Educación del Paciente

Glosario Dental ADA

Explicaciones claras y sencillas para términos dentales comunes y procedimientos para ayudarte a navegar tu viaje hacia la salud bucal con confianza.

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A

Abscess

Acute or chronic localized inflammation, probably with a collection of pus, associated with tissue destruction and, frequently, swelling; usually secondary to infection.

Abutment

A term with different meanings depending on the clinical scenario.

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.

Acetaminophen

A common over-the-counter medicine used to relieve pain and reduce fever.

Acid Etching

Use of an acidic chemical substance to prepare the tooth enamel and or dentin surface to provide retention for bonding.

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.

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. See dental benefit organization: third-party administrator.

Adolescent Dentition

Refers to the stage of permanent dentition prior to cessation of skeletal growth.

Adult Dentition

See definition of permanent dentition.

Allogenic

Belonging to the same species, but genetically different. See graft.

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.

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 amalgam.

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.

Alveolar

Referring to the bone to which a tooth is attached.

Alveolar Bone

The part of the jawbone that surrounds and supports the roots of the teeth.

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 anesthesia.

Analgesia

the diminution or elimination of pain.

Anatomical Crown

That portion of tooth normally covered by, and including, enamel.

Ancillary

Subordinate or auxiliary to something or someone else; supplementary.

Anesthesia

A procedure that controls the patient's level of anxiety or pain. Delivery of an anesthesia inducing agent by a dentist or other health care practitioner is regulated by state dental boards. See ADA anesthesia policy and guidelines (PDF). The following terms concerning methods of anxiety and pain control are found in CDT code nomenclatures and descriptors:

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 Specification No. 3950.

Mandibular and maxillary centrals, laterals and cuspids. The codes for anterior teeth in the Universal/National Tooth Numbering System are 6 through 11 (maxillary), and 22 through 27 (mandibular) for permanent dentition; C through H (maxillary), and M through R (mandibular) for primary dentition. This is also a term that, in general, refers to the teeth and tissues located towards the front of the mouth.

Anxiolysis

the diminution or elimination of anxiety.

Anxiolysis

See definition under anesthesia.

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 on patient records and on claims submitted 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.

Attachment

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 graft.

Autogenous Graft

Taken from one part of a patient's body and transferred to another.

Avulsion

Separation of tooth from its socket due to trauma. See evulsion.

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. See prompt payment laws.

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 non-autogenous 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 papoose board, education or anxiety relief techniques.

Beneficiary

A person who is eligible for benefits under a dental benefit contract. See also covered person, insured, and member.

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 Summary Plan Description.

Benefit Plan Summary

The description or synopsis of employee benefits as required by ERISA 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. 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.

Bitewing X-ray

A type of dental X-ray used to show the crowns of the upper and lower teeth in a specific area of the mouth.

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 tooth bounded space.

Bridge

See fixed partial denture.

Bruxism

The parafunctional 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; must be part of the patient’s record and included on the claim submission.

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 cavity caused by caries.

Cast

See diagnostic cast or study model.

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, State Children’s Health Insurance Program (SCHIP), HIPAA, 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 porcelain/ceramic.

Chairside

See definition under direct.

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.

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 metals, classification of

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

Re-approximation of fractured bone segments without direct visualization.

Closed Reduction

Re-approximation of fractured bone segments without direct visualization. open reduction: Re-approximation of fractured bony segments accomplished through cutting the adjacent soft tissues and bone to allow direct access.

Cms

See Centers for Medicare and Medicaid Services.

Cob

See coordination of benefits.

Code on Dental Procedures and Nomenclature (CDT 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 CDT Code is printed in a manual titled Current Dental Terminology (CDT).

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 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). See resin.

Compound Fracture

Break in bone which is exposed to external contamination.

Comprehensive Oral [evaluation](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#eval): See evaluation.

Conscious Sedation

See definition of minimal sedation under anesthesia.

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 a 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 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

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.

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

Dentists’ fees that 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. Reimbursement amounts are subject to any contractual agreements, exclusions and limitations.

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). See also abutment crown, anatomical crown, and clinical crown.

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 Code on Dental Procedures and Nomenclature and other information pertinent to patient record keeping and claim preparation by a dental office; published biennially (e.g., CDT Coding Manual).

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.

Cytology

The study of cells, including their anatomy, chemistry, physiology and pathology.

D

Debridement

Removal of subgingival and/or supragingival plaque and calculus.

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. See transitional dentition.

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. See family deductible.

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.

Deep Sedation

See definition under anesthesia.

Definitive Prosthesis

Prosthesis to be used over an extended period of time.

Dental [prophylaxis](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#proph): See prophylaxis.

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. 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 Implant

A device specially designed to be placed surgically within or on the mandibular or maxillary bone as a means of providing location and support for dental replacement prosthesis.

Dental Prepayment

A method of financing the cost of dental services prior to receiving the services.

Dental Prosthesis

Any device or appliance replacing one or more missing teeth and/or, if required, associated structures. (This is a broad term which includes abutment crowns and abutment inlays/onlays, bridges, dentures, obturators, gingival prostheses.)

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.

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.

Denture Framework

Rigid frame of a denture that supports the denture components. It provides rigidity, retention, and support for the artificial teeth and acrylic portions.

Denture Substructure

Reinforcement material added to the acrylic portion of a denture.

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

A procedure where the service is delivered completely in the patient’s oral cavity and without the use of a dental laboratory.

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 of any type (e.g., “filling”; crown) fabricated inside the mouth.

Discectomy

Excision of the intra-articular disc of a joint.

Displaced Tooth

A partial evulsion of a tooth.

Distal

Surface or position of a tooth most distant from the median line of the arch.

Downcoding

A third-party payer claim adjudication process that uses a procedure code that is different from the one reported on the claim so that the reimbursement amount is less than would be allowed for the submitted code.

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. ECF: See extended care facility.

Ectopic

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 beneficiary.

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.

Endosteal (endosseous)

Device placed into the alveolar and basal bone of the mandible or maxilla and transecting only one cortical plate.

Enrollee

Individual covered by a benefit plan. See beneficiary.

Enteral

any technique of administration in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa (i.e., oral, rectal, sublingual).

Enteral

See definition under anesthesia.

Entity

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

Eob

See explanation of benefits.

Eposteal (subperiosteal)

Subperiosteal implant that conforms to the superior surface of an edentulous area of alveolar bone.

Epsdt

See Early and Periodic Screening, Diagnosis and Treatment Program.

Equilibration

Reshaping of the occlusal surfaces of teeth to create harmonious contact relationships between the upper and lower teeth; also known as occlusal adjustment.

Erisa

See Employment Retirement Income Security Act.

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 (D01xx) 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. See avulsion.

Excision

Surgical removal of bone or tissue.

Exclusions

Dental services not covered under a dental benefit program.

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. See torus.

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 adjudicated, indicating the 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.

Extracoronal

Outside the crown of a tooth.

Extraction

The process or act of removing a tooth or tooth parts.

Extraoral

Outside the oral cavity.

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](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#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. See deductible.

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, 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 describe fees. The ADA recommends not using this term. 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.

Female Component

The concave component of an attachment that fits into the projecting component of an attachment. See semi and precision attachment.

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 natural teeth or their implant replacements.

Fixed Prosthesis

Non-removable dental prosthesis which is solidly attached to abutment teeth, roots or implants.

Fixed-removable Prosthesis

Combined prosthesis, one or more parts of which are fixed, and the other(s) attached by devices which allow their detachment, removal and reinsertion by the dentist only.

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. See cafeteria plans; flexible spending account.

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.

Fluoride

A natural mineral that helps prevent tooth decay by making the enamel more resistant to acid attacks.

Follow-up Care

Any care provided after a procedure; a service whose nature, scope and timing is determined by the clinical and professional judgment of the dentist.

Foramen

Natural opening into or through bone.

Fracture

The breaking of a part, especially of a bony structure; breaking of a tooth. See simple fracture and compound fracture.

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](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#fee): see fee.

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](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#anesthesia): See definition under anesthesia.

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.

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

A restorative material listed as a “resin” in the CDT manual’s “Classification of Materials” that may be used to restore teeth, fill pits and fissures, lute and line cavities.

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.

Gtr

See guided tissue regeneration.

Guidance Prosthesis

Synonymous terminology: guidance device, guidance appliance. A prosthesis which guides the remaining portion of the mandible, left after a partial resection, into a more normal relationship with the maxilla. This allows for some tooth-to-tooth or an improved tooth contact, it may also artificially replace missing teeth and thereby increase masticatory efficiency.

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.

Gum Disease

An infection of the tissues that support the teeth, ranging from gingivitis to advanced periodontitis.

H

Halitosis

The professional term for chronic bad breath.

Health Care Financing Administration (hcfa)

See Centers for Medicare and Medicaid Services. 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 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.

Hemisection

Surgical separation of a multi-rooted tooth.

Hipaa

See Health Insurance Portability and Accountability Act of 1996.

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

Similar in structure. See graft.

Hygienist

A licensed dental professional who focuses on preventative care, including cleanings and patient education.

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.

Implant Case

the fixture that is placed between the implant body (aka implant post) and the restorative prosthesis (e.g., single crown; denture).

Implant Index

See radiographic/surgical implant index.

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.

Incentive Program

A dental benefit program that pays an increasing share of the treatment cost, provided that the covered individual utilizes the benefits of the program during each incentive period (usually a year) and receives the treatment prescribed. For example, a 70%–30% copayment program in the first year of coverage may become an 80%–20% program in the second year if the subscriber visits the dentist in the first year as stipulated in the program. Most frequently, there is a corresponding percentage reduction in the programs copayment level if the covered individual fails to visit the dentist in a given year (but never below the initial copayment level).

Incisal

Pertaining to the biting edges of the incisor and cuspid teeth.

Incisal Angle

One of the angles formed by the junction of the incisal and the mesial or distal surfaces of an anterior tooth; called the mesioincisal and distoincisal angle respectfully.

Incision and Drainage

The procedure of incising a fluctuant mucosal lesion to allow for the release of fluid from the lesion.

Incisor

A tooth for cutting or gnawing; located in the front of the mouth in both jaws.

Indemnification Schedule

See table of allowancesada.org/publications/cdt/glossary-of-dental-clinical-terms#tableofallowances).

Indemnity Plan

A non-network dental plan that reimburses the member or dentist at a certain percentage of charges for services rendered, often after a deductible has been satisfied. Indemnity plans typically place no restrictions on which dentist a member may visit. Indemnity plans are also referred to as fee-for-service plans.

Indigent

Those individuals whose income falls below the poverty line as defined by the federal Office of Management and Budget (OMB).

Indigent

Those individuals whose income falls below the poverty line as defined by the federal Office of Management and Budget (OMB).

Indirect

A procedure that involves activity that occurs away from the patient, such as creating a restorative prosthesis. An indirect procedure is also known as a laboratory procedure, and the laboratory’s location can be within or separate from the dentist’s practice.

Indirect Pulp Cap

Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin.

Indirect Restoration

A restoration fabricated outside the mouth.

Individual Practice Association (ipa)

A legal entity organized and governed by individual participating dentists for the primary purpose of collectively entering into contracts to provide dental services to enrolled populations.

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.

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.

Inhalation

See definition under anesthesia.

Inlay

A fixed intracoronal restoration; a fixed dental restoration made outside of a tooth to correspond to the form of the prepared cavity, which is then luted to the tooth. (Glossary of Prosthodontic Terms, 9th Edition; ©2019 Academy of Prosthodontics).

Insured

Person covered by the program. See beneficiary.

Insurer

The party in an insurance contract that promises to pay a benefit if a specified loss occurs. Usually an insurance company.

Intentional Reimplantation

The intentional removal, radicular repair and replacement of a tooth into its alveolus.

Interim Prosthesis

A provisional prosthesis designed for use over a limited period of time, after which it is to be replaced by a more definitive restoration.

Interproximal

Between the adjoining surfaces of adjacent teeth in the same arch.

Intracoronal

Referring to "within" the crown of a tooth.

Intraoral

Inside the mouth.

Intravenous

a technique of administration in which the anesthetic agent is introduced directly into the patient’s venous system.

Intravenous

See definition under anesthesia.

ISO Tooth Numbering System

See Specification No. 3950.

J

Jaw

A common name for either the maxilla or the mandible.

Jawbone

The bone that supports the teeth and forms the structure of the mouth.

Jo

Code that identifies a tooth numbering schema that may be used on a claim submission. Identifies the ANSI/ADA/ISO Tooth Numbering System, a HIPAA standard code set not commonly used in the United States, but used in many other countries. See Specification No. 3950.

Jp

Code that identifies the tooth numbering schema used on a claim submission. Designation of Identifies the Universal/National Tooth Numbering System on the dental claim form., a HIPAA standard that is most commonly used in the United States.

K

Keeper or Keeper Assembly

Any one of various devices used for keeping something in position (Glossary of Prosthodontic Terms, 9th Edition; © Academy of Prosthodontics); see precision attachment.

Keratin

A protein present in all cuticular structures of the body, such as hair, epidermis and horns.

Keratinized Gingiva

The oral surface of the gingiva extending from the mucogingival junction to the gingival margin. In gingival health, the coronal portion of the sulcular epithelium may also be keratinized.

L

Labial

Pertaining to or around the lip. See facial.

Laboratory

See indirect

Laminate Veneer

A thin covering of the facial surface of a tooth usually constructed of tooth colored material used to restore discolored, damaged, misshapen or misaligned teeth.

Laser Dentistry

The use of lasers to treat various dental conditions, providing more precise and often less painful treatment.

Least Expensive Alternative Treatment (leat)

Contractual language that allows a plan only to pay for the least expensive treatment if there is more than one way to treat a condition.

Lesion

An injury or wound; area of diseased or abnormal tissue.

Liability

An obligation to pay an amount in money, goods, or services to another party.

Limitations

Restrictive conditions stated in a dental benefit contract, such as age, length of time covered, and waiting periods, which affect an individual’s or group’s coverage. The contract may also exclude certain benefits or services, or it may limit the extent or conditions under which certain services are provided. See exclusions.

Limited Oral [evaluation](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#eval): See evaluation

Line Angle

An angle formed by the junction of two planes; used to designate the junction of two surfaces of a tooth, or of two walls of a tooth cavity preparation.

Lingual

Pertaining to or around the tongue; surface of the tooth directed toward the tongue; opposite of facial.

Local [anesthesia](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#anesthesia): See definition under anesthesia.

Local Anesthesia

the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.

Locus

A site or location.

Loss Ratio for Dental Plans

the proportion of premium revenues that is spent on clinical services, specifically: The numerator is the sum of (1) the amount paid for clinical dental services provided to enrollees and (2) the amount paid to providers on activities that improve oral health through clinical services for plan enrollees. The denominator is the total amount of premium revenue, excluding only (1) federal and state taxes, (2) licensing and regulatory fees paid, and (3) any other payments required by federal law. Numerator definitions: 1. funds withheld from providers for any reason 2. over payments recovered from providers 3. any cost-sharing amount paid by the plan enrollee 4. adjustments recouped pursuant to coordination of benefit policies 5. payments recovered through fraud reduction efforts 6. share of expenses that are for lines of business or products other than those being reported, including but not limited to, those that are for or benefit self-funded plans issued by the same carrier 1. directed toward individual enrollees, i.e., plan participants or incurred for the benefit of specified segments of plan enrollees to improve access and outcomes 2. based on clearly defined, objectively measurable, evidence-based criteria issued by the ADA or nationally recognized healthcare quality organizations 1. are designed primarily to control or contain costs 2. are expenditures towards community benefit or persons not enrolled in the plan 3. were paid for with grant money or other funding separate from premium revenue 4. can be billed or allocated by a provider for care delivery and which are, therefore, reimbursed as clinical services Denominator definitions: Overhead administrative cost expenditures that should not be included in the numerator or deducted from the denominator include expenditures related to: 1. are available broadly to the public, e.g., activities supporting water fluoridation 2. reduce geographic, financial, or cultural barriers to accessing health services or 3. advance health care knowledge through education or research that benefits the public

Lumineers

A specific brand of very thin porcelain veneers used to enhance the appearance of teeth.

M

Maintenance, Periodontal

Therapy for preserving the state of health of the periodontium.

Malar

Pertaining to the cheek or cheek bone; see zygomatic bone.

Male Component

The projecting part of an attachment that fits into the concave component of an attachment. See semi and precision attachment.

Malignant

Having the properties of dysplasia, invasion, and metastasis.

Malocclusion

Improper alignment of biting or chewing surfaces of upper and lower teeth.

Managed Care

Any contractual arrangement where payment or reimbursement and/or utilization are controlled by a third party. The term “managed care” refers to a cost containment system that directs the utilization of health benefits by: a.) restricting the type, level and frequency of treatment; b.) limiting the access to care; and c.) controlling the level of reimbursement for services. 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.

Mandible

The lower jaw.

Mandibular Resection Prosthesis

A mandibular resection prosthesis is fabricated on a resected mandible that has been reconstructed due to tumor or trauma. This prosthesis can be tissue supported, tooth supported or implant supported. Mandibular continuity is maintained or restored. This prosthesis aids in masticatory function while providing support for the lip and cheek. (American Academy of Maxillofacial Prosthetics and the American College of Prosthodontists).

Maryland Bridge

A resin-bonded fixed partial denture with wing like retainer(s) bonded to abutment teeth.

Maxilla

The upper jaw.

Maxillary Resection Prosthesis

A maxillary resection prosthesis is fabricated on a resected maxilla that has been reconstructed due to tumor or trauma. This prosthesis can be tissue supported, tooth supported or implant supported. This prosthesis aids in masticatory function while providing support for the lip and cheek. (American Academy of Maxillofacial Prosthetics and the American College of Prosthodontists).

Medicaid

A federal assistance program established as Title XIX under the Social Security Act of 1965 which provides payment for medical care for certain low income individuals and families. The program is funded jointly by the state and federal governments and administered by states.

Medically Necessary Care

The reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies, appliances and devices) as determined and prescribed by qualified, appropriate health care providers in treating any condition, illness, disease, injury, or birth developmental malformations. Care is medically necessary for the purpose of: controlling or eliminating infection, pain, and disease; and restoring facial configuration or function necessary for speech, swallowing or chewing.

Medicament

Substance or combination of substances intended to be pharmacologically active, specially prepared to be prescribed, dispensed or administered by authorized personnel to prevent or treat diseases in humans or animals.

Medicament, Topical

Pharmacological substance especially prepared to be applied on tissues of the oral cavity.

Medicare

A federal insurance program enacted in 1965 as Title XVIII of the Social Security Act that provides certain inpatient hospital services and physician services for all persons age 65 and older and eligible disabled individuals. The program is administered by the Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA).

Member

An individual enrolled in a dental benefit program. See beneficiary.

Membrane

See barrier membrane.

Mesial

Nearer the middle line of the body or the surface of a tooth nearer the center of the dental arch. metals, classification of: The noble metal classification system has been adopted as a more precise method of reporting various alloys used in dentistry. The alloys are defined on the basis of the percentage of metal content and listed in order of biocompatibility. High Noble Alloys—Noble Metal Content > 60% (gold + platinum group*) and gold > 40% Au) Titanium and Titanium Alloys—Titanium (Ti) > 85%. Noble Alloys—Noble Metal Content > 25% (gold + platinum group*). Predominantly Base Alloys—Noble Metal Content) < 25% (gold + platinum group*). *metals of the platinum group are platinum, palladium, rhodium, osmium and ruthenium

Microabrasion

Mechanical removal of a small amount of tooth structure to eliminate superficial enamel discoloration defects.

Microorganisms

A minute living organism, such as a bacterium, fungus, yeast, virus or rickettsia.

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.

Minimal Sedation

See definition under anesthesia.

Mixed Dentition

– see transitional dentition. moderate sedation: See definition under anesthesia.

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.

Molar

Teeth posterior to the premolars (bicuspids) on either side of the jaw; grinding teeth, having large crowns and broad chewing surfaces.

Most Favored Nation Clauses

Contractual language that requires a dentist to give the beneficiaries of a dental plan the same lower fee that the dentist may have charged another patient

Moulage

A positive reproduction of a body part formed on a cast from a negative impression.

Mouthguard

Individually molded device designed primarily to be worn for the purpose of helping prevent injury to the teeth and their surrounding tissues. Sometimes called a mouth protector.

Mucositis

Inflammation of a mucous membrane. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Mucous Membrane

Lining of the oral cavity as well as other canals and cavities of the body; also called "mucosa."

N

National Association of Insurance Commissioners (naic)

Professional or trade association for state departments of insurance (http://www.naic.org).

National Provider Identifier (npi)

This is an identifier assigned by the federal government to all providers considered to be HIPAA covered entities. Dentists who are not covered entities may elect to obtain an NPI at their discretion, or may be enumerated if required by a participating provider agreement with a third-party payer, or applicable state law/regulation. An NPI is unique to an individual dentist or dental entity, and has no intrinsic meaning. There are two types of NPI available to dentists and dental practices:

Natural Tooth Case

the tooth used as the support for one end of a denture.

Necessary Treatment

A necessary dental procedure or service as determined by a dentist, to either establish or maintain a patient’s oral health. Such determinations are based on the professional diagnostic judgment of the dentist, and the standards of care that prevail in the professional community.

Nightguard

A type of mouthguard specifically designed to be worn during sleep to protect teeth from bruxism.

Non-[covered Charges](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#coveredcharges): See covered charges.

Non-autogenous

A graft from donor other than patient.

Non-intravenous

a technique of administration in which the anesthetic agent is not introduced directly into the patient’s venous system.

Non-intravenous

See definition under anesthesia.

Noncontributory Program

A method of payment for group coverage in which the sponsor pays the entire monthly premium for the program.

Nonduplication of Benefits

Term used to describe one of the ways the secondary carrier may calculate its portion of the payment if a patient is covered by two benefit plans. The secondary carrier calculates what it would have paid if it were the primary plan and subtracts what the other plan paid. For example, if the primary carrier paid 80 percent, and the secondary carrier normally covers 80 percent as well, the secondary carrier would not make any additional payment. If the primary carrier paid 50 percent, however, the secondary carrier would pay up to 30 percent.

Nonparticipating Dentist

Any dentist who does not have a contractual agreement with a dental benefit organization to render dental care to members of a dental benefit program.

Normal Post-operative Follow-up

see follow-up care.

Note

The terms definitive and permanent are often used interchangeably.

Note

The term follow-up care is interchangeable with a variety of similar terms (e.g., normal post-operative follow-up; routine follow-up [or post-delivery or post-operative] care).

Npi

See National Provider Identifier.

O

Obturate

With reference to endodontics, refers to the sealing of the canal(s) of tooth roots during root canal therapy procedure with an appropriately prescribed material such as gutta percha in combination with a suitable luting agent.

Obturator

A disc or plate which closes an opening; a prosthesis that closes an opening in the palate.

Occlusal

Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth or opposing occlusion rims.

Occlusal Guard

A removable dental appliance that inserts over the dentition of the maxillary or mandibular arch to protect teeth and periodontium, implants and peri-implant tissues, TMJ and/or restorations from occlusal forces. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Occlusal Radiograph

An intraoral radiograph made with the film, phosphorous plate, emulsion or digital sensor being held between the occluded teeth.

Occlusal Surface

Occlusion

Any contact between biting or chewing surfaces of maxillary (upper) and mandibular (lower) teeth.

Odontogenic

Refers to tooth-forming tissues.

Odontogenic [cyst](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#cyst): See cyst.

Odontogenic Cyst

Cyst derived from the epithelium of odontogenic tissue (developmental, primordial).

Odontoplasty

Adjustment of tooth length, size, and/or shape; includes removal of enamel projections.

Onlay

A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface. It is retained by luting cement. (American College of Prosthodontics; The Glossary of Prosthodontic Terms)

Open Enrollment

The annual period in which employees can select from a choice of benefit programs.

Open Panel

This type of dental benefits plan allows covered patients to receive care from any dentist and allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans.

Open Reduction

Re-approximation of fractured bony segments accomplished through cutting the adjacent soft tissues and bone to allow direct access.

Operculectomy

Removal of the operculum.

Operculum

The flap of tissue over an unerupted or partially erupted tooth.

Oral

Pertaining to the mouth.

Oral and Maxillofacial Pathologist

A dental specialist whose practice is concerned with recognition, diagnosis, investigation and management of diseases of the oral cavity, jaws, and adjacent structures.

Oral and Maxillofacial Pathology

Oral pathology is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.

Oral and Maxillofacial Radiologist

A dental specialist whose practice is concerned with the production and interpretation of images and data produced by all modalities of radiant energy used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region.

Oral and Maxillofacial Radiology

Oral and maxillofacial radiology is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region.

Oral and Maxillofacial Surgeon

A dental specialist whose practice is limited to the diagnosis, surgical and adjunctive treatment of diseases, injuries, deformities, defects and esthetic aspects of the oral and maxillofacial regions.

Oral and Maxillofacial Surgery

Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Oral Diagnosis

The determination by a dentist of the oral health condition of an individual patient achieved through the evaluation of data gathered by means of history taking, direct examination, patient conference, and such clinical aids and tests as may be necessary in the judgment of the dentist.

Oral Diagnosis

Oral Health Literacy

The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions.

Oral Surgeon

A dental specialist trained to perform surgical procedures in the mouth, jaws, and face.

Orthodontic Retainer

Appliance to stabilize teeth following orthodontic treatment.

Orthodontics

A dental specialty focused on correcting misaligned teeth and jaws (e.g., braces or clear aligners).

Orthodontics and Dentofacial Orthopedics

Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures.

Orthodontist

A dental specialist whose practice is limited to the interception and treatment of malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures.

Orthognathic

Functional relationship of maxilla and mandible.

Orthotic Device

Apparatus used to support, align, prevent or correct deformities, or to improve the function of movable parts of the body.

Osha

Abbreviation for Occupational Safety and Health Administration. Federal agency in the US responsible for making and enforcing employee safety regulations.

Osseous

Pertaining to or composed of bone (bony). (American Academy of Periodontology’s Glossary of Periodontal Terms).

Ostectomy

The excision or removal of alveolar bone proper (tooth supporting bone) in osseous resective and/or crown lengthening surgery. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Osteitis

See dry socket.

Osteoplasty

Surgical procedure that modifies the configuration of bone.

Osteotomy

Surgical cutting of bone.

Overbilling

The misrepresentation of a fee as higher than actual charges; for example, when a patient is charged one fee and an insurance company is billed a higher fee to benefit the patient’s co-payment, or to increase a fee to a patient solely because the patient is covered under a dental benefits plan.

Overcoding

Reporting a more complex and/or higher cost procedure than was actually performed.

Overdenture

A removable prosthetic device that overlies and may be supported by retained tooth roots or implants.

P

Palate

The hard and soft tissues forming the roof of the mouth that separates the oral and nasal cavities.

Palliative

Action that relieves pain but is not curative.

Panoramic Radiograph

An extraoral projection whereby the entire mandible, maxilla, teeth and other nearby structures are portrayed on a single image, as if the jaws were flattened out.

Panoramic X-ray

A single X-ray that provides a comprehensive view of the entire mouth, including all teeth and the jawbones.

Papoose Board

A behavior management technique utilizing immobilization to control the actions of a patient who is receiving dental treatment.

Parafunctional

Other than normal function or use.

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].)

Partial Denture

Usually refers to a prosthetic device that replaces missing teeth. See fixed partial denture or removable partial denture.

Participating Dentist (in-network Dentist)

Any dentist who has a contractual agreement with a dental benefit organization to render care to eligible persons.

Participating Practice (in-network Practice)

Any dental practice or organization that has a contractual arrangement with an insurer for the provision of services under an insurance contract.

Patient

An individual who has established a professional relationship with a dentist for the delivery of dental health care. For matters relating to communication of information and consent this term includes the patient’s parent, caretaker, guardian, or other individual as appropriate under state law and the circumstances of the case.

Payer

A self-insured employer, insurance company, governmental agency or other party responsible for payment of health care claims of covered persons.

Pediatric Dentist

A dental specialist whose practice is limited to treatment of children from birth through adolescence, providing primary and comprehensive preventive and therapeutic oral health care; formerly known as a pedodontist.

Pediatric Dentistry

Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Pedodontist

See pediatric dentist.

Peer Review

An evaluation of the quality and conduct of an individual’s work by the individual’s professional equals (peers) in order to resolve questions or disputes regarding the quality, or conduct of the work. Peer review, when applied to dentistry, is a process, consistently structured and implemented by organized dentistry, in which a dentist’s professional equals (peers) resolve questions or disputes (regarding the quality or appropriateness of care provided by the dentist or the fairness of the fee the dentist charged in an individual case) by retrospectively evaluating the quality or appropriateness of care in relation to professional norms or criteria or evaluating the fee charged in relation to the dentist’s fee for the given complexity and level of care provided.

Peer Review Organization (pro)

An organization established by an amendment of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), to provide for the review of medical services furnished primarily in a hospital setting and/or in conjunction with care provided under the Medicare and Medicaid programs. In addition to their review and monitoring functions, these entities can invoke sanctions, penalties, or other corrective actions for noncompliance in organization standards.

Percentile

The number in a frequency distribution below which a certain percentage of fees will fall. For example, the 90th percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level at which 90% of dentists charge that amount or less, and 10% more.

Peri-implant Mucositis

A disease in which the presence of inflammation is confined to the mucosa surrounding a dental implant with no signs of loss of supporting bone. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Peri-implantitis

An inflammatory process around an implant which includes both soft tissue inflammation and loss of supporting bone. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Periapical

The area surrounding the end of the tooth root.

Periapical [abscess](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#abscess): See abscess.

Periapical [cyst](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#cyst): See cyst.

Periapical Cyst

An apical inflammatory cyst containing a sac-like epithelium-lined cavity that is open to and continuous with the root canal.

Periapical Radiograph

A radiograph made by the intraoral placement of film, phosphorous plate, emulsion or digital sensor, for disclosing the apices of the teeth.

Pericoronal

Around the crown of a tooth.

Periodic Oral [evaluation](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#eval): See evaluation.

Periodontal

Pertaining to the supporting and surrounding tissues of the teeth.

Periodontal [abscess](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#abscess): See abscess.

Periodontal Disease

Inflammatory process of the gingival tissues and/or periodontal membrane of the teeth, resulting in an abnormally deep gingival sulcus, possibly producing periodontal pockets and loss of supporting alveolar bone.

Periodontal Pocket

Pathologically deepened gingival sulcus; a feature of periodontal disease.

Periodontics

Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Periodontics

Periodontist

A dental specialist whose practice is limited to the treatment of diseases of the supporting and surrounding tissues of the teeth.

Periodontitis

Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss and periodontal pocketing. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Periodontium

The tissues that invest and support the teeth including the gingiva, alveolar mucosa, cementum, periodontal ligament, and alveolar supporting bone. Also known as SUPPORTING STRUCTURES OF A TOOTH. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Periradicular

Surrounding a portion of the root of the tooth.

Permanent

see definitive

Permanent Dentition

Refers to the permanent (“adult”) teeth in the dental arch that either replace the primary dentition or erupt distally to the primary molars. See Dentition.

Permanent Dentition (adult Dentition)

Refers to the permanent teeth in the dental arch.

A small rod, cemented or driven into dentin to aid in retention of a restoration.

Plaque

A soft sticky substance that accumulates on teeth composed largely of bacteria and bacterial derivatives.

Point of Service

A health plan allowing the member to choose to receive a service from a participating or non-participating provider, usually with different benefits levels associated with the use of participating providers.

Pontic

The term used for an artificial tooth on a fixed partial denture (bridge).

Porcelain/ceramic

Refers to materials containing predominantly inorganic refractory compounds including porcelains, glasses, ceramics, and glass-ceramics.

Post

Rod-like component designed to be inserted into a prepared root canal space so as to provide structural support. This device can either be in the form of an alloy, carbon fiber or fiberglass, and posts are usually secured with appropriate luting agents.

Post-treatment Review

See audit.

Posterior

Refers to teeth and tissues towards the back of the mouth (distal to the canines); maxillary and mandibular premolars and molars. The designation of permanent posterior teeth in the Universal/National tooth numbering systeminclude teeth 1 through 5 and 12 through 16 (maxillary), and 17 through 21 and 28 through 32 (mandibular); primary teeth in the Universal tooth numbering system are designated A, B, I and J (maxillary), and K, L, S and T (mandibular).

Pre-existing Condition

Oral health condition of an enrollee which existed before his/her enrollment in a dental program.

Preauthorization

Statement by a third-party payer indicating that proposed treatment will be covered under the terms of the benefit contract. See also precertification, predetermination.

Precertification

Confirmation by a third-party payer of a patient’s eligibility for coverage under a dental benefit program. See preauthorization, predetermination.

Precision Attachment

An interlocking device, one component of which is fixed into an abutment or abutments, and the other is integrated into a removable partial denture to stabilize and/or retain it (Glossary of Prosthodontic Terms, 9th Edition; © Academy of Prosthodontics).

Predetermination

A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan and notifies the dentist and patient of one or more of the following: patient’s eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums.

Preferred Provider Organization (PPO)

A formal agreement between a purchaser of a dental benefit program and a defined group of dentists for the delivery of dental services to a specific patient population, as an adjunct to a traditional plan, using discounted fees for cost savings.

Prefiling of Fees

The submission of a participating dentist’s full fees for the purpose of establishing, in advance, that dentist’s full fees and the fees in a geographic area to determine benefits under a dental benefit program.

Premedication

The use of medications prior to dental procedures.

Premium

The amount charged by a dental benefit organization for coverage of a level of benefits for a specified time.

Premolar

See bicuspid.

Prepaid Group Practice

See closed panel.

Pretreatment Estimate

See predetermination.

Preventive Dentistry

Aspects of dentistry concerned with promoting good oral health and function by preventing or reducing the onset and/or development of oral diseases or deformities and the occurrence of oro-facial injuries.

Preventive Dentistry

Primary [dentition](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#Dentition): The first set of teeth; see deciduous and dentition.

Primary Deciduous (dentition)

Refers to the deciduous or primary teeth in the dental arch.

Primary Payer

The third party payer determined to have initial responsibility in a benefit determination.

Prior Authorization

See predetermination.

Prompt Payment Laws

Also known as fair claims practice regulations. Enacted state by state, prompt payment laws set standards for the prompt, fair and equitable settlements of insurance claims by requiring that a set amount of interest be paid on “clean claims” that are paid beyond the established timeframe. “Clean claim” means a claim for payment of covered health care expenses that is submitted to a payer on the carrier’s standard claim form using the most current published procedural codes, with all the required fields completed with information sufficient to adjudicate the claim in accordance with the payer’s published filing requirements. These laws need to be analyzed on a case by case basis to determine whether a lawsuit has to be filed by the state department of insurance.

Proof of Loss

Verification of services rendered or expenses incurred by the submission of claim forms, radiographs, study models, and/or other diagnostic material. Documentary evidence required by a payer to prove a valid claim exists. It usually consists of a claim form completed by the patient’s treating dentist.

Prophylaxis

Removal of plaque, calculus and stains from the tooth structures. It is intended to control local irritational factors.

Prosthesis

Artificial replacement of any part of the body.

Prosthodontic Retainer

A part of a prosthesis that attaches a denture to an abutment tooth, implant abutment, or implant body.

Prosthodontics

Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.

Prosthodontist

A dental specialist whose practice is limited to the restoration of the natural teeth and/or the replacement of missing teeth with artificial substitutes.

Provider

is an administrative and commercial term used in the context of billing, reimbursement, and revenue cycle management. It does not imply or confer equivalency in training, education, or clinical scope among the various individuals or entities who may participate in dental care delivery. A provider is defined as: 1. An individual — licensed, certified, or otherwise authorized under applicable state law to furnish health care services in the ordinary course of professional practice, who submits claims for reimbursement either directly or through an affiliated entity. 2. An entity or institution — licensed, certified, or otherwise authorized to deliver health care services or supplies, as recognized under CMS regulations and state law, and submits claims to bill payers for covered services and supplies. Providers must be properly enrolled, credentialed, and in compliance with federal regulations and state insurance requirements.

Provisional

a restoration or prosthesis placed for a longer time period to enable healing, stabilization or diagnostic purposes – see interim and temporary.

Public Health Dentist

A dentist whose practice is limited to the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts.

Public Health Dentistry

Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.

Pulp

Connective tissue that contains blood vessels and nerve tissue which occupies the pulp cavity of a tooth.

Pulp Cap

See direct pulp cap; indirect pulp cap.

Pulp Cavity

The space within a tooth which contains the pulp.

Pulpectomy

Complete removal of vital and non-vital pulp tissue from the root canal space.

Pulpitis

Inflammation of the dental pulp.

Pulpotomy

Removal of a portion of the pulp, including the diseased aspect, with the intent of maintaining the vitality of the remaining pulpal tissue by means of a therapeutic dressing.

Purchaser

Organization or entity, often employer or union, that contracts with the dental benefit organization to provide dental benefits to an enrolled population.

Q

Quadrant

One of the four equal sections into which the dental arches can be divided; begins at the midline of the arch and extends distally to the last tooth.

Quadrant

One of the four equal sections into which the dental arches can be divided; begins at the midline of the arch and extends distally to the last tooth.

R

Radicular

Pertaining to the root.

Radiograph

An image or picture produced on a radiation sensitive film, phosphorous plate, emulsion or digital sensor by exposure to ionizing radiation.

Radiographic/surgical Implant Index

An appliance, designed to relate osteotomy or fixture position to existing anatomic structures.

Rebase

Process of refitting a denture by replacing the base material.

Recalcification

Procedure used to encourage biologic root repair of external and internal resorption defects. See apexification. reduction:

Regional Block [anesthesia](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#anesthesia): See definition under anesthesia.

Regional Block Anesthesia

a form of local anesthesia that induces numbness in areas of the mouth and face.

Reimbursement

Payment made by a third party to a beneficiary or to a dentist on behalf of the beneficiary, to offset expenses incurred for a service covered by the dental benefit plan.

Reimplantation, Tooth

The return of a tooth to its alveolus.

Reinsurance

Insurance for third-party payers to spread their risk for losses (claims paid) over a specified dollar amount.

Relative Value System

Coded listing of professional services with unit values to indicate relative complexity as measured by time, skill, and overhead costs. Third-party payers typically assign a dollar value per unit to calculate provider reimbursement.

Reline

Process of resurfacing the tissue side of a removable prosthesis with new base material.

Removable Partial Denture

A removable partial denture is a prosthetic replacement of one or more missing teeth that can be removed by the patient.

Removable Prosthesis

Complete or partial prosthesis, which after an initial fitting by a dentist, can be removed and reinserted by the patient.

Residual Root

Remaining root structure following the loss of the major portion (over 75%) of the crown.

Resin

Resinous material of the various esters of acrylic acid, used as a denture base material, for trays or for other restorations.

Resin Infiltration

Application of a resin material engineered to penetrate and fill the sub-surface pore system of an incipient caries lesion to strengthen, stabilize, and limit the lesion's progression, as well as mask visible white spots. retainer:

Resin-based [composite](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#composite): See composite.

Retail Store Dentistry

Refers to dental services offered within a retail, department or drug store operation. Typically, space is leased from the store by a separate administrative group that, in turn, subleases to a dentist or dental group providing the actual dental services. The dental operation generally maintains the same hours of operation as the store and appointments often are not necessary. Considered to be a type of practice, not a dental benefit plan model.

Retrograde Filling

A method of sealing the root canal by preparing and filling it from the root apex.

Retrospective Review

A post-treatment assessment of services on a case-by-case or aggregate basis after the services have been performed.

Revision

The act of revising; second or more surgical procedure for correction of a condition.

Risk Pool

A portion of provider fees or capitation payments withheld as financial reserves to cover unanticipated utilization of services in an alternative benefit plan.

Root

The anatomic portion of the tooth that is covered by cementum and is located in the alveolus (socket) where it is attached by the periodontal apparatus; radicular portion of tooth.

Root Canal

The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp.

Root Canal Therapy

The treatment of disease and injuries of the pulp and associated periradicular conditions.

Root Planing

A treatment procedure designed to remove cementum or surface dentin that is rough, impregnated by calculus, or contaminated with toxins or microorganisms.

Routine [follow-up Care](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#followupcare): see follow-up care

Routine Post-delivery Care

see follow-up care

Routine Post-operative Care

see follow-up care

Rubber Dam

A barrier technique used to prevent the passage of saliva or moisture, or to provide an isolated operative field.

S

Salivary Gland

Exocrine glands that produce saliva and empty it into the mouth; these include the parotid glands, the submandibular glands and the sublingual glands.

Scaling

Removal of plaque, calculus, and stain from teeth.

Schedule of Allowances

See table of allowances.

Schedule of Benefits

A listing of dental services and the maximum benefit amounts an insurer will pay for a given service. Specificity will vary by benefit plan.

Sealant

A resinous material designed to be applied to the occlusal surfaces of posterior teeth to prevent occlusal caries.

Second-opinion Program

An opinion about the appropriateness of a proposed treatment provided by a practitioner other than the one making the original recommendation; some benefit plans require such opinions for selected services.

Sedation

See definitions under anesthesia.

Sedative Filling

A temporary restoration intended to relieve pain.

Self-funded Plan

A benefit plan in which the plan sponsor bears the entire risk of utilization. Some plans may be partially self-funded, if the sponsor employs indemnified stop-loss insurance to protect against the risk of unanticipated higher utilization. Third party administrators may provide claims processing and other administrative services, without bearing any of the risk of utilization of the plan.

Self-insurance

Setting aside of funds by an individual or organization to meet anticipated dental care expenses or its dental care claims, and accumulation of a fund to absorb fluctuations in the amount of expenses or claims. The funds set aside or accumulated are used to provide dental benefits directly instead of purchasing coverage from an insurance carrier.

Semi-precision Attachment

A laboratory fabricated rigid metallic extension of a fixed or removable partial denture that fits into cast restoration, allowing some movement between the components; attachments with plastic components are often called semi-precision attachments. (see Glossary of Prosthodontic Terms, 9th Edition; ©Academy of Prosthodontics).

Service Corporations

Dental benefit organizations established under not-for-profit state statutes for the purpose of providing health care coverage, e.g., Delta Dental Plans, Blue Cross and Blue Shield Plans.

Sextant

One of the six relatively equal sections into which a dental arch can be divided, for example: tooth numbers 1-5; 6-11; 12-16; 17-21; 22-27; 28-32. Sometimes used for recording periodontal charting.

Sialodochoplasty

Surgical procedure for the repair of a defect and/or restoration of portion of a salivary gland duct.

Sialography

Inspection of the salivary ducts and glands by radiograph after the injection of a radiopaque medium.

Sialolithotomy

Surgical procedure by which a stone within a salivary gland or its duct is removed, either intraorally or extraorally.

Simple Fracture

Break in bone which is not exposed to external contamination.

Site

A term used to describe a single area, position, or locus. For periodontal procedures, an area of soft tissue recession on a single tooth or an osseous defect adjacent to a single tooth; also used to indicate soft tissue defects and/or osseous defects in edentulous tooth positions.

Some Examples of Inappropriate Fee Discounting Practices Include

issuing reimbursement checks which, upon signing, result in the dentist accepting the amount as payment in full; using claim forms which, upon signing, require the dentist to accept the terms of the plan’s contract; issuing insurance cards which state that the submittal of a claim by a dentist means that he or she accepts all terms and conditions set forth in the participating provider contract; and sending communications to patients of nonparticipating dentists which state that he or she is not responsible for any amount above usual, customary and reasonable fees as established by the plan.

Space Maintainer

A passive appliance, usually cemented in place, that holds teeth in position.

Specification No. 3950

This schema (ANSI/ADA/ISO Specification No. 3950–1984 Dentistry Designation System for Tooth and Areas of the Oral Cavity) is designed to identify areas of the oral cavity as well as uniquely number permanent and primary dentition. Supernumerary teeth are not yet identified using this standard.

Splint

A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured or traumatized. Also refers to devices used in the treatment of temporomandibular joint disorders.

Statistically-based Utilization Review

A system that examines the distribution of treatment procedures based on claims information. In order to be reasonably reliable, the application of such claims analyses of specific dentists should include data on type of practice, dentist’s experience, socioeconomic characteristics, and geographic location.

Stomatitis

Inflammation of the membranes of the mouth.

Stop-loss

A general term referring to that category of coverage that provides insurance protection (reinsurance) to an employer for a self-funded plan. summary plan description: See benefit plan summary.

Stress Breaker

That part of a tooth-borne and/or tissue-borne prosthesis designed to relieve the abutment teeth and their supporting tissues from harmful stresses.

Study Model

Plaster or stone model of teeth and adjoining tissues; also referred to as diagnostic cast. See diagnostic cast.

Succedaneous Tooth

A permanent tooth that replaces a primary (deciduous) tooth.

Supernumerary Teeth

Extra erupted or unerupted teeth that resemble teeth of normal shape.

Surgical Stent

Suture

Stitch used to repair incision or wound.

T

Table of Allowances

A list of covered services with an assigned dollar amount that represents the total obligation of the plan with respect to payment for such service, but does not necessarily represent the dentist’s full fee for that service.

Tartar

Another name for calculus; hardened plaque that requires professional removal.

Tax Equity and Fiscal Responsibility Act of 1982 (tefra)

Legislation (Public Law 97-248) affecting health maintenance organizations and the Medicare and Medicaid programs. Provides regulations for the development of HMO risk contracting with the Medicare program and, through amendment, established new provisions for the foundation and operation of peer review organizations.

Temporary

a restoration or prosthesis placed for a shorter time interval for use while a definitive restoration or prosthesis is being fabricated – see interim and provisional.

Temporary Removable Denture

An interim prosthesis designed for use over limited period of time.

Temporomandibular Joint (TMJ)

The connecting hinge mechanism between the base of the skull (temporal bone) and the lower jaw (mandible).

Temporomandibular Joint Dysfunction (tmd or Tmjd)

Abnormal functioning of temporomandibular joint; also refers to symptoms arising in other areas secondary to the dysfunction.

Termination Date

See expiration date.

Therapeutic

Of or pertaining to therapy or treatment; beneficial. Therapy has as its goal the elimination or control of a disease or other abnormal state.

Third-party

The party to a dental benefit contract that may collect premiums, assume financial risk, pay claims, and/or provides other administrative services. Also known as administrative agent, carrier, insurer or underwriter.

Third-party Administrator (tpa)

Claims payer who assumes responsibility for administering health benefit plans without assuming any financial risk. Some commercial insurance carriers and Blue Cross & Blue Shield plans also have TPA operations to accommodate self-funded employers seeking administrative services only (ASO) contracts.

Third-party Payer

An organization other than the patient (first party) or health care provider (second party) involved in the financing of personal health services.

Tissue Conditioning

Material intended to be placed in contact with tissues, for a limited period, with the aim of assisting the return to a healthy condition.

Title Xix

Portion of the Social Security Act that provides for federal grants to the states for medical assistance programs, commonly known as Medicaid.

Tmd

See temporomandibular joint dysfunction (TMJD).

TMJ

See temporomandibular joint.

Tmjd

See temporomandibular joint dysfunction.

Tomography

An X-ray technique that produces an image representing a detailed cross section of tissue structures at a predetermined depth.

Tooth Bounded Space

A space created by one or more missing teeth that has a tooth on each side.

Torus

A bony elevation or protuberance of bone. See exostosis.

Tracheotomy

A surgical procedure to create an opening in the trachea (windpipe) to aid in breathing.

Transdermal

a technique of administration in which the drug is administered by patch or iontophoresis through skin.

Transitional

Relating to a passage or change from one position, state, phase or concept to another.

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.

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.

Transmucosal

a technique of administration in which the drug is administered across mucosa such as intranasal, sublingual or rectal.

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.

Transplantation

Surgical placement of biological material from one site to another.

Transplantation of Tooth

Transfer of a tooth from one socket to another, either in the same or a different person.

Transseptal

Through or across a septum.

Treatment Plan

The sequential guide for the patient's care as determined by the dentist's diagnosis and is used by the dentist for the restoration to and/or maintenance of optimal oral health.

Trigeminal Division Block [anesthesia](https

//www.ada.org/publications/cdt/%20#anesthesia): See definition under anesthesia.

Trigeminal Division Block Anesthesia

a form of local anesthesia that is an injection of medication that helps relieve facial pain. Routes of Administration

Trismus

Restricted ability to open the mouth, usually due to inflammation or fibrosis of the muscles of mastication.

Tuberosity

An osseous projection or protuberance, usually for the attachment of a muscle or tendon. (American Academy of Periodontology’s Glossary of Periodontal Terms).

Type 1 Individual Provider

A health care practitioner who is a single human being. ALL dentists are eligible to apply for Type 1 NPIs, regardless of whether they are covered by HIPAA.

Type 2 Organization Provider

A health care provider that is an organization, such as a group practice or corporation. Individual dentists who are incorporated may enumerate as Type 2 providers, in addition to being enumerated as a Type 1. All incorporated dental practices and group practices are eligible for enumeration as Type 2 providers. On paper, there is no way to distinguish a Type 1 from a Type 2 in the absence of any associated data; they are identical in format.

U

Unbundling of Procedures

The separating of a dental procedure into component parts with each part having a charge so that the cumulative charge of the components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure.

Unerupted

Tooth/teeth that have not penetrated into the oral cavity.

Unerupted Tooth

A tooth that has not yet broken through the gum into the mouth.

Unilateral

One-sided; pertaining to or affecting but one side.

Universal/national Tooth Numbering System

The ADA and HIPAA standard code set, most commonly used in the United States, that assigns a unique number (from 1-32) to Permanent Dentition, and a unique letter (A-T) to Primary Dentition. This system includes codes for Supernumerary Teeth. The complete schema is illustrated in the Comprehensive ADA Dental Claim Form Completion Instructions posted online at https://www.ada.org/en/publications/cdt/ada-dental-claim-form.

Upcode

Reporting a more complex and/or higher cost procedure than was actually performed. Also known as overcoding.

Usual [fee](https

//www.ada.org/publications/cdt/glossary-of-dental-clinical-terms#fee): See fee.

Usual, Customary and Reasonable Fees

See fee.

Utilization

The extent to which the members of a covered group use a program over a stated period of time; specifically measured as a percentage determined by dividing the number of covered individuals who submitted one or more claims by the total number of covered individuals. Also, an expression of the number and types of services used by the members of a covered group over a specified period of time.

Utilization Management

A set of techniques used by or on behalf of purchasers of health care benefits to manage the cost of health care prior to its provision by influencing patient care decision-making through case-by-case assessments of the appropriateness of care based on accepted dental practices.

Utilization Review, Statistically Based

A system that examines the distribution of treatment procedures based on claims information and in order to be reasonably reliable, the application of such claims analyses of specific dentists should include data on type of practice, dentist’s experience, socioeconomic characteristics, and geographic location.

V

Veneer

See laminate veneer.

Vertical Bitewing

A dental image with a central projection on which the teeth can close, holding it in a vertical position for the radiographic examination of several upper and lower teeth simultaneously.

Vertical Dimension

The vertical height of the face with the teeth in occlusion or acting as stops.

Vestibuloplasty

Any of a series of surgical procedures designed to increase relative alveolar ridge height.

Viral Culture

A collection of specimen for the purpose of incubating a virus for identification.

W

Waiting Period

The period between employment or enrollment in a dental program and the date when a covered person becomes eligible for a given benefit.

Wax Pattern

A wax form that is the positive likeness of an object to be fabricated.

Whitening

Any process that makes teeth appear whiter, ranging from professional bleaching to over-the-counter products.

Wisdom Tooth

The third and final set of molars that typically erupt in the late teens or early twenties.

Worker’s Compensation

A benefit paid to an employee who suffers a work-related injury or illness.

X

X-ray

See radiograph.

Xerostomia

Decreased salivary secretion that produces a dry and sometimes burning sensation of the oral mucosa and/or cervical caries.

Y

Yeast

A general term for a fungus occurring as a . unicellular, nucleated organism that usually reproduces by budding. Some yeasts may reproduce by fission, many producing mycelia or pseudomycelia.

Z

Zygomatic Bone

Quadrangular bone on either side of face that forms the cheek prominence. See malar. ADA

Glosario Dental ADA

No se encontraron resultados

A

Abscess

Abutment

Abutment Crown

Accession

Acetaminophen

Acid Etching

Acute Periradicular or Acute Apical Abscess

Adhesion

Adhesive

Adjunctive

Administrative Costs

Administrative Services Only (ASO)

Administrator

Adolescent Dentition

Adult Dentition

Allogenic

Allograft

Alloplastic

Allowable Charge

Alloy

Alternate Benefit

Alveolar

Alveolar Bone

Alveoloplasty

Amalgam

Analgesia

Analgesia

Anatomical Crown

Ancillary

Anesthesia

Anomaly

Ansi/ada/iso

Ansi/ada/iso Tooth Numbering System

Anterior

Anxiolysis

Anxiolysis

Any Willing Provider

Apex

Apexification

Apexogenesis

Apicoectomy

Appeal

Arch, Dental

Areas of Oral Cavity

Arthrogram

Artificial Crown

Assignment of Benefits

Attachment

Attending Dentist’s Statement

Audit

Autogenous

Autogenous Graft

Avulsion

B

Bad Faith Insurance Practices

Balance Billing

Barrier Membrane

Behavior Management

Beneficiary

Benefit

Benefit Booklet

Benefit Plan Summary

Benign

Bicuspid

Bilateral

Biologic Materials

Biopsy

Birthday Rule

Bitewing Radiograph

Bitewing X-ray

Bleaching

Bonding

Bounded Tooth Space

Bridge

Bruxism

Buccal

Bundling of Procedures