1.905.668.6301




4
Mar
2020

Dentures are artificial replacements for your natural teeth and gums. If an accident, a disease or poor oral health care has left you with only a few healthy teeth or none at all, your dentist or prosthodontist might suggest dentures to replace your missing teeth. There are 2 types of dentures: partial and complete. For both types of dentures your dentist or specialist makes a model of your teeth by taking impressions. The models are used to custom-make your dentures.

Types of Dentures

Partial dentures are also called “removable partial denture prostheses” or “partials.” They may be used when nearby teeth are not strong enough to hold a bridge, or when more than just a few teeth are missing. Partial dentures are made up of one or more artificial teeth held in place by clasps that fit onto nearby natural teeth. You can take the partial denture out yourself, for cleaning and at night.

Partial Denture

A partial denture

Complete dentures are what we most often refer to as “false teeth.” They are also called “full dentures” and are used when all your natural teeth are missing. Complete dentures are removable as they are held in place by suction. They can cause soreness at first and take some time to get used to. There are 2 types of complete dentures: immediate dentures and conventional dentures.

Full Upper Denture

A full upper denture

Immediate dentures are made before your teeth are removed. Your dentist takes measurements and makes models of your jaws during your first visit. Once your teeth are extracted, your dentist inserts the immediate dentures. The benefit of immediate dentures is that you are not without teeth during the healing period, which can take up to 6 months. During the healing period, your bones and gums can shrink and your immediate dentures may need to be relined by your dentist for a proper fit.

Conventional dentures are made and inserted into your mouth after your teeth have been extracted and the gums and jaw tissues have healed.

Overdentures

If you are having trouble with your complete dentures, your dentist may suggest overdentures. An overdenture is a removable denture that fits over the natural teeth left in your mouth or over dental implants. If you have some natural teeth left, they are reshaped to fit in the denture. If there are no natural teeth left, small implants are placed into the jawbone. The overdenture attaches to the implants or rests on the natural teeth.

Caring for your Dentures

Complete and partial dentures need to be cleaned every day just like natural teeth. Otherwise, plaque and tartar can build up on your dentures and cause stains, bad breath and gum problems. Plaque from your dentures can also spread to your natural teeth and gums, causing gum disease and cavities.

To clean your dentures, remove them from your mouth and run them under water to rinse off any loose food particles. Then wet a denture brush or a regular soft-bristle toothbrush and apply denture cleaner or a mild soap. Household cleaners and regular toothpaste are too abrasive and should not be used for cleaning dentures. Gently brush all surfaces of the dentures including under the clasps where bacteria collect. Be careful not to damage the plastic or bend the attachments. Rinse your dentures well in clean water before placing them back in your mouth.

While your dentures are removed, be sure to clean and massage your gums. If your toothbrush hurts your gums, run it under warm water to make it softer or try using a finger wrapped in a clean, damp cloth. If you have partial dentures, brush your natural teeth with a soft-bristled toothbrush and floss. After flossing, roll it up in a tiny ball and put it in the garbage. Never flush floss down the toilet.

Always remove your dentures overnight to give your mouth a chance to rest. Soak them in warm water with or without denture cleanser. If your dentures have metal clasps, only use warm water for soaking, as other soaking solutions can tarnish the metal. When you’re not wearing your dentures, keep them in water to stop them from drying out or warping. Never use hot water for soaking.

Dentures can break if dropped or squeezed too tightly. When you are handling your dentures, stand over a folded towel or a sink of water just in case you accidentally drop them.

Look for cracks in your dentures. If you find any, take them to your dentist or specialist for repair. See your dentist regularly and at least once a year. Your mouth is always changing, so your dentures will need adjusting or relining from time to time to make sure they fit well. Poorly fitted dentures may cause denture sores that make oral cancer more difficult to spot. At your dental exam, your dentist will also examine your gums for any signs of disease or oral cancer and any natural teeth you may have for signs of decay or infection.

Please call 905-668-6301 to book a consultation appointment.

(Information provided by the Canadian Dental Association)
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26
Feb
2020

 

Please visit the following site for answers to the most frequently asked questions about the Coronavirus.

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

 

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12
Feb
2020

Toothache


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Toothache is pain in or around a tooth that may be caused by:

  • Tooth decay
  • Abscessed tooth
  • Tooth fracture
  • A damaged filling
  • Repetitive motions, such as chewing gum or grinding teeth
  • Infected gums

Symptoms of a toothache may include:

  • Tooth pain that may be sharp, throbbing, or constant. In some people, pain results only when pressure is applied to the tooth.
  • Swelling around the tooth
  • Fever or headache
  • Foul-tasting drainage from the infected tooth

When Should I See a Dentist About a Toothache?

See your dentist as soon as possible about your toothache if:

  • You have a toothache that lasts longer than 1 or 2 days
  • Your toothache is severe
  • You have a fever, earache, or pain upon opening your mouth wide

Treatment of dental infections is important to prevent its spread to other parts of the face and skull and possibly even to the bloodstream.

What Happens When I Go to the Dentist for a Toothache?

To treat your toothache, your dentist will first obtain your medical history and conduct a physical exam.   He or she will ask you questions about the pain, such as when the pain started, how severe it is, where the pain is located, what makes the pain worse, and what makes it better. Your dentist will examine your mouth, teeth, gums, jaws, tongue, throat, sinuses ears, nose, and neck.

X-rays may be taken as well as other tests, depending on what your dentist suspects is causing your toothache.

What Treatments Are Available for a Toothache?

Treatment for a toothache depends on the cause. If a cavity is causing the toothache, your dentist will fill the cavity or possibly extract the tooth, if necessary. A  root canal might be needed if the cause of the toothache is determined to be an infection of the tooth’s nerve. Bacteria that have worked their way into the inner aspects of the tooth cause such an infection. An antibiotic may be prescribed if there is fever or swelling of the jaw.

How Can Toothaches Be Prevented?

Since most toothaches are the result of tooth decay, following good oral hygiene practices can prevent toothaches. Good oral hygiene practices consist of brushing regularly with a fluoride-containing toothpaste, flossing once daily, rinsing once or twice a day with an antiseptic mouthwash, and seeing your dentist twice a year for professional cleaning. In addition to these practices, eat foods low in sugar and ask your dentist about fluoride applications.

Please call our office at 905-668-6301 at the first sign of a toothache.

( Information provided by WEBMD)
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18
Dec
2019

Flouride FAQ’s


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Frequently Asked Questions

Listed below are answers to commonly asked questions about fluoride.

What is fluoride?
Fluoride is a mineral found in soil, water (both fresh and salt) and various foods.

How does fluoride prevent tooth decay?
Fluoride has a positive effect on oral health by making teeth more resistant to decay. Fluoride can also prevent or even reverse tooth decay that has started.

Where do I get the fluoride that prevents tooth decay?
For many Canadians, fluoride is in public drinking water, which provides protection to the entire community. Fluoride toothpastes and rinses are available for purchase, and your dentist can provide professional fluoride products such as gels and varnish.

What is dental fluorosis?
Dental fluorosis is a change in the appearance of teeth. It is caused when higher than optimal amounts of fluoride are ingested in early childhood. In its mildest and most common form, it affects the look of the tooth with small white specks appearing on a child’s teeth.

Is dental fluorosis a concern in Canada?
The Canadian Health Measures Survey 2007-2009 found that dental fluorosis is not an issue of concern for the vast majority of children (84%). Some children (16%) have mild forms of fluorosis that often go unnoticed by both the children and their parents.

What is water fluoridation?
Water fluoridation is the process of adjusting the level of fluoride in a public drinking water supply to optimize the dental benefits of preventing tooth decay.

Why is fluoride added to the public drinking water if it is available in other ways?
Fluoride is added to public drinking water to protect all members of the community from tooth decay. Community water fluoridation is a safe and effective way of preventing tooth decay at a low cost.

Who watches the fluoride levels in the drinking water?
The Federal-Provincial-Territorial Committee on Drinking Water makes recommendations about the optimal level of fluoride in public drinking water to prevent tooth decay. The recommended level takes into account that Canadians receive fluoride from other sources such as food and beverages.

What does an “optimal” level of water fluoridation mean?
An optimal level of water fluoridation is achieved by adjusting the level of fluoride in the water to achieve the right balance between the benefit of preventing tooth decay and the risk of developing dental fluorosis.

 Are there any health risks associated with water fluoridation?
With the exception of dental fluorosis, scientific studies have not found any credible link between water fluoridation and adverse health effects.

Should I be using fluoridated toothpaste with my child?
For children from birth to 3 years of age, the use of fluoridated toothpaste is determined by the level of risk of tooth decay. Parents should consult a health professional to determine whether their child up to 3 years of age is at risk of developing tooth decay. If such a risk exists, the child’s teeth should be brushed by an adult using a minimal amount (a portion the size of a grain of rice) of fluoridated toothpaste. Use of fluoridated toothpaste in a small amount has been determined to achieve a balance between the benefits of fluoride and the risk of developing fluorosis. If the child is not considered to be at risk, the teeth should be brushed by an adult using a toothbrush moistened only with water.

For children from 3 to 6 years of age, only a small amount (a portion the size of a green pea) of fluoridated toothpaste should be used. Children in this age group should be assisted by an adult in brushing their teeth.

Why do young children need to be assisted or supervised with tooth brushing?
Young children tend to swallow toothpaste when they are brushing, which may increase their exposure to fluoride and contribute to dental fluorosis. For this reason, children need to be assisted or supervised with tooth brushing. An adult needs to ensure that an appropriate amount of toothpaste is used, that the child spits out the toothpaste rather than swallows it, and that the teeth are cleaned effectively.

How do I know if my child is getting enough fluoride protection?
Your dentist is able to assess your child’s risk of developing tooth decay and advise you of an appropriate level of fluoride protection.

(Source: Canadian Dental Association)

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12
Dec
2019

Dental Anxiety


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Going to the dentist can cause anxiety, and that’s a normal reaction. It’s estimated that between 15 and 40 percent of people are affected by dental anxiety.

If not addressed, dental anxiety can lead to unnecessary oral health problems as a result of avoidance behavior, which can ultimately lead to more time spent in the dental chair to receive more extensive and potentially costly treatment.

Why do people experience dental related anxiety?

There are many causes of dental anxiety:
• The fear of pain
• Feeling as if you are not in control or are helpless
• Feeling embarrassed about the condition of your teeth
• Recalling your own past experiences or the experiences of your family and friends
• The fear of needles, drills and gagging
• Anticipating costly and/or extensive treatment

What can I do to alleviate dental anxiety?

• Talk with your dentist. He or she can help dispel any negative or frightening perceptions you may have. Having an understanding of your dental health and the dental services or treatment that you and your dentist have discussed and decided upon will help to relieve dental anxiety. Ask questions, and request informational materials.
• Avoid caffeine and sugar before a dental appointment; they may make you anxious.
• Schedule dental appointments early in the day, before you have the chance to become stressed or rushed.
• Focus on relaxing. Breathe regularly and slowly during the procedure. When you are nervous you tend to hold
your breath, which decreases oxygen levels and further increases feelings of panic.
• Use hand signals to inform the dentist when you are uncomfortable.

What if my self-relaxation attempts don’t work?

Before your appointment, you can ask your dentist about sedation. There are different types of sedation methods. The most common are inhaled (breathing in a mixture of nitrous oxide and oxygen) and oral (taking a medication by mouth). Another type is intravenous (IV) sedation. Sedation will make you feel more relaxed and even sleepy. It is safe when administered by a trained dentist, but it’s important that you talk with your dentist about any potential risks and questions that you have.
Regular six-month preventive checkups help detect oral health problems early and acquaint you with the dental office and procedures you may feel anxious about. Remember: When it comes to dental anxiety, knowledge is the greatest defense.

If you have any questions please call the office at 905-668-6301 to speak to Dr. Appleton or Dr. Bana.

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27
Nov
2019

The Dental Exam


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The dental exam is critical to your ongoing oral health—and only your dentist can perform this.

The exam consists, in part, of the dentist looking inside your mouth. In the past, you may not have ever realized an exam was taking place. Perhaps you thought the dentist was checking the work the hygienist had just completed.

Not so. The dentist actually looks in your mouth for things that can affect your oral—and your overall—health. Many of these are things you can’t see on your own, but that a dentist is trained to detect. Here is some of what your dentist is looking for during a dental exam:

  • damaged, missing or decayed teeth
  • early signs of cavities
  • condition of your gums, such as periodontal pockets, inflammation or other signs of gum disease (which can lead to tooth and bone loss)
  • to see how previous dental work such as root canals, fillings and crowns are holding up
  • early signs of mouth or throat cancer, such as white lesions or blocked salivary glands
  • other suspicious growths or cysts
  • position of your teeth (e.g., spacing, bite)
  • signs that you clench or grind your teeth (a treatable problem that can cause headache or sore jaw and can, if serious, lead to hearing loss and tooth loss)
  • signs of bleeding or inflammation on your tongue and on the roof or floor of your mouth
  • the overall health and function of your temporomandibular joint (which joins the jaw to skull), checking for signs of disorders that can cause pain or tenderness
  • the general condition of the bones in your face, jaw and around your mouth

The dental exam can catch problems early—before you see or feel them—when they are much easier and less expensive to treat.

As well as the visual inspection of your mouth, the exam includes:

  • a complete medical history so the dentist knows about any health conditions that may affect the success of dental treatments or procedures or that may be associated with oral health problems.

It may also include:

  • an examination of your neck area, with the dentist feeling the glands and lymph nodes for possible signs of inflammation that could indicate general health problems; and
  • dental x-rays, if necessary. These can show such problems as cavities under existing fillings, fractures, impacted wisdom teeth, decay under your gum line and bone loss caused by gum disease.

Your dentist may explain what’s happening during the exam and give you a summary of the findings. If not, be sure to ask. As patient, you are a full partner in your oral health care.

 

Be Sure to Tell Your Dentist

The more your dentist knows about your overall health, the more effective they can be in addressing your oral health care needs. Be sure to mention:

  • any new medical conditions you’ve been diagnosed with since your last visit, such as diabetes or AIDS, even if they don’t seem pertinent. Your dentist needs to know to properly manage your treatment and prevention program.
  • any new medications you’re taking (side effects can often include dry mouth and overgrown gums)
  • if you’re pregnant
  • if you have any allergies
  • any changes you’ve noticed in your teeth, such as changes in colour, looseness or position
  • any changes you’ve noticed in your gums, such as bleeding when you brush or floss, or changes in appearance
  • any increased sensitivity to heat, cold or sweets
  • whether your floss catches on rough edges, causing it to shred
  • any colour changes in the skin on the inside of your mouth
  • if you smoke or chew tobacco (which increases the likelihood of oral cancer)
  • if your neck or jaw muscles are tight or if you’re aware of clenching or grinding your teeth
  • if you’re nervous about going to the dentist—new ways of doing things have made modern dentistry more comfortable for patients, and talking to your dentist may reassure you and help you feel more relaxed.

Please call the office at 905-668-6301 to book your dental exam appointment.

(Information provided by the Canadian Dental Association)

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6
Nov
2019

ODA Suggested Fee Guide

The Ontario Dental Association publishes The ODA Suggested Fee Guide for General Practitioners©.  The Guide is based on the provision of dental services which are performed under normal conditions.  It is intended to serve only as a reference for the general practitioner to enable development of a structure of fees which is fair and reasonable to the patient and to the practitioner.  The Guide is not obligatory and each practitioner is expected to determine independently the fees which will be charged for the services performed, which means that fees will vary both above and below the Guide.  The Guide is issued merely for professional information purposes, without any intention or expectation whatsoever that a practitioner will adopt the suggested fees.

The Guide is not available on the ODA website. However, copies have been placed in the reference section of many public libraries so that members of the public can access this document.

The Guide is approximately 80 pages in length, contains roughly 1,300 dental services and it is written using correct dental terminology so you will not find words such as cleaning, check-up, filling, cap, bridge and so on.  Each dental service is identified by a five-digit number called a procedure code.  The descriptions attached to the procedure code describe the dental service but not the reason the service was performed.  For example, the Guide contains several procedure codes that describe veneers — however, none of the descriptions identify the reason the veneer is being placed (i.e., for cosmetic reasons or to restore a tooth that  is missing or has lost tooth structure).  Furthermore, you will not find dental plan contract language such as basic, major, cosmetic nor will you find frequency limitations such as “once every six months”.  This type of language is specific to a dental plan contract and it is used to describe the situations under which subscribers will be reimbursed for specific dental services.  The Guide is a listing of dental services that general practitioners may perform.

If you have the procedure codes for the treatment that was prescribed or performed by your dentist, you may contact the ODA’s Practice Advisory Services staff who can provide you with information about the suggested fees.

 

(Information provided by the ODA)

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9
Oct
2019

Dental Benefits FAQs

1. What will my dental plan administrator do with the information I submit?

Once your plan administrator has the necessary forms and any supplementary information requested, he or she will be able to determine your plan’s liability based upon the provisions set out in the contract.

You will be sent an explanation of how the benefit was calculated. All, some or none of your treatments may be covered or, for some services, coverage may be limited to an alternative, less expensive procedure. It is important to understand that necessary treatment and covered expenses are not the same things.

2. My reimbursement was limited or declined. Where do I turn for clarification?

First, read the explanation from your plan administrator carefully. In most cases, it will explain how the benefit was calculated and it will identify any limitations or exclusions that have been applied. Look for language such as “Under the terms of your dental plan…”, “Your plan limits coverage to…” and “These services are covered only when…”.

These types of statements indicate that there are limitations within your contract and they have been applied to your claim. As a result, some or all of the costs associated with your treatment will remain an out-of-pocket expense not reimbursable under your plan.

For more detailed information about the specific provisions of your plan, either consult your employee handbook, discuss the matter with your benefits department or speak directly to your plan administrator.

The Advisory Services Department of The Ontario Dental Association is also able to provide you with assistance and advice.

(Information provided by the Ontario Dental Association)

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2
Oct
2019

All About Claims Forms

Filling out a dental claim form can be a bit of a challenge. In most cases, help is available from your human resources department or the customer service contact at your benefit plan provider. However, what you may not be aware of is that there are laws governing how a claim form may be used by an employer or plan provider.

In this section we’ll highlight some important things you should know, which will help you protect your privacy and security and that of any family members who are covered under your benefits.

Assignment of Benefits

The “assignment of benefits” is when a dental patient instructs an insurance carrier to make a payment of allowable benefits directly to the dentist. This has obvious appeal to a dental patient because the patient often does not have to pay the dentist up front, and then go through the process of filing a claim with their insurance carrier and wait to get reimbursed.

Why the ODA Opposes Assignment

The ODA is opposed to assignment of benefits and actively encourages dental plan sponsors to make their dental plans “non-assignment” plans. Many people wonder why the ODA would oppose a process that many find convenient.

The answer lies in the fact that “non-assignment” dental plans can be less expensive than those that allow assignment, simply because the act of a patient paying for their dental care makes them financially involved in their oral health care. This provides very a good incentive for the patient to use their dental plan wisely.

Dental claim reimbursement is much faster than it was years ago, and patients are finding that when they pay the dentist directly their reimbursement cheque is received quickly; greatly minimizing the time they are out of pocket. It is not unusual to see the dentist on Monday and have the reimbursement cheque before the end of the week, thanks to electronic claims submission.

Also, many dentists accept credit cards, which typically have a monthly billing cycle. If complex treatment is necessary, dentists can arrange a payment schedule that allows a patient to budget for expenses and get reimbursement that is more conveniently timed.

Active decision-making about oral health care by patients and meaningful involvement in the financial matters of dental care, including the dental plan, is an important part of achieving excellent oral health care.

Co-Pay

 

Many dental plans have co-payments, or in other words, a percentage of the claim amount that is not covered by the dental plan. These co-payments are usually 20 to 50 percent — or more — of the claim amount.

Many dental patients believe that the dentist can waive these amounts so the patient doesn’t have to pay the money. This is not the case and the consequences to dentists for not making a reasonable attempt to collect the co-payment are very serious.

Patient Fact Sheet: “Waiving the Dental Plan Co-Payment

Under the Dentistry Act, 1991 (Regulated Health Professions Act) dentists are required to make a reasonable attempt to collect the co-payment portion of dental fees for which the patient has payment responsibility.

The profession’s regulatory body, the Royal College of Dental Surgeons of Ontario (RCDSO) is responsible for ensuring dentists adhere to this requirement.

When collection of co payment is not possible

In short, the dentist has a professional obligation to collect the co-payment. On some occasions, the dentist may run into difficulties doing so. On these occasions, the term “reasonable” should be noted, by taking into account the circumstances of the situation. This includes occasions when it is clear to the dentist that the patient cannot afford to pay the co-payment.

The dentist may then decide to cease pursuing the collection. The following options are open to make sure that the dental plan administrator is not misled:

1. Citing the reasons why this decision has been made, the dentist can advise the dental plan administrator of the situation and obtain his or her consent in writing to cease attempting to collect the co-payment and;

2. Also stating the reasons why, the dentist could advise the dental plan administrator that he or she does not intend to collect the co-payment, and that he or she will accept as full payment, the amount the plan administrator will pay under the plan.

In either of these scenarios, no attempts to mislead the dental plan administrator have been made. Intentional misrepresentation by the dentist can result in discipline by the RCDSO, loss or suspension of dental registration and criminal proceedings for insurance fraud.

Insurance companies also reserve the right to request that the patient provide proof that the co-payment has been paid. If the patient is unable to provide that proof, the insurance company may demand the patient make financial restitution to the insurance company or it may apply the overpayment to future claims.

Clearly, waiving the co-payment and misleading the plan administrator jeopardizes everyone involved — the dentist, the plan administrator and the plan sponsor.

“Please Pay Subscriber”

Printed in capital letters at the top right hand corner on the ODA Standard Dental Claim Form is a box stamped, “Please Pay Subscriber.”

Although it may appear to be just a stamp on a form intended to conform to the rigor of a well-thought out administrative process, its history and meaning go far deeper. It is there to encourage the patient to be an active participant in his or her dental care, in a system where a plan sponsor and an insurance carrier is involved.

By not signing this box, the patient pays the dentist for the care received and then submits the completed claim form to the insurance carrier for reimbursement for the eligible benefit amount. The carrier then pays that amount directly to you, the plan member or subscriber.

Although the stamp has lost its place with the advent of electronic transmissions, the philosophy behind it remains. If the claim is electronically transmitted by the dental office to the carrier, then — unless otherwise agreed — the patient pays the dentist and the carrier will send the reimbursement to the plan member.

This process is called non-assignment. In other words, the subscriber did not assign his or her insurance benefits to the dentist, nor did the dentist accept assignment. This simple process has far-reaching benefits. The patient is aware of the cost of the dental service and will be more likely to:

  • comply with treatment regimens;
  • acquire knowledge about the nature and extent of dental benefits;
  • become a better consumer of dental care and wise user of dental benefits;
  • develop an important comfort level for discussing fees with the dentist;
  • identify areas in the design of a dental plan that could be improved and apprise dental plan sponsors in response.

The ODA has a long-standing philosophy encouraging non-assignment dental plans for the simple reason that when patients have a meaningful financial involvement in their dental care, better decisions are made.

Information About Using Claim Forms

Using Your Social Insurance Number as Identification

In the early ’90s, Bill C-18 amended a 1988 Income Tax ruling that specified that it is an offence for a person or employer to use an employee’s Social Insurance Numbers (SIN) for any purpose other than income tax reasons, unless authorized by the individual.

The modified provisions contained in C-18 extended liability to include consulting firms and insurance companies that use SIN numbers for group benefit administration. This meant that employers obtain either written permission to use SINs from each employee, including retirees, or they must devise a different numbering scheme.

The patient must provide his or her certification, SIN or identification number in Part 2 of the ODA Standard Dental Claim Form. Patients who are unsure of their identification number should refer to their employee benefits card or consult the Benefits Department at their place of employment.

Privacy Concerns

The standard dental claim form conforms with the Personal Information Protection and electronic Documents Act (PIPEDA), a federal privacy law. The release on the claim form reads as follows:

I understand that the fees listed in this claim may not be covered by or may exceed my plan benefits. I understand that I am financially responsible to my dentist for the entire treatment. I acknowledge that the total fee of $ is accurate and has been charged to me for services rendered.

I authorize the release of information contained in this claim to my ensuring company/plan administrator. I also authorize the communication of information related to the coverage of services described in this form of the named dentist.

The Canadian Dental Association (CDA) is in the process of notifying dentists, dental plan administrators, printers and software vendors of this change. By January 1, 2007 dentists should be using the revised form.

The Canadian Dental Association is also amending the standard dental pre-treatment form to reflect the same wording change.

Dentists using CDAnet, will also be required to update each patient (parent/guardian) signature on file. For each patient participating in CDAnet the following wording must accompany the signature:

I authorize release, to my dental benefit plan administrator and the CDA, information contained in claims submitted electronically. I also authorize the communication of information related to the coverage of services described to the named dentist. This authorization shall continue in effect until the undersigned revokes the same.

The signature on file must be updated every three years.

The signature serves two purposes: it authorizes the dentist to submit the claim/estimate electronically and it authorizes the plan administrator to send the electronic explanation of benefits (EOB) or pre-determination of benefits (POB) or claim acknowledgement back to the dental office. Dentists are obligated to give the EOB, POB or claim acknowledgment to the patient prior to leaving the office.

If you have any questions about the claim form, the pre-treatment form or the signature on file, please contact the ODA’s Advisory Services Department at advisoryservices@oda.ca.

Co-Payments

Many dental plans have co-payments, or in other words, a percentage of the claim amount that is not covered by the dental plan. These co-payments are usually 20 to 50 percent — or more — of the claim amount.

Many dental patients believe that the dentist can waive these amounts so the patient doesn’t have to pay the money. This is not the case and the consequences to dentists for not making a reasonable attempt to collect the co-payment are very serious.

Patient Fact Sheet: “Waiving the Dental Plan Co-Payment

Under the Dentistry Act, 1991 (Regulated Health Professions Act) dentists are required to make a reasonable attempt to collect the co-payment portion of dental fees for which the patient has payment responsibility.

The profession’s regulatory body, the Royal College of Dental Surgeons of Ontario (RCDSO) is responsible for ensuring dentists adhere to this requirement.

When collection of co payment is not possible

In short, the dentist has a professional obligation to collect the co-payment. On some occasions, the dentist may run into difficulties doing so. On these occasions, the term “reasonable” should be noted, by taking into account the circumstances of the situation. This includes occasions when it is clear to the dentist that the patient cannot afford to pay the co-payment.

The dentist may then decide to cease pursuing the collection. The following options are open to make sure that the dental plan administrator is not misled:

1. Citing the reasons why this decision has been made, the dentist can advise the dental plan administrator of the situation and obtain his or her consent in writing to cease attempting to collect the co-payment and;

2. Also stating the reasons why, the dentist could advise the dental plan administrator that he or she does not intend to collect the co-payment, and that he or she will accept as full payment, the amount the plan administrator will pay under the plan.

In either of these scenarios, no attempts to mislead the dental plan administrator have been made. Intentional misrepresentation by the dentist can result in discipline by the RCDSO, loss or suspension of dental registration and criminal proceedings for insurance fraud.

Insurance companies also reserve the right to request that the patient provide proof that the co-payment has been paid. If the patient is unable to provide that proof, the insurance company may demand the patient make financial restitution to the insurance company or it may apply the overpayment to future claims.

Clearly, waiving the co-payment and misleading the plan administrator jeopardizes everyone involved — the dentist, the plan administrator and the plan sponsor.

“Please Pay Subscriber”

Printed in capital letters at the top right hand corner on the ODA Standard Dental Claim Form is a box stamped, “Please Pay Subscriber.”

Although it may appear to be just a stamp on a form intended to conform to the rigor of a well-thought out administrative process, its history and meaning go far deeper. It is there to encourage the patient to be an active participant in his or her dental care, in a system where a plan sponsor and an insurance carrier is involved.

By not signing this box, the patient pays the dentist for the care received and then submits the completed claim form to the insurance carrier for reimbursement for the eligible benefit amount. The carrier then pays that amount directly to you, the plan member or subscriber.

Although the stamp has lost its place with the advent of electronic transmissions, the philosophy behind it remains. If the claim is electronically transmitted by the dental office to the carrier, then — unless otherwise agreed — the patient pays the dentist and the carrier will send the reimbursement to the plan member.

This process is called non-assignment. In other words, the subscriber did not assign his or her insurance benefits to the dentist, nor did the dentist accept assignment. This simple process has far-reaching benefits. The patient is aware of the cost of the dental service and will be more likely to:

  • comply with treatment regimens;
  • acquire knowledge about the nature and extent of dental benefits;
  • become a better consumer of dental care and wise user of dental benefits;
  • develop an important comfort level for discussing fees with the dentist;
  • identify areas in the design of a dental plan that could be improved and apprise dental plan sponsors in response.

The ODA has a long-standing philosophy encouraging non-assignment dental plans for the simple reason that when patients have a meaningful financial involvement in their dental care, better decisions are made.

Information About Using Claim Forms

Using Your Social Insurance Number as Identification

In the early ’90s, Bill C-18 amended a 1988 Income Tax ruling that specified that it is an offence for a person or employer to use an employee’s Social Insurance Numbers (SIN) for any purpose other than income tax reasons, unless authorized by the individual.

The modified provisions contained in C-18 extended liability to include consulting firms and insurance companies that use SIN numbers for group benefit administration. This meant that employers obtain either written permission to use SINs from each employee, including retirees, or they must devise a different numbering scheme.

The patient must provide his or her certification, SIN or identification number in Part 2 of the ODA Standard Dental Claim Form. Patients who are unsure of their identification number should refer to their employee benefits card or consult the Benefits Department at their place of employment.

Privacy Concerns

The standard dental claim form conforms with the Personal Information Protection and electronic Documents Act (PIPEDA), a federal privacy law. The release on the claim form reads as follows:

I understand that the fees listed in this claim may not be covered by or may exceed my plan benefits. I understand that I am financially responsible to my dentist for the entire treatment. I acknowledge that the total fee of $ is accurate and has been charged to me for services rendered.

I authorize the release of information contained in this claim to my ensuring company/plan administrator. I also authorize the communication of information related to the coverage of services described in this form of the named dentist.

The Canadian Dental Association (CDA) is in the process of notifying dentists, dental plan administrators, printers and software vendors of this change. By January 1, 2007 dentists should be using the revised form.

The Canadian Dental Association is also amending the standard dental pre-treatment form to reflect the same wording change.

Dentists using CDAnet, will also be required to update each patient (parent/guardian) signature on file. For each patient participating in CDAnet the following wording must accompany the signature:

I authorize release, to my dental benefit plan administrator and the CDA, information contained in claims submitted electronically. I also authorize the communication of information related to the coverage of services described to the named dentist. This authorization shall continue in effect until the undersigned revokes the same.

The signature on file must be updated every three years.

The signature serves two purposes: it authorizes the dentist to submit the claim/estimate electronically and it authorizes the plan administrator to send the electronic explanation of benefits (EOB) or pre-determination of benefits (POB) or claim acknowledgement back to the dental office. Dentists are obligated to give the EOB, POB or claim acknowledgment to the patient prior to leaving the office.

If you have any questions about the claim form, the pre-treatment form or the signature on file, please contact the ODA’s Advisory Services Department at advisoryservices@oda.ca.

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Employers sponsor dental plans for a variety of reasons, including the promotion of good health, keeping their work force healthy and fit, and attracting and retaining top-notch employees.

Your employer will provide you with details of your plan that are easy to understand. It will give you a brief overview of the services that are covered, limitations and exclusions, and the fee guide used to calculate benefits. Keep in mind that this page offers a brief summary and the actual specifics of the plan will be spelled out in a contract between the employer and the dental plan administrator.

The employer enters into a dental plan contract with a third party that will act as the plan administrator. Dental plan contracts are lengthy, complex documents that define what services are covered and under what circumstances those services are eligible for reimbursement.

Some limitations such as frequency limitations — for example, “This service is covered once every three years” — are easily understood, while others are more complex, such as, “This service is covered only when there is evidence of recurrent decay or fracture”. Dental plan administrators are contractually obligated to reimburse patients based upon the terms of the dental plan contract. This means that in some instances, necessary treatment may not be covered.

You and Your Dental Plan

The Patient’s Responsibilities

There are more than 30,000 dental plan contracts in Ontario, and each one is a little different from the next. As a smart consumer, you should make it your job to understand the details of your dental plan, and to supply your dental plan administrator with necessary information such as pre-treatment forms, claim forms or any supplementary information. You are also responsible for making arrangements for payment to your dentist for the dental care received.

The Dentist’s Responsibilities

Your dentist, in accordance with the Regulated Health Professions Act and applicable regulations, will give you information on available treatment options appropriate to address your dental care needs, regardless of the nature and extent of your dental plan coverage. In addition, the dentist will assist you by supplying information required to enable you to receive benefits to which you may be entitled under your dental plan.

How Your Dentist Helps You With Your Dental Plan

Your dentist will be happy to supply you with claim and pre-treatment forms, which you will need to receive benefits through your dental plan.

Sometimes additional information may be requested by your plan administrator in order to ensure that the treatment is covered by your plan. In such cases the plan administrator will write to you and ask you to obtain the information from your dentist. Your dentist will supply any information you request, but it is your responsibility to provide it to your dental plan administrator. This ensures that your health record remains confidential and your privacy is protected.

Dental plans are designed to help patients pay for their dental treatment. However, not all dental treatments are eligible or fully reimbursable. If your dental treatment is only partially covered, you will have to share in the cost of your dental care.

Remember, you are a partner in your oral health. All treatment and care decisions should be made by you and your dentist based upon your actual needs, aside from your dental plan coverage. Your dental plan is not necessarily a treatment plan!

Dental Fees vs. Dental Plans

There may be a difference between the price your dentist may charge you and the amount covered by your dental plan. Here are three reasons why:

I. The Factors Considered When Calculating the Cost

The amount your dentist may charge you and the amount your dental plan may reimburse you for might be different because these two prices are not derived in the same way.

When your employer and insurance carrier determine the amount of money your dental plan will pay for services covered under the plan, they take into account the specific circumstances of your company and its employees.

They consider such factors as company funds available for employee benefits, the nature and extent of use of the dental plan by the employees, and which version of the ODA Suggested Fee Guide for General Practitioners is used by the insurance carrier.

The ODA Fee Guide is a reference of suggested fees for dental services that is updated annually by the Ontario Dental Association. Some employers may use a current issue of the guide, while others may use past issues of the guide.

On the other hand, every dentist sets his or her own fees, considering the factors affecting both the practice and the patients served. The ODA Suggested Fee Guide helps dentists derive fees, but this is only a guide and the fees are only “suggested.”

A dentist may use this guide to formulate a fee for their dental services. Once a dentist has established a fee for a certain service, with special exceptions, he/she will charge that fee to all patients, regardless of whether or not the patient has a dental plan.

II. The Plan Design

For some dental services, payment may be based on a cost-sharing arrangement between the employer and employee. In these cases, the patient pays for a portion of the cost, while the plan pays for the remainder.

As identified on the claim form you sign after you receive a service, you are responsible for the bill. This means you are also responsible to pay for the portion of the bill not covered by your plan — the portion known as the co-payment. It is illegal for the dentist to waive or ignore the co-payment and a dentist who does this could lose his or her licence.

III. The Individual Circumstances of the Patient

If the problem requiring dental services is harder to resolve and requires more time or work by the dentist, the fee may be higher than the dentist’s usual fee. Similarly, if the problem is less complicated and requires less time or work to resolve, the fee may be lower than what the dentist would normally charge.

In other cases, sometimes the fee will prevent a patient or group of patients from obtaining dental care when it is needed the most. For example, a toothache can result in oral infection if not treated on time. This can pose a great risk to patients who are in poor overall health, particularly those who suffer from heart disease.

In cases like this it is better to discuss the situation — including the fee — with the dentist. Often, a better solution can be found rather than having the patient forgo the necessary care. This should involve working out financial terms with the dentist and discussing all possible options.

Commercial Lab Charges Explained

There are many dental services that require additional “commercial laboratory procedures.” As your dentist can explain, dental procedures that involve the services of a commercial laboratory may include:

  • inlays or onlays — small and large restorations, respectively
  • veneers
  • crowns
  • bridges
  • posts and cores for crown and bridge restorations
  • dentures
  • implant procedures
  • night guards, sports guards, sleep apnea appliances, orthodontic appliances, and
  • repairs to any of the above restorations or appliances.

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Laboratory Fees Are Not Dental Fees

The fees charged for laboratory services are in addition to the dentist’s professional fee for the service or treatment provided. In most cases, the laboratory services are performed by companies and not your dentist. Your dentist will arrange for a commercial laboratory to do the work to precise specifications that meet your treatment needs.

While the lab fee is passed on to patients, it is not the dentist’s fee. The lab charges passed on to you by the dentist will be the exact amount that the laboratory has charged your dentist to provide the service.

When completing your claim form, the fee for the service performed by the dentist, such as a crown or bridge, will be listed as a professional fee. The laboratory charges reported on the form, using procedure code 99111, will be the fee charged by the commercial laboratory. Again, this is not the dentist’s fee.

Lab Fees and Your Dental Plan Coverage

Laboratory charges must be completed in conjunction with other services. The amount payable by your dental plan will be limited to the reimbursement percentage of the services that required the lab work. This percentage is determined by the employer or plan sponsor and there are a variety of ways in which reimbursement is handled by the plan administrator.

To find out the level of reimbursement that can be expected from your dental plan, you should request that your dentist prepare an estimate of the professional services and the estimated laboratory charges, which should then be submitted to your plan administrator.

The predetermination of benefits you receive back from your plan administrator will explain how your benefits for these services are calculated so that you are aware of what your costs will be, before you receive the treatment.

Stay tuned next week for Part 2 in the series.

(Information provided by the Ontario Dental Association)

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