Glossary of Dental Clinical and Administrative Terms There are many terms used daily by dentists and their staff in the course of delivering care to patients, maintaining patient records and preparing claims. Many terms are familiar, especially to experienced individuals. New dentists and staff, however, may not be as familiar – and over time new terms come into use and old terms are revised for clarity. The ADA's Council on Dental Benefit Programs has included a glossary of dental clinical and administrative terms in each edition of the CDT manual.

• Dental Terminology For Dummies
• Dental Terminology For Receptionist

Although glossary information in the printed CDT Manual serves a legitimate purpose, the online version of the Glossary has the advantage of being readily updated. This online glossary contains the Council's most current set of terms and definitions. Content is based on the CDT 2011-2012 glossary, with some changes (e.g., definitions of inlays and onlays) that came about after the manual was printed. The Council intends to keep this glossary current, and include its contents in the next CDT manual.

Please check this page for the latest information. Updates will continue as long as the terms used by dentists and their staff continue to expand and evolve. Contact Information Telephone: ADA Members, please use the toll-free number on the back of your membership card Direct dial, 312.440.2500 Email: (Words and terms in bold are defined within this glossary. Click a letter to jump to that section.) A 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 or 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 or 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 periradiucular periodontitis.

Abutment: A tooth or implant fixture used as a support for a prosthesis. Abutment crown: Artificial crown also 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. 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.

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. Alternative benefit plan: A plan, other than a traditional (fee-for-service, freedom-of-choice) indemnity or service corporation plan, for reimbursing a participating dentist for providing treatment to an enrolled patient population. Alternative delivery system: An arrangement for the provision of dental services in other than the traditional way (e.g., licensed dentist providing treatment in a fee-for-service dental office). 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. Analgesia: See definition under.

Anatomical crown: That portion of tooth normally covered by, and including, enamel. Ancillary: Subordinate or auxiliary to something or someone else; supplementary. 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. The ADA House of Delegates adopted and has published anesthesia policy and guidelines, which are available online. (PDF).

(PDF). (PDF) Select definitions from the policy and guidelines follow. Please refer to the cited sources for complete and current information. Methods of Anxiety and Pain Control 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. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. 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. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function.

Cardiovascular function may be 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.

Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. 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, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Routes of Administration enteral–any technique of administration in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa (i.e., oral, rectal, sublingual). Inhalation–a technique of administration in which a gaseous or volatile agent is introduced into the lungs and whose primary effect is due to absorption through the gas/blood interface. Parenteral–a technique of administration in which the drug bypasses the gastrointestinal (GI) tract (i.e., intramuscular IM, intravenous IV, intranasal IN, submucosal SM, subcutaneous SC, intraosseous IO.) transdermal–a technique of administration in which the drug is administered by patch or iontophoresis through skin.

Transmucosal – a technique of administration in which the drug is administered across mucosa such as intranasal, sublingual or rectal. Anomaly: deviation from the normal anatomic structure, growth, development or function; an abnormality. ANSI/ADA/ISO: Acronyms for organizations that administer or develop national and international standards. ANSI (American National Standards Institute) is the national organization established for the purpose of accrediting and coordinating product standards development activities in the United States.

It is not a US government agency. The ADA (American Dental Association) is a national standards development organization accredited by ANSI. ISO (International Organization for Standardization) is a worldwide federation of national standards bodies. The results of ISO technical work are published as International Standards. Efforts in the United States directed toward the development of ISO standards are channeled through ANSI. ANSI/ADA/ISO Tooth Numbering System: See. Anterior: Mandibular and maxillary centrals, laterals and cuspids.

The designation of permanent anterior teeth in the include teeth 6 through 11 (maxillary), and 22 through 27 (mandibular); primary teeth in the Universal/National tooth numbering system 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. Any willing provider: Legislation that requires managed care organizations (MCOs), such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any providers who are willing to meet the terms of the contract.

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. Artificial crown: Restoration covering or replacing the major part, or the whole of the clinical crown of a tooth, or implant. 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. Attending dentist's statement: An obsolete term for the ADA Dental Claim Form. See claim form.

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. Avulsion: Separation of tooth from its socket due to trauma. B 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. Some examples of potential bad faith insurance practices include: evaluating claims based on standards which are significantly at variance with the standards of the community; failure to properly investigate a claim for care; and unreasonably and purposely delaying and/or withholding payment of a claim. 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 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, education or anxiety relief techniques. Beneficiary: A person who is eligible for benefits under a dental benefit contract.

See also, and. 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. Benefit plan summary: The description or synopsis of employee benefits as required by that is to be distributed to the employees. 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.

Dental Terminology For Dummies

These agents are added to graft material or used alone to effect acceleration of healing or regeneration in hard and soft tissue surgical procedures. 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, but it may be superseded by a court order such as a divorce agreement. Bitewing radiograph: Interproximal radiographic view of the coronal portion of the tooth/teeth.

A form of dental radiograph that may be taken with the long axis of the image oriented either horizontally or vertically, 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, sometimes in combination with the application of heat and light. Bleaching has been achieved through short and long term applications of pastes or solutions containing various concentrations of hydrogen peroxide and carbamide peroxide. Normally applied externally to teeth; may be used internally for endodontically treated teeth. Bonding: Process by which two or more components are made integral by mechanical and/or chemical adhesion at their interface. Bounded tooth space: See.

Bruxism: The 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. C 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.

Carious lesion: A caused by caries. Carrier: See. Case management: The monitoring and coordination of treatment rendered to patients with specific diagnoses or requiring high cost or extensive services. May include complex treatment plans or discussion between multiple practitioners. A process of identifying patients with special health care needs, developing a healthcare strategy that meets those needs, and coordinating and monitoring the care, with the ultimate goal of achieving the 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, 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: see. 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. Classification of Metals: See (source: ADA Council on Scientific Affairs). 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. 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 of the covered dental service and the beneficiary pays the remainder of the amount due the dentist. Percentages vary and may apply to table of allowance plans; maximum allowable benefit plans and direct reimbursement programs.

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:A n 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 (source: FDA/ADA radiographic guidelines). 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.

Consolidated Omnibus Budget Reconciliation Act (COBRA): Legislation relative to mandated benefits for all types of employee benefit plans. The most significant aspects within this context are the requirements for continued coverage for employees and/or their dependents for 18 months who would otherwise lose coverage (30 months for dependents in the event of the employee's death). Consultation: In a dental setting, a diagnostic service provided by a dentist where the dentist, patient, or other parties (e.g., another dentist, physician, or legal guardian) 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 of contracts include: 1) contracts between a dental benefit organization and an individual dentist to provide dental treatment to members of an alternative benefit plan. These contracts define the dentist's duties both to beneficiaries of the dental benefit plan and the dental benefit organization, and usually define the manner in which the dentist will be reimbursed; and 2) contracts between a dental benefit organization and a group plan sponsor.

These contracts typically describe the benefits of the group plan and the rates to be charged for those benefits. 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 practice: A dental practice or organization that has a contractual arrangement with an insurer for the provision of services under an insurance contract.

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 so as to act as a substructure onto which other components can be added to give final form to a restoration or prosthesis. It can be used as a definitive restoration or as part of a transfer procedure. 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 source: ADA policy 'Cosmetic Dentistry (1976:850). 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. Charges are subject to any contractual agreements, exclusions and limitations. 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: An artificial replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure, or is placed on a dental implant.

It is made of metal, ceramic or polymer materials or a combination of such materials. It is retained by luting cement or mechanical means. (American College of Prosthodontics; The Glossary of Prosthodontic Terms).

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 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. D debridement: Removal of subgingival and/or supragingival plaque and calculus which obstructs the ability to perform an evaluation. Decay: The lay term for carious lesions in a tooth; decomposition of tooth structure.

Deciduous: Having the property of falling off or shedding; a term used to describe the primary teeth. Deductible: The amount of dental expense for which the beneficiary is responsible before a third party will assume any liability for payment of benefits. Deductible may be an annual or one-time charge, and may vary in amount from program to program. Deep sedation: See definition under. Dental assessment: A limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.

Dental benefit organization: Any organization offering a dental benefit plan. Also known as dental plan organization. Dental benefit program: The specific dental benefit plan being offered to enrollees by the sponsor. Dental enrollment credentialing: A formal process that defines the standards and requirements for participation in third-party programs.

Dental Terminology For Receptionist

The process verifies professional qualifications in order to allow licensed dentists to provide services to members of these programs. Dental home: The ongoing relationship between the dentist who is the Primary Dental Care Provider and the patient, which includes comprehensive oral health care, beginning no later than age one, pursuant to ADA policy. Dental prepayment: A method of financing the cost of dental services prior to receiving the services. Dental prophylaxis: See.

Dental service corporation: A legally constituted, not-for-profit organization that negotiates and administers contracts for dental care. Delta Dental Plans and Blue Cross & Blue Shield Plans are such organizations. Dentin: Hard tissue which forms the bulk of the tooth and develops from the dental papilla and dental pulp, and in the mature state is mineralized. Dentistry: The evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law. Dentition: The teeth in the dental arch. Adolescent dentition –In orthodontic coding, refers to the stage of permanent dentition prior to cessation of growth. Deciduous dentition –Refers to the deciduous or primary teeth in the dental arch.

Permanent dentition (adult dentition) – Refers to the permanent teeth in the dental arch. Transitional dentition–Refers to a mixed dentition; begins with the appearance of the permanent first molars and ends with the exfoliation of the deciduous teeth. Denture: An artificial substitute for some or all of the natural teeth and adjacent tissues.

Denture base: That part of a denture that makes contact with soft tissue and retains the artificial teeth. Dependents: Generally spouse and children of covered individual, as defined by terms of the dental benefit contract. Diagnostic cast: A replica of teeth and adjoining tissues created digitally or by a casting process (e.g., plaster into an impression). “Study model” is another term used for such a replica. Diagnostic casts have various uses, most often the examination of relationships between oral tissues to determine how those relationships will effect form and function of a dental restoration or appliance being planned or to determine whether tissue treatment or modification might be necessary before a pre-definitive impression is taken to ensure optimal performance of the planned restoration or appliance. Diagnostic imaging: A visual display of structural or functional patterns for the purpose of diagnostic evaluation. May be photographic or radiographic.

Diastema: A space, such as one between two adjacent teeth in the same dental arch. Direct pulp cap: Procedure in which the exposed vital pulp is treated with a therapeutic material, followed with a base and restoration, to promote healing and maintain pulp vitality. Direct reimbursement: A self-funded program in which the individual is reimbursed based on a percentage of dollars spent for dental care provided, and which allows beneficiaries to seek treatment from the dentist of their choice.

Direct restoration: A restoration fabricated inside the mouth. Discectomy: Excision of the intra-articular disc of a joint. Displaced tooth: A partial evulsion of a tooth; may be mesial, distal, facial, lingual or incisal. Distal: Surface or position of a tooth most distant from the median line of the arch.

Downcoding: A practice of third-party payers in which the benefit code has been changed to a less complex and/or lower cost procedure than was reported, except where delineated in contract agreements. Dressing: Medication, bandages or other therapeutic material applied to a wound. DRGs (diagnosis related groups): A system of classifying hospital patients on the basis of diagnosis, consisting of distinct groupings. A DRG assignment to a case is based on the patient's 1) principal diagnosis; 2) treatment procedures performed; 3) age; 4) gender; and 5) discharge status. Dry socket: Localized inflammation of the tooth socket following extraction due to infection or loss of blood clot; osteitis. Dual choice program: A benefit package from which an eligible individual can choose to enroll in either an alternative dental benefit program or a traditional dental benefit program.

E Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT): A federal program that provides comprehensive health care for children through periodic screenings, diagnostic and treatment services. Edentulous: Without teeth. Eligibility date: The date an individual and/or dependents become eligible for benefits under a dental benefit contract. Often referred to as effective date.

Eligible person: See. Employment Retirement Income Security Act (ERISA): A federal act, passed in 1974, which established new standards and reporting/disclosure requirements for employer-funded pension and welfare benefit programs. To date, self-funded health benefit plans operating under ERISA have been held to be exempt from most state insurance laws, although the courts have held that the states can regulate the medical care provided under such plans, as by requiring mandatory review of adverse HMO determinations. Enamel: Hard calcified tissue covering dentin of the crown of tooth. Endodontics: Endodontics is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. Endodontist: A dental specialist who limits his/her practice to treating disease and injuries of the pulp and associated periradicular conditions.

Enrollee: Individual covered by a benefit plan. Enteral: See definition under.

Entity: Something that exists as a particular and discrete unit. Persons and corporations are equivalent entities under the law.

Equilibration: Reshaping of the occlusal surfaces of teeth to create harmonious contact relationships between the upper and lower teeth; also known as occlusal adjustment. Established patient: A patient who has received professional services from a dentist or another dentist of the same specialty who belongs to the same group practice, within the past three years, subject to state laws. Evaluation: The patient assessment that may include gathering of information through interview, observation, examination, and use of specific tests that allows a dentist to diagnose existing conditions. Please refer to specific oral evaluation code descriptors for more complete definitions. Evidence-Based Dentistry: An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific data relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. Evulsion: Separation of the tooth from its socket due to trauma.

Excision: Surgical removal of bone or tissue. Exclusions: Dental services not covered under a dental benefit program. Exclusive Provider Organization (EPO): A type of preferred provider organization under which employees must use providers from the specified network of dentists to receive coverage; there is no coverage for care received from a non-network provider except in an emergency situation.

Exfoliative: Refers to a thin layer of epidermis shed from the surface. Exostosis: Overgrowth of bone.

Expiration date: In dentistry, the date on which the dental benefit contract expires; the date an individual ceases to be eligible for benefits. Explanation of benefits: A written statement to a beneficiary from a third-party payer, after a claim has been reported, indicating the benefit/charges covered or not covered by the dental benefit plan. Extended care facility: A facility such as a nursing home which is licensed to provide 24-hour nursing care service in accordance with state and local laws.

Several levels of care may be provided—skilled, intermediate, custodial, or any combination. Extension of benefits: Extension of eligibility for benefits for covered services, usually designed to ensure completion of treatment commenced prior to the expiration date. Duration is generally expressed in terms of days. Extraoral: Outside the oral cavity. Extracoronal: Outside the crown of a tooth.

Extraction: The process or act of removing a tooth or tooth parts. Exudate: A material usually resulting from inflammation or necrosis that contains fluid, cells, and/or other debris. F facial: The surface of a tooth directed toward. The cheeks or lips (i.e., the buccal and labial surfaces) and opposite the lingual surface. Family deductible: A deductible that is satisfied by combined expenses of all covered family members.

For example, a program with $25 deductible may limit its application to a maximum of three deductibles, or $75 for the family, regardless of the number of family members. Fascial: Related to a sheet or band of fibrous connective tissue enveloping, separating or binding together muscles, organs and other soft tissue structures of the body. Fee: The monetary value ascribed to a procedure delivered by a dentist to a patient. There are various terms that include the word or concept of a fee that are defined as follows. Full fee–The fee for a service that is set by the dentist, which reflects the costs of providing the procedure and the value of the dentist's professional judgment. A contractual relationship does not change a dentist's full fee.

It is always appropriate to report the full fee for each service reported to a third party payer. Maximum plan benefit – The reimbursement level determined by the administrator of a dental benefit plan for a specific dental procedure.

This may vary widely by geographic region or by benefit plans within a region. Usual fee–The fee which an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify this fee based on the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances. Usual, Customary and Reasonable Fees–These are three separate terms that are often incorrectly used interchangeably, synonymously or as a single term abbreviated as 'UCR' when describing dental benefit plans. Definitions of these three terms are posted online. Fee-for-service–A method of reimbursement by which the dentist establishes and expects to receive his or her full fee for the specific service(s) performed.

Fee schedule–A list of the charges established or agreed to by a dentist for specific dental services. Filling: A lay term used for the restoring of lost tooth structure by using materials such as metal, alloy, plastic or porcelain. Fixed partial denture: A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teeth or implant replacements. Flexible benefits: A benefit program in which an employee has a choice of credits or dollars for distribution among various benefit options, e.g., health and disability insurance, dental benefits, childcare, or pension benefits.

Flexible spending account: Employee reimbursement account primarily funded with employee designated salary reductions. Funds are reimbursed to the employee for health care (medical and/or dental), dependent care, and/or legal expenses, and are considered a nontaxable benefit. Foramen: Natural opening into or through bone. Fracture: The breaking of a part, especially of a bony structure; breaking of a tooth. Franchise dentistry: Refers to a system for marketing a dental practice, usually under a trade name, where permitted by state laws. In return for a financial investment or other consideration, participating dentists may also receive the benefits of media advertising, a national referral system, and financial and management consultation. Freedom of choice: The concept that a patient has the right to choose any licensed dentist to deliver his or her oral health care without any type of coercion.

Frenum: Muscle fibers covered by a mucous membrane that attaches the cheek, lips and or tongue to associated dental mucosa. Full fee: see.

Furcation: The anatomic area of a multirooted tooth where the roots diverge. G gate keeper system: A managed care concept used by some alternative benefit plans, in which enrollees select a primary care dentist, usually a general practitioner or pediatric dentist, who is responsible for providing non-specialty care and managing referrals, as appropriate, for specialty and ancillary care. General anesthesia: See. Genetic test: Laboratory technique used to determine if a person has a genetic condition or disease or is likely to get the disease.

Gingiva: Soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted. Gingivectomy: The excision or removal of gingiva.

Gingivitis: Inflammation of gingival tissue without loss of connective tissue. Gingivoplasty: Surgical procedure to reshape gingiva. Glass ionomer: Polyelectrolyte cement in which the solid powder phase is a fluoride-containing aluminosilicate glass powder to be mixed with polymeric carboxylic acid. The cement can be used to restore teeth, fill pits and fissures, lute and line cavities. It is also known as glass polyalkenoate cement, ionic polymer cement, polyelectrolyte cement.

Gold foil: Thin pure gold leaf that is self adhering when condensed into a cavity. One of the oldest restorative techniques, it is compacted or condensed into a retentive cavity form. Graft: A piece of tissue or alloplastic material placed in contact with tissue to repair a defect or supplement a deficiency.

Allograft–Graft of tissue between genetically dissimilar members of the same species. Donors may be cadavers, living related or living unrelated individuals. Also called allogenic graft or homograft. Autogenous graft–Taken from one part of a patient's body and transferred to another. Guided tissue regeneration (GTR): A surgical procedure that uses a barrier membrane placed under the gingival tissue and over the remaining bone support to enhance regeneration of new bone. H Health Care Financing Administration (HCFA): See.

Health Insurance Portability and Accountability Act (HIPAA) of 1996: A federal law that includes Administrative Simplification Provisions that require all health plans, including ERISA, as well as health care clearinghouses and any dentist who transmits health information in an electronic transaction, to use a standard format. The HIPAA standard electronic dental claim also requires use of the ADA's Code on Dental. Procedures and Nomenclature code set. Paper transactions are not subject to this requirement. Health Maintenance Organization (HMO): A legal entity that accepts responsibility and financial risk for providing specified services to a defined population during a defined period of time at a fixed price.

An organized system of health care delivery that provides comprehensive care to enrollees through designated providers. Enrollees are generally assessed a monthly payment for health care services and may be required to remain in the program for a specified amount of time. Healthcare Provider Taxonomy: The code that identifies the type of health care provider involved in furnishing services to beneficiaries. Hemisection: Surgical separation of a multi-rooted tooth. Histopathology: The study of disease processes at the cellular level.

Hold harmless clause: A contract provision in which one party to the contract promises to be responsible for liability incurred by the other party. Hold harmless clauses frequently appear in the following contexts: 1) Contracts.

Between dental benefit organizations and an individual dentist often contain a promise by the dentist to reimburse the dental benefit organization for any. Liability the organization incurs because of dental treatment provided to beneficiaries of the organization's dental benefit plan. This may include a promise to pay the dental benefit organization's attorney fees and related costs; and 2) Contracts between dental benefit organizations and a group plan sponsor may include a. Promise by the dental benefit organization to assume responsibility for disputes between a beneficiary of the group plan and an individual dentist when. The dentist's charge exceeds the amount the organization pays for the service on behalf of the beneficiary. If the dentist takes action against the patient to recover the difference between the amount billed by the dentist and the amount paid by the organization, the dental benefit organization will take over the defense of the claim and will pay any judgments and court costs.

Homologous: See. Hyperplastic: Pertaining to an abnormal increase in the number of cells in an organ or a tissue with consequent enlargement.

I imaging, diagnostic: This would include, but is not limited to, CAT scans, MRIs, photographs, radiographs, etc. Immediate denture: Prosthesis constructed for placement immediately after removal of remaining natural teeth. Impacted tooth: An unerupted or partially erupted tooth that is positioned against another tooth, bone, or soft tissue so that complete eruption is unlikely. Implant: Material inserted or grafted into tissue. Dental implant – A device specially designed to be placed surgically within or on the mandibular or maxillary bone as a means of providing for dental replacement. Endosteal ( endosseous ): Device placed into the alveolar and basal bone of the mandible or maxilla and transecting only one cortical plate.

Eposteal ( subperiosteal ): Subperiosteal implant that conforms to the superior surface of an edentulous area of alveolar bone. Transosteal ( transosseous ): Device with threaded posts penetrating both the superior and inferior cortical bone plates of the mandibular symphysis and exiting through the permucosa. It may be intraoral or extraoral.

Implant index: See. Implantation, tooth: Placement of an artificial or natural tooth into an alveolus.

Inappropriate fee discounting practices: Intentionally engaging in practices which would force a dentist, who does not have a participating provider agreement, to accept discounted fees or be bound by the terms and conditions set forth in the participating provider contract.