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Orthodontics/Adult in Braces - Prosthodontist

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Paul Supan, DDS, MA, MPH,

Hey. Alright, so in the long run I am really seeking financial guidance/advice with my orthodontic-prosthodontist care and trying to to freak out about the expenses. So if this really isn't your area of expertise and you more answer clinical questions, that's okay. Maybe just typing this out will help me remain calm. So thanks in advance for at least reading this!

Okay, so it will be nearing 2 years that I have had my braces on. I paid in full for them and had no dental insurance at the time. Since then I have graduated college and have Dental Care Plus through my job, but nonetheless it only covers orthodontic work if you are a dependent and 19 years of age or younger; which I am neither of these; not fun, no reimbursement!

So, as I near the end of the orthodontic phase I am going to have a consultation with a prosthodontist to bond my four front, top teeth. The consultation alone is 186 dollars! I am wondering if you could help guide me in what I should do to help me financially. Should I maybe find a supplemental insurance, different dental insurance, a dental discount plan? This is all new to me and I just don't even know who to go go. Would speaking with someone in the office I will be going to for prosthodontist work be able to help me? I understand most insurances you have to have for 6 months before they even start to help you. Ideally, it would be absolutely wonderful if I get get some reimbursement from my orthodontic costs and help with the phase of prosthodintist work. So this is my story. What do you think?

Thank you so much,
Brittany

Answer


Hi Brittany,

Wow, what a hard question. I have spent some extra time asking around at several other doctor's offices in order to better answer your questions. I am afraid I am not really that expert at financial reimbursement and insurance coverage issues. Let me cover this in simple steps.

1.   First of all the initial Orthodontic treatment I hope addressed the fact that there would or might be a need for cosmetic treatment at the end of orthodontics. This can often be due to undersized lateral incisors, severe discolorations, malformed or unevenly matched teeth, etc. I currently have a case where the left and right lateral incisors have remarkably different widths, and obviously at the end will have to be better matched. This is a cosmetic adjustment and not something that can be achieved with orthodontics.

2.   You did not include any photos and it s not clear just why you are getting bonding. There are many options here, because there are various issues which may need to be addressed. Brittany, you need to closely examine your teeth and assess several things. Look at the two upper central incisors and ask yourself if you like the shape and proportion. Are they too overly square ? Are they too tall and skinny? Are they too triangular shaped ? If a tooth is too "short" sometimes the gum tissue can be slightly trimmed back via cosmetic periodontal surgery much like one would trim back fingernail cuticle to more expose a nail. In other words, a tooth needs to have an esthetically acceptable height width proportion. You don't want your teeth to look like pieces of square chicklet gum.

3.   Aside from each tooth having a proper proportion, the central and lateral incisors need to be proportionate to one another. Imagine a person with a small face having lip augmentation that gets out of hand. In other words really large lips would look awkward. Likewise, the two central incisors need to proportionately match up with the two lateral incisors.


4.   The question of bonding or veneers is a major question in and of itself. Then there are issues of what type of veneers, since there are many different kinds. This is a technical issue which you should discuss with your clinician. If you do decide on veneers and have a question, I urge you to submit a follow up question and I will be happy to review those options for you as well.


5.   Now regarding the costs and the role of insurance. if the issues are slight and only for cosmetics, and not function, it often takes a very high end full coverage plan to get any reimbursement form an insurance carrier. Severely stained or disfigured teeth may have a better chance at being covered. Likewise if a person has very small peg shaped lateral incisors and they create a speech problem. In other words if functional issues come into play, reimbursement chances ay be more favorable.


6.  Brittany at your stage, I would check with your benefits officer and ask what the high end options are for your plan. Also ask if there is a waiting period, and if so how long. Insurance plans are often very tricky at providing benefits and have all sorts of exclusion clauses as you have already found out.


7.  My recommendation Brittany is that you do your homework with your benefits officer, and then thoroughly discuss this with your family dentist and specialist prosthodontist. I have seen excellent results with veneers as well as bonding. If the adjustment needed is slight, bonding in fact ay be a superior approach since less reduction of the existing tooth may be needed. There are also so called zero reduction veneers, and whether you are a candidate for that is difficult for me to say without a clinical examination.  Veneers tend to be more expensive than bonding. The more expensive version is not necessarily best; it all depends on your individual needs.

Brittany I hope I have not overly confused you. If you do find that you are a candidate for veneers, I invite you to write again, because that deserves a discussion all its own.

Paul Supan, DDS, MA, MPH
http://www.Braces.com
http://www.LeesburgBraces.com  

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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