Dental and Medical Coverage for Periodontal Disease
People with periodontal disease must go to a hygienist, dentist, or periodontist, all of whom could address their disease, before it worsens (Mayo Clinic Staff 2018). According to Michael Roizen, MD, “Periodontal (gum) disease is a bacterial infection of the gums… Early in the infection, periodontal disease is called gingivitis; later on, as the infection gets worse, it is called periodontitis.” As the disease develops and goes throughout the mouth, eventually, the gum and jawbones would “deteriorate to the point that [the patients’] teeth will fall out” (Braden). This disease is also connected to conditions, such heart attacks, type 2 diabetes, strokes, etc. (Roizen). The price of treating the disease varies based on “the severity of the gum infection, degree of receding gums, extent of bleeding gums, x-ray findings and weather [sic] the patient have [sic] gingivitis or periodontal disease” (“Laser Gum Treatment & Cost”). People that need treatments for periodontal disease can utilize their dental and medical insurance.
Dental insurance can cover some treatments for periodontal disease. People should enroll into periodontal insurance, which is dental insurance that covers periodontal care (“Periodontal Insurance”). They may have to pay their deductible before receiving coverage for this care (“Laser Gum Treatment & Cost”). Dental insurance can have different types of benefits for people, such as “full or partial coverage for non-surgical and surgical periodontal treatment,” some coverage for “extra cleanings to prevent gingivitis from progressing to periodontitis,” and “periodontal maintenance coverage for patients who have previously been treated for periodontal disease” (Clements 2016; Roizen). Most plans may categorize “periodontal surgical services” under a “separate periodontal maximum,” which could limit coverage (Clements 2016). PPO dental plans provide partial coverage for deep cleanings and laser gum disease treatment (“Laser Gum Treatment & Cost”). Also, while beneficiaries can receive coverage for medically necessary deep cleaning and surgical procedures, they will not receive coverage if they undergo these procedures “for cosmetic reasons” (“Laser Gum Treatment & Cost”).
Medical insurance can also cover some treatments for periodontal disease and conditions related to the disease. While medical insurance policies usually do not cover procedures related to periodontics, they “may sometimes pay for the periodontal examination and treatment if the patient is undergoing a different surgical procedure included in the plan” (Haney 2018). Some policies provide partial coverage for gum surgery if they categorize the surgery as “a medical procedure” (“Laser Gum Treatment & Cost”). Policies usually do not cover “gum grafting, where [the patients’] periodontist takes tissue from the roof of [their] mouth, and grafts it over exposed roots, or to replace diseased gums” (Haney 2018). In addition, a periodontal, or gum, abscess can stem from periodontitis disease, a deep periodontal pocket, or a weak immune system “unable to fight off infections” (Higuera 2018). Dentists can bill the non-surgical medical treatment, “curettage of periodontal abscesses,” to medical insurance (Taxin 2016).
Both dental and medical insurance can include benefits for treating periodontal disease. Coverage from both sources can help people pay for their treatments.
Braden, Susan. “Everything You Need to Know About Periodontal Disease.” 1Dental.com.
Accessed February 28, 2019. https://www.1dental.com/articles/dental/affordable-dental-care-periodontal-disease/.
Clements, Julie. “Periodontal Care – Importance of Comprehensive Insurance Verification.”
Outsource Strategies International, March 9, 2016.
Haney, Kevin. “Does Private Health Insurance Cover Dental Work?” Growing Family Benefits,
Higuera, Valencia. “Gum Abscess.” healthline, February 26, 2018.
“Laser Gum Treatment & Cost.” Sedation Dentistry. Accessed February 28, 2019.
Mayo Clinic Staff. “Periodontitis.” Mayo Clinic, March 6, 2018.
“Periodontal Insurance.” Dental Insurance Store. Accessed February 28, 2019.
Roizen, Michael. “Does dental insurance cover gum disease (periodontal disease)?” sharecare.
Accessed February 28, 2019. https://www.sharecare.com/health/dental-insurance-plans/does-dental-insurance-cover-gum-disease.
Taxin, Christine. “What makes it medical? A basic guide to medical vs. dental procedures.”
DentistryiQ, June 22, 2016. https://www.dentistryiq.com/articles/2016/06/what-makes-it-medical-a-basic-guide-to-medical-vs-dental-procedures.html.