You wake up with a toothache. Your first thought: Ouch! Your next thought is: How much will this cost once I sit in the dentist’s chair?
There’s no doubt that dental emergencies can be stressful. The good news is that if you have dental insurance, it will often cover a portion of the cost, says Jonelle Anamelechi, D.D.S. She’s the owner of Children’s Choice Pediatric Dentistry and Orthodontics in Washington, D.C.
Even if you don’t have coverage, some dentists may work with you on a payment plan. Some private dental offices even offer financing for dental work. Patients can also take advantage of using their health spending account (HSA) or flexible spending account (FSA) to pay for dental services.
Here’s a look at some of the most common dental emergencies and how they may be covered by your insurance.
Dental emergency #1: Your child loses a tooth in an accident
What to do: If it’s a permanent tooth, find it, gently rinse it with water, and try to place it back in the socket without touching the root. If you can’t, put it in milk until you can get to the dentist’s office. If you can arrive within 60 minutes, there’s a good chance the doctor will be able to reimplant it, says Dr. Anamelechi.
Even if it’s a baby tooth, and you can find it, it’s still a good idea to keep it in a container covered by milk until you can get to a dentist. “Sometimes people don’t know if it’s a baby tooth or adult tooth that was knocked out,” says Dr. Anamelechi.
Falls are the most common cause of lost teeth, followed by cycling accidents, full-contact sports (ice hockey, football, lacrosse), and assaults, according to the National Center for Biotechnology Information.
Is it covered by your insurance? “Many traumatic procedures are covered by dental at some portion,” says Dr. Anamelechi. However, it really depends on your plan. While she notes that there are times when such an emergency might be covered by your health or dental insurance, dental work isn’t traditionally considered medically necessary.
Dental emergency #2: You wake up with a toothache
What to do: That pain in your tooth might be due to a serious tooth infection or an abscess. If you have a deep cavity, or even a cracked or fractured tooth, the tissues around the root of your tooth can become infected.
This can cause pain and swelling, and if left untreated it can even mean losing your tooth completely, says Daniel Di Cesare, D.M.D. He’s the CEO of Endeavor Dentistry and co-owner of Ironbound Dental, Shore Dental, Livingston Smiles, Marine Dental, and A Perfect Smile Dental Arts in Colts Neck, New Jersey. Bacteria can damage the bone that keeps your tooth attached to your jaw.
If you have a toothache, call your dentist and schedule an appointment. It is possible that you may need a root canal. With this procedure, your dentist removes the tooth’s nerve, cleans inside the tooth and in the areas around the root, and fills the root canal itself with a rubberlike material to protect against future infection.
Is it covered by your insurance? Many dental insurance plans will cover a percentage of the cost of a root canal after your deductible has been met. (The deductible is what you pay out of pocket before your insurance pays the rest.) However, root canal coverage varies from plan to plan.
Dental emergency #3: You lose or crack a crown on your tooth
What to do: If you lose a crown—a cap that completely covers a tooth or dental implant—you’ll want to contact your dentist right away. Even if it’s after hours, you should reach out to your dentist’s office. Because your tooth is exposed, it’s more vulnerable to infection, says Dr. Di Cesare. “We’re seeing more crown cracks since the start of the pandemic, since more people are grinding their teeth,” he explains.
Is it covered by your insurance? It depends on the plan, but your insurance may cover a new crown, unless the crown is less than five years old. “Your insurance company may not cover it twice during that period,” says Dr. Di Cesare. It’s always worth calling your insurance company to double-check.
Dental emergency #4: You chip your tooth
What to do: If you chip a tooth—maybe that candy bar was a little too tough—you’ll want to see your dentist right away.
Is it covered by your insurance? It depends! Yes, a chipped tooth is covered, as long as it’s deemed medically necessary, says Dr. Di Cesare. Your dentist’s office may have to call your insurance company to get approval. Your insurance may cover a percentage of the cost once you’ve met your deductible. If it’s not medically necessary to fix the tooth, double check your dental insurance plan for coverage.
Dental emergency #5: Your jaw is swollen and painful
What to do: If your jaw is hurting, and you’re having difficulty swallowing, breathing, or eating, you’ll want to go to the emergency room or see your dentist as soon as possible. It could be due to a tooth infection or even arthritis (inflammation of joints).
You’ll hear your dentist refer to these joints as temporomandibular joints (TMJ), the two that connect your lower jaw to your skull. You could also be experiencing one of more than 30 temporomandibular disorders, or TMD. These are a group conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement. Your dentist will need to do a physical exam and take x-rays to understand what’s causing your pain.
Is it covered by your insurance? Dental insurance generally covers x-rays at least once a year, says Di Cesare. If your pain is due to TMD, your health insurance may cover some or all the cost for diagnosis and treatment.
Dental emergency #6: You don’t have dental insurance
Take a deep breath and think about signing up for a discount plans. These plans aren’t insurance and don’t pay for services. However, they allow you to pay for services at a reduced rate. Another option would be to call a licensed insurance agent at (800) 642-0607 to discuss what dental plan might work best for you. You can also browse healthmarkets.com to check for available plans.