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44-583: Delta Dental member companies serve more than one third of the estimated 166 million Americans with dental insurance . In 1954, several dental service corporations formed in California , Oregon , and Washington . These corporations were created by dentists who recognized the need to increase access to oral health care, and later joined to form Delta Dental. Delta Dental began working with Washington Dental Service to provide dental benefit programs for organized labor unions and later underprivileged residents through

88-418: A 3D object. It is mostly used to ascertain the position of an unerupted tooth in relation to the erupted ones (i.e. if the unerupted tooth is buccally / palatally placed / in line of the arch). Other indications for radiographic localization include: separating the multiple roots/canals of teeth in endodontics, assessing the displacement of fractures, or determining the expansion or destruction of bone. With

132-838: A DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified. Dental insurance companies divide benefits, services, or procedures into categories and refer to them with American Dental Association (ADA) 3-4 digit code. As an example, Preventive and Diagnostic procedures often include exams (ADA code 0120), x-rays (ADA code 0210), and basic cleanings or prophylaxis (ADA code 1110). Basic procedures often include fillings , periodontics , endodontics , and oral surgery . Major procedures often are crowns , dentures , and implants . Procedures such as periodontics , endodontics , and oral surgery may be considered major, depending on

176-419: A computer. However digital sensors are extremely costly and have historically had poor resolution , though this is much improved in modern sensors. It is possible for both tooth decay and periodontal disease to be missed during a clinical exam, and radiographic evaluation of the dental and periodontal tissues is a critical segment of the comprehensive oral examination. The photographic montage at right depicts

220-590: A partnership with the Washington State Department of Public Assistance. Delta Dental Plans Association (DDPA) was created in Fall of 1966 to bring together these local state service organizations and coordinate dental benefit programs for customers with employees in multiple states. A year later, the first multi-state program was sold by WDS to the International Association of Machinists . WDS ceded

264-464: A reduced cost for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods and no annual maximum benefit limitations, while covering major dental work near the start of the policy period. This plan is sometimes purchased to help defray the high cost of the dental procedures. Some dental insurance plans offer free semi-annual preventive treatment. Fillings, crowns, implants, and dentures may have various limitations. In

308-416: A shallow/flat palate. The bisecting angle technique is an older method for periapical radiography. It can be a useful alternative technique when the ideal receptor placement using the paralleling technique cannot be achieved, for reasons such as anatomical obstacles e.g. tori, shallow palate, shallow floor of mouth, or narrow arch width. This technique is based on the principle of aiming the central ray of

352-415: A situation in which extensive decay had been overlooked by a number of dentists prior to radiographic evaluation. Placing the radiographic film or sensor inside the mouth produces an intraoral radiographic view. Periapical radiographs are taken to evaluate the periapical area of the tooth and surrounding bone For periapical radiographs, the film or digital receptor should be placed parallel vertically to

396-496: A stated tenfold reduction in radiation. Although computed tomography offers high quality images and accuracy, the radiation dose of the scans is higher than the other conventional radiography views, and its use should be justified. Controversy surrounds the degree of radiation reduction though as the highest quality cone beam scans use radiation doses not dissimilar to modern conventional CT scans. Cone beam computed tomography (CBCT), also known as digital volume tomography (DVT),

440-421: Is a special type of X-ray technology that generates 3D images. In the recent years, CBCT has been developed specifically for its use in the dental and maxillofacial areas to overcome the limitations of 2D imaging such as buccolingual superimposition. It is becoming the imaging modality of choice in certain clinical scenarios although clinical research justifies its limited use. Indications of CBCT, according to

484-478: Is exposed while outside the patient's mouth, and they were developed by the United States Army as a quick way to get an overall view of a soldier's oral health. Exposing eighteen films per soldier was very time consuming, and it was felt that a single panoramic film could speed up the process of examining and assessing the dental health of the soldiers; as soldiers with toothache were incapacitated from duty. It

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528-519: Is formed by a controlled burst of X-ray radiation which penetrates oral structures at different levels, depending on varying anatomical densities, before striking the film or sensor. Teeth appear lighter because less radiation penetrates them to reach the film. Dental caries , infections and other changes in the bone density, and the periodontal ligament , appear darker because X-rays readily penetrate these less dense structures. Dental restorations (fillings, crowns) may appear lighter or darker, depending on

572-439: Is generally accepted that the paralleling technique offers more advantages than disadvantages, and gives a more reflective image, as compared to the bisecting angle technique. This can be used for both periapical and bitewing radiographs. The image receptor is placed in a holder and positioned parallel to the long axis of the tooth being imaged. The X-ray tube head is aimed at right angles, both vertically and horizontally, to both

616-465: Is of utmost importance to produce diagnostic radiographs and to avoid retakes, hence minimizing the radiation exposure of the patient. The requirements for ideal positioning include: However, the anatomy of the oral cavity makes it challenging to satisfy the ideal positioning requirements. Two different techniques have hence been developed to be utilised in the undertaking of an intra-oral radiograph – Paralleling technique and Bisected angle technique. It

660-414: The cementoenamel junctions , which are the demarcation lines on the teeth which separate tooth crown from tooth root. Routine bitewing radiographs are commonly used to examine for interdental caries and recurrent caries under existing restorations. When there is extensive bone loss, the films may be situated with their longer dimension in the vertical axis so as to better visualize their levels in relation to

704-494: The SEDENTEXCT (Safety and Efficacy of a New and Emerging Dental X-ray Modality) guidelines include: Developing dentition Restoration of dentition (if conventional imaging is inadequate) Surgical Research A cross sectional diagnostic study compared and correlated bone sounding and open bone measurements with conventional radiograph and CBCT for periodontal disease. The study did not find any superior result of CBCT over

748-447: The US government providing dental insurance coverage for all Medicare recipients. In the US, two-thirds of dentists do not accept dental insurance through Medicaid. Medicaid covers both basic and emergency dental care for children while it only covers emergency care for adult Medicaid recipients. With indemnity dental plans, the insurance company generally pays the dentist a percentage of

792-511: The United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to

836-786: The Washington Dental Service was rebranded as Delta Dental of Washington. If individuals have dental insurance through their employer, the Delta Dental member company in the state of their headquarters usually will handle coverage. Individual Delta Dental insurance is available in several states either through that state's member company or the state or federal health care exchange. Other individual dental insurance options are available through specialty groups such as AARP and military retiree, federal employee and veterans' groups. Dental Service of Massachusetts, also known as Delta Dental of Massachusetts, illustrates vertical integration in

880-451: The X-ray beam at 90° to an imaginary line which bisects the angle formed by the long axis of the tooth and the plane of the receptor. The image receptor is placed as close as possible to the tooth under investigation, without bending the packet. Applying the geometrical principle of similar triangles, the length of the tooth on the image will be the same as that of the actual length of the tooth in

924-723: The administration for enrollees in other states to other Delta Dental member companies and contracted with the Blue Cross and Blue Shield Association for administration in those states without a Delta Dental affiliate organization. Coverage was provided this way until the late 1980s when Delta Dental of California won the bid for the Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) program. Delta Dental member companies agreed to share its provider data so

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968-478: The administration of this very large account could be centralized, with Delta Dental of California sharing the administrative income and risk. The OCHAMPUS program led to the creation of the National Provider File (NPF), which was made available for commercial accounts in 1990 via Delta USA – providing Delta Dental coverage to organizations with employees and subscribers located in multiple states. In 2013,

1012-405: The conventional techniques, except for lingual measurements. The concept of parallax was first introduced by Clark in 1909. It is defined as "the apparent displacement or difference in apparent direction of an object as seen from two different points not on a straight line with the object". It is used to overcome the limitations of the 2D image in the assessment of relationships of structures in

1056-437: The cost of services. Restrictions may include the co-payment requirements, waiting period , stated deductible , annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned. Dental Health Maintenance Organization plans entail dentists contracting with a dental insurance company that dentists agree to accept an insurance fee schedule and give their customers

1100-407: The density of the material. The dosage of X-ray radiation received by a dental patient is typically small (around 0.150 mSv for a full mouth series ), equivalent to a few days' worth of background environmental radiation exposure, or similar to the dose received during a cross-country airplane flight (concentrated into one short burst aimed at a small area). Incidental exposure is further reduced by

1144-487: The dental industry of Massachusetts. Some dental providers charge that this practice reduces insurance competition and dictates prices for clinical services. Delta Dental of Massachusetts and DentaQuest (a competitor) are subordinate companies of Dental Service of Massachusetts. Dental insurance Dental insurance is a form of health insurance designed to pay a portion of the costs associated with dental care . The American Dental Association has lobbied against

1188-511: The films are sensitive to normal light. This can be a time-consuming process, and incorrect exposures or mistakes in the development process can necessitate retakes, exposing the patient to additional radiation. Digital X-rays, which replace the film with an electronic sensor, address some of these issues, and are becoming widely used in dentistry as the technology evolves. They may require less radiation and are processed much more quickly than conventional radiographic films, often instantly viewable on

1232-409: The full length of the teeth being imaged. The main indications for periapical radiography are Intraoral periapical radiographs are widely used for the preoperative due to its simple technique, low cost and less radiation exposure and widely available in clinical settings. The bitewing view is taken to visualize the crowns of the posterior teeth and the height of the alveolar bone in relation to

1276-464: The inside of the cheek to confirm the presence of a sialolith in Stenson's duct, which carries saliva from the parotid gland . The occlusal view is not included in the standard full mouth series. 1. Anterior oblique occlusal mandible – 45° Technique: the collimator is positioned in the midline, thru the chin aiming an angle of 45° to the image receptor which is placed centrally into the mouth, on to

1320-516: The large numbers of radiographs involved, many of which will not be necessary for the patient's treatment. An alternative approach using bitewing screening with selected periapical views is suggested as a method of minimising radiation dose to the patient while maximizing diagnostic yield. Contrary to advice that emphasises only conducting radiographs when in the patient's interest, recent evidence suggests that they are used more frequently when dentists are paid under fee-for-service Accurate positioning

1364-409: The mandible, aiming upwards and forwards at the image receptors which is placed centrally into the mouth, on to the occlusal surface of lower arch. Patients must turn their head away from the side of investigation. Indications: 1) Detection of any sialoliths in submandibular salivary glands 2) Used to demonstrate unerupted lower 8's 3) Assess the size of lesions such as cyst or tumours in

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1408-553: The mouth. The many inherent variables can inevitably result in image distortion and reproducible views are not possible with this technique. An incorrect vertical tube head angulation will result in foreshortening or elongation of the image, while an incorrect horizontal tube head angulation will cause overlapping of the crowns and roots of teeth. Many frequent errors that arise from the bisecting angle technique include: improper film positioning, incorrect vertical angulation, cone-cutting, and incorrect horizontal angulation. Placing

1452-414: The occlusal surface of the lower arch. Indications: 1) Periapical status of lower incisor teeth for patients who cannot tolerate periapical radiographs. 2) Assess the size of lesions such as cyst or tumours at anterior area of mandible 2. Lateral oblique occlusal mandible – 45° Technique: The collimator is positioned from below and behind the angle of mandible and parallel to the lingual surface of

1496-449: The photographic film or sensor outside the mouth, on the opposite side of the head from the X-ray source, produces an extra-oral radiographic view. A lateral cephalogram is used to evaluate dentofacial proportions and clarify the anatomic basis for a malocclusion, and an antero-posterior radiograph provides a face-forward view. Lateral cephalometric radiography (LCR) is a standardized and reproducible form of skull radiography taken from

1540-580: The policy. Some dental insurance plans may have an annual maximum benefit limit. Once the annual maximum benefit is exhausted any additional treatments may become the patient's responsibility. Each year, the annual maximum is reissued. The reissue date may vary as a calendar year, company fiscal year, or date of enrollment based on the specific plan. Dental radiography Dental radiographs , commonly known as X-rays , are radiographs used to diagnose hidden dental structures, malignant or benign masses , bone loss , and cavities . A radiographic image

1584-671: The posterior of body and angle of mandible A full mouth series is a complete set of intraoral X-rays taken of a patients' teeth and adjacent hard tissue. This is often abbreviated as either FMS or FMX (or CMRS, meaning Complete Mouth Radiographic Series). The full mouth series is composed of 18 films, taken the same day: The Faculty of General Dental Practice of the Royal College of Surgeons of England publication Selection Criteria in Dental Radiography holds that given current evidence full mouth series are to be discouraged due to

1628-537: The rise in 3D radiographic techniques, the use of CBCT can be used to replace the undertaking of parallax radiographs, overcoming the limitations of the 2D radiographic technique. In cases of impacted teeth, the image obtained via CBCT can determine the buccal-palatal position and angulation of the impacted tooth, as well as the proximity of it to the roots of adjacent teeth and the degree of root resorption, if any. Dental radiographs are an essential component to aid in diagnosis. Alongside an efficient clinical examination,

1672-399: The side of the face with precise positioning. It is used primarily in orthodontics and orthognathic surgery to assess the relationship of the teeth to the jaws, and the jaws to the rest of the facial skeleton. LCR is analyzed using cephalometric tracing or digitizing to obtain maximum clinical information. Indications of LCR include: Panoramic films are extraoral films, in which the film

1716-409: The skeletal or pathologic anatomy of either the floor of the mouth or the palate . The occlusal film, which is about three to four times the size of the film used to take a periapical or bitewing, is inserted into the mouth so as to entirely separate the maxillary and mandibular teeth, and the film is exposed either from under the chin or angled down from the top of the nose. Sometimes, it is placed in

1760-513: The teeth. Because bitewing views are taken from a more or less perpendicular angle to the buccal surface of the teeth, they more accurately exhibit the bone levels than do periapical views. Bitewings of the anterior teeth are not routinely taken. The name bitewing refers to a little tab of paper or plastic situated in the center of the X-ray film, which when bitten on, allows the film to hover so that it captures an even amount of maxillary and mandibular information. The occlusal view reveals

1804-458: The tooth and the image receptor. This positioning has the potential to satisfy four out of the five above requirements – the tooth and image receptor cannot be in contact whilst they are parallel. Because of this separation, a long focus-to-skin distance is required to prevent magnification. This technique is advantageous as the teeth are viewed exactly parallel with the central ray and therefore there are minimal levels of object distortion. With

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1848-400: The use of a lead shield, lead apron, sometimes with a lead thyroid collar. Technician exposure is reduced by stepping out of the room, or behind adequate shielding material, when the X-ray source is activated. Once photographic film has been exposed to X-ray radiation, it needs to be developed, traditionally using a process where the film is exposed to a series of chemicals in a dark room, as

1892-440: The use of this technique, the positioning can be duplicated with the use of film holders. This makes the recreation of the image is possible, which allows for future comparison. There is some evidence that the use of the paralleling technique reduces the radiation hazard to the thyroid gland, as compared to the use of the bisecting angle technique. This technique, however, may be impossible in some patients due to their anatomy, e.g.

1936-530: Was later discovered that while panoramic films can prove very useful in detecting and localizing mandibular fractures and other pathologic entities of the mandible, they were not very good at assessing periodontal bone loss or tooth decay. There is increasing use of CT (computed tomography ) scans in dentistry, particularly to plan dental implants; there may be significant levels of radiation and potential risk. Specially designed CBCT (cone beam CT) scanners can be used instead, which produce adequate imaging with

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