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Preventive Dental Care: How to Clear the Insurance Hurdle

Nov 2, 2018

Author: Susanna Scherer RDH 

Preventive dental care is an integral part of whole mouth health. X-rays, fluoride varnish applications and individualized recall appointments are a few examples of measures dental professionals take for early detection and prevention of dental disease. While you understand the benefits of preventive care, your patients may not. They are likely to agree to treatment as long as they have an insurance plan to pay for it, but what happens when dental insurance doesn't cover these recommended treatments?

As dental hygienists, it is our responsibility to help patients understand the benefits of the preventive dental care we are recommending, even when insurance may not pay for treatment. Educating patients about their oral health needs will allow them to make an informed decision.

Seeing Is Believing

According to Dentistry IQ, clear communication and visual aids are key in showing a patient the value of a recommended treatment plan. If they can see and understand an oral problem with their own eyes, they may be more willing to find a way to pay for treatment. You probably already have the tools to incorporate visual aids while educating patients about preventive dental care:

  • Show the patient examples of X-rays that compare early detection and late detection scenarios. This can help patients see the need for routine recommended X-rays as opposed to waiting until they feel there is a problem.
  • Digital X-rays are an excellent tool for showing patients areas of incipient decay. This will allow for a conversation about the benefits of a fluoride varnish treatment in the office and the use of prescription fluoride toothpaste at home.
  • Use an intraoral camera to show patients what you are seeing. Using a hand mirror to show the patient an area of concern is not always effective, but intraoral cameras eliminate any confusion the patient may have about the area you are showing them.
  • The Gum Health Physical tool is an interactive probe that allows you to teach patients about periodontal pocketing, the progression of gum disease and the need for more frequent hygiene appointments.

Discussing Out-of-Pocket Expenses

Many patients assume that if insurance does not cover treatment then it simply isn't necessary. The dental hygienist is responsible for educating patients about their oral health needs regardless of whether or not insurance covers the treatment. Make sure your patients completely understand why they should come back for a crown or a fluoride treatment that their insurance does not cover. When the patient is made aware of the oral health benefits of an out-of-pocket preventive dental treatment, they can make an informed decision to proceed with treatment.

Don't assume a patient can or cannot afford to pay if insurance does not cover the cost. Your dental team should establish a policy for procedures that are not covered by dental insurance. For example, your office may choose to create a monthly payment plan instead of requiring payment at the time of service. While that may not be a good solution for every office, it is important for your team to discuss how to provide access to care for all of your patients.

Helping Your Patients Afford Their Care

Even after being informed, patients may opt out of preventive care that is not covered by insurance because they cannot afford the cost. In this case you can consider a referral. Dental clinics, dental schools and dental hygiene schools offer preventive services that may be more affordable than a standard office visit. For example, if a patient requires four hygiene visits per year, but their dental insurance only covers two, you could refer them to the local dental hygiene school for the two additional hygiene visits. The American Dental Association has a list of organizations that provide further information about assistance programs in your area.


  • Use visual aids to help patients see the need for preventive dental care.
  • Never assume a patient can or cannot afford treatment.
  • Educate patients to allow them the opportunity to make an informed decision about care.

Why It's Important

It is our responsibility as care providers to help patients to make an informed decision about their oral health care. Education about preventive dental care can help patients move beyond the barrier of dental insurance coverage.

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