unlike dental crowns, veneers fit over a tooth’s front surface rather than covering its entirety like a cap.
There are several types of dental veneers, including porcelain, composite, resin, and zirconia veneers. All veneers need the removal of at least some natural tooth enamel, meaning they may be reversible based on the type you select. Mostly, porcelain veneers require replacing every ten or so years.
Dental veneers are usually a 100% elective procedure. That is because veneers are more cosmetic than functional, compared to dental crowns that can change or restore your bite. Veneers cover only the front tooth surface and are mainly utilized on front-facing teeth. However, if the enamel has worn down, the placement of dental veneers can assist in repairing the tooth structure and preventing further damage.
Dental Bonding
Teeth bonding entails applying composite resin to the damaged tooth. The dental professional uses the composite resin material to conceal craze lines, discoloration, and other imperfections because it is tooth-colored. Teeth bonding will alter a tooth’s shape to widen it, lengthen it, or make it more uniform.
Usually, tooth bonding requires replacement every 5-7 years. It does not need the extraction of natural enamel either, meaning it is entirely reversible.
Your dental insurance may entirely or partially cover your dental bonding procedure (based on your plan) if you are undergoing the procedure to correct structural problems such as cracked or chipped teeth. But if you are going through the dental bonding procedure only for cosmetic reasons (for example, to close a small gap between your teeth), many dental insurance providers will not cover it.
Gum Contouring
Some individuals are born with excessive gum tissue. If that is the case, your smile may appear unbalanced or gummy. During the gum contouring procedure, your dental professional will remove excessive gum tissue and reshape the gum line to achieve a more balanced, symmetrical appearance.
Gum contouring can also be conducted during a medically necessary periodontal dental surgery because of injury or infection.
Cosmetic Procedures Not Covered By Dental Procedures
Most dental insurance plans do not cover these procedures:
Teeth Whitening or Bleaching
Dark-colored drinks and foods (such as berries, tea, and coffee) can cause teeth to stain. Professional teeth bleaching or whitening can safely and dramatically lighten your teeth’s shade and brighten your smile. Most dental professionals offer both at-home and in-office teeth whitening and bleaching.
With in-office cleaning, you will be subject to a higher dosage of active bleaching ingredients to acquire visible results quickly. You may have to undergo several sessions to obtain the results you desire. A single in-office teeth whitening session takes approximately 60 minutes to complete.
With at-home whitening, you can buy yourself a dentist-approved whitening kit and use it in the comfort of your home to whiten your teeth. Home whitening products generally come in gel or paste form or sticky strips. At-home teeth whitening or bleaching usually takes several weeks to be effective.
You can also use over-the-counter teeth whitening products such as teeth whitening toothpaste with enamel-bleaching ingredients and dental whitening mouthwash. Most of these products have abrasive charcoal or baking soda ingredients to scrub and absorb teeth stains immediately, particularly if you are a regular coffee or tea drinker or a tobacco smoker. Over-the-counter whitening products may even have low carbide and hydrogen peroxide concentrations (some ingredients are utilized for in-office whitening).
Tooth Contouring
The tooth contouring procedure entails the removal of small amounts of enamel to change the tooth’s shape. Since you only have so much natural tooth enamel, there is a limit to the amount of tooth structure your dental professional can extract. Your dental professional can complete the tooth contouring procedures in one dental visit.
Dental Braces
Dental braces are a form of orthodontic treatment, but some people use them for cosmetic purposes. They refer to metallic restraints fastened on teeth to strengthen and improve a person’s smile. Braces help correct a wide range of dental problems. The ideal time to undergo treatment with braces is during childhood or adolescence. Adults, too, can wear braces, provided they have healthy teeth.
Braces can be worn for several reasons. You are an ideal candidate for dental braces if you have any of the following issues:
- Overcrowded or crooked teeth.
- Inadequate space between teeth or overcrowding.
- Too much space between teeth or gapped teeth.
- Crooked teeth.
- Underbite.
- Overbite.
- Overjet.
- Misaligned teeth.
As you put on braces, they gradually align and straighten your teeth and assist you in having a normal bite. The cost of dental braces varies based on the type.
Other treatments not covered are:
- The initial insertion of veneers, if not medically required, and
- Correcting spaces between teeth when not inflicted by disease, injury, or accident.
However, note that you may be covered under insurance for whitening, orthodontic, or cosmetic services if your group or employer purchased these elective benefits for your dental insurance plan. To determine whether your benefits include these treatment procedures, consulting your benefits administrator is an ideal place to begin.
Check With Your Insurance Provider to See What It Covers
The only way to know 100% whether insurance can cover your cosmetic dental procedure is to contact your dental professional’s office or consult your dental insurer directly. If it does, there has never been an ideal time to undergo that procedure other than immediately.
Find a Reliable Cosmetic Dentist Near Me
If you wish to have a smile makeover by undergoing a cosmetic dental procedure, your first move should be to set up a consultation with your dentist. Once you share your specific needs with the dentist, they will recommend the ideal procedure and inform you whether dental insurance will cover it.
At The Lakewood Dentist, we love it when patients leave our clinic with confident and joyful smiles. If you wish to undergo a cosmetic dental procedure, call us today at 562-423-1441 for a dental evaluation. We strive to create beautiful smiles for every patient.