the hard and soft tissues forming the roof of the mouth that separates the oral and nasal cavities.
action that relieves pain but is not curative.
an extraoral radiograph on which the maxilla and mandible are depicted on a single film.
other than normal function or use
usually refers to a prosthetic device that replaces missing teeth; (see fixed partial denture or removable partial denture).
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.
a dental specialist whose practice is limited to treatment of children from birth through adolescence; formerly known as a pedodontist.
see Pediatric Dentist.
1) A retrospective consideration or an examination by one or more individuals of equal standing or rank. 2) A process established to provide for review by licensed dentists of: the care provided by a dentist for a single patient; disputes regarding fees; cases submitted by carriers, initiated by patients or dentists; quality of care and appropriateness of treatment.
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.
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% charge more.
the area surrounding the end of the tooth root.
a radiograph made by the intraoral placement of film for disclosing the apices of the teeth.
around the crown of a tooth.
Periodic Oral Evaluation
An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic evaluation. This includes periodontal screening and may require interpretation of information acquired through additional diagnostic procedures.
pertaining to the supporting and surrounding tissues of the teeth.
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.
pathologically deepened gingival sulcus; a feature of periodontal disease.
a dental specialist whose practice is limited to the treatment of diseases of the supporting and surrounding tissues of the teeth.
inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth with loss of attachment.
surrounding a portion of the root of the tooth.
a soft sticky substance that accumulates on teeth composed largely of bacteria and bacterial derivatives.
Point of Service (POS)
an option that a health insurance issuer offers to enrollees health insurance coverage which provides for coverage of services only if such services are furnished through health professionals and providers who are members of a network of health professionals and providers who have entered into a contract with the issuer to provide such services, the issuer shall also offer to such enrollees (at the time of enrollment) the option of health insurance coverage which provides for coverage of such services which are not furnished through health professionals and providers who are members of such a network.
the term used for an artificial tooth on a fixed partial denture (bridge).
an elongated projection fitted and cemented within the prepared root canal, serving to strengthen and retain restorative material and/or a crown restoration.
refers to teeth and tissues towards the back of the mouth (distal to the canines) - maxillary and mandibular premolars and molars.
oral health condition of an enrollee which existed before his/her enrollment in a dental program.
statement by a third-party payer indicating that proposed treatment will be covered under the terms of the benefit contract. See also precertification, predetermination.
confirmation by a third-party payer of a patient’s eligibility for coverage under a dental benefit program. See also Preauthorization, Predetermination.
interlocking device, one component of which is fixed to an abutment or abutments and the other is integrated into a fixed or removable prosthesis in order to stabilize and/or retain it.
an administrative procedure that may require the dentist to submit a treatment plan to the third party before treatment is begun. The third party usually returns the treatment plan indicating one or more of the following: patient's eligibility, guarantee of eligibility period, covered services, benefit amounts payable, application of appropriate deductibles, copayment and/or maximum limitation. Under some programs, predetermination by the third party is required when covered charges are expected to exceed a certain amount, such as $200. Also known as preauthorization, precertification, pretreatment review, prior authorization.
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 usual fees to a service corporation for the purpose of establishing, in advance, that dentist's usual fees and the customary ranges of fees in a geographic area to determine benefits under a usual, customary, and reasonable dental benefit program.
the use of medications prior to dental procedures.
the amount charged by a dental benefit organization for coverage of a level of benefits for a specified time.
Prepaid Dental Plan
a method of financing the cost of dental care for a defined population, in advance of receipt of services.
Prepaid Group Practice
see Closed Panel.
When an eye doctor determines that corrective lenses are needed, she writes a prescription. The prescription is a concise description that includes all the details needed to create the desired lenses. Eyeglass or contact lenses that are created in this way are called prescription lenses.
term used by some dental benefit organizations to refer to the fee most commonly charged for a dental service in a given area.
refers to the procedures in dental practice and health programs which prevent the occurrence of oral diseases.
the first set of teeth; see Deciduous.
Proof of Loss
verification of services rendered expenses incurred by the submission of claim forms, radiographs, study models, and/or other diagnostic material.
scaling and polishing procedure performed to remove coronal plaque, calculus and stains.
prior assessment by a payer or payer’s agent that proposed services are appropriate for a particular patient, and/or the patient and the category of service are covered by a benefit plan. (See preauthorization, precertification, predetermination, second-opinion program.)
artificial replacement of any part of the body 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); definitive prosthesis - a prosthesis to be used over an extended period of time; fixed prosthesis - non-removable tooth or implant borne dental prosthesis which is solidly attached to abutment teeth or roots or implants; 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; removable prosthesis - dental prosthesis designed to be removed and reinserted by the patient.
a dental specialist whose practice is limited to the restoration of the natural teeth and/or the replacement of missing teeth with artificial substitutes.
formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration.
connective tissue that contains blood vessels and nerve tissue which occupies the pulp cavity of a tooth.
the space within a tooth which contains the pulp.
complete removal of vital and non vital pulp tissue from the root canal space.
inflammation of the dental pulp.
surgical removal of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means of an adequate dressing; pulp amputation.
program sponsor, often employer or union, that contracts with the dental benefit organization to provide dental benefits to an enrolled population.