Does dental insurance cover tooth extractions? | Guardian Direct

Does dental insurance cover tooth extractions?

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Many dental insurance plans have some level of benefits for tooth extractions.

Key highlights

  • A tooth extraction can cost up to $4,0001
  • There are two types of tooth extractions: simple and complex/surgical
  • A simple dental extraction may be covered at up to 70%2

Having a tooth pulled, also called a tooth extraction, can be a painful but necessary part of dental care to remove an infected tooth or make room for other teeth. 

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By age 50, the average American has lost 12 teeth to decay.¹ It’s typically rare for an adult tooth to fall out on its own. Usually teeth have to be pulled, or extracted, by a dentist. Having a tooth pulled can be a painful but necessary part of dental care to remove an infected tooth or make room for other teeth. Broken teeth may need to be pulled if the break is so severe that it can’t be fixed any other way. 

Everyone loses their baby teeth as they grow, but that’s different from what happens when you lose an adult tooth. Losing baby teeth is less complicated because your permanent tooth underneath usually push them out naturally. But permanent teeth have long roots, and the molars in the back of the mouth can have as many as three to five roots that are firmly attached to the bone and gums. A tooth extraction as an adult can not only be painful but typically also costly without dental insurance. 

Tooth extraction costs

Typically, how much is a tooth extraction? If you don’t have dental insurance the cost will be higher than if you have insurance. Tooth extraction costs are determined by many factors, including the type of dental plan insurance you have, another common factor is the type of extraction that you need. Simple extractions which are typically easier for the dentist to do, may cost less than a more invasive extraction that must be done when for example a tooth has broken off or has another issue that makes the extraction difficult. 

A simple extraction is typically one where the tooth has grown all the way through the bone and gums and that the dentist can see in your mouth. Your dentist can usually extract this type of tooth in one piece. An X-ray will help show if the roots are straight or have crooked places that might snap off, causing the extraction to become more complex. An X-ray will also help show your dentist the position of the roots in the bone and how close they are to the other teeth and nerve supply. If your dentist does not foresee any expected complications, typically a simple extraction may be all you need. 

If the tooth is still under the gums or bone—either partially or fully—then the tooth may require a surgical or complex extraction. These are typically more costly and invasive than simple extractions because your dentist must cut away the gums and bone to get to the tooth. 

Surgical extractions can vary in cost depending on the complexity of the surgery, the type of anesthesia needed, and whether a general dentist or an oral surgery specialist extracts the tooth. 

A simple tooth extraction can cost up to $200 per tooth. A complex tooth extraction can cost up to $4,000 or more depending on your dental policy, where you live and what other dental care you receive² among other factors.

There are other factors that can determine the total tooth extraction cost including location, credentials of the dentist, and the type of anesthesia used. Tooth extraction costs vary widely from state to state, region to region, and dentist to dentist. 

In addition to the extraction, there may be additional charges for examinations, X-rays, scans, anesthesia, or other necessary services. Having dental insurance can help reduce the cost of the additional procedures that are necessary for the extraction so that you will pay less out of pocket. 

Dental insurance for extractions

Dental insurance for extractions can help make expensive tooth extractions more affordable, especially if you need multiple dental extractions. Figuring out if your dental insurance covers extractions may be complicated because every plan and every insurer has a different level of coverage. 

Subject to applicable waiting period limitations, Guardian Direct® Dental Gold plan covers simple extractions at 70% and complex extractions at 50%. The Dental  Bronze and Silver plans both cover simple extractions at 50%. 

Why teeth need to be pulled

Adult or permanent teeth need to be pulled for many reasons. Among the most common reasons are cavities that are too deep to fill, advanced gum disease, infections in the nerves of the tooth, trauma or injuries to the mouth and face, and the lack of space in the mouth for wisdom teeth to erupt naturally. 

Occasionally, a dentist must remove permanent teeth to make space for braces or to prepare the mouth for dentures or partial dentures. Tooth extractions are unavoidable when a tooth develops frequent infections that do not respond to treatments such as root canals or antibiotic therapy. 

Cavities and tooth decay are common reasons why teeth need to be pulled.³ Tooth decay typically happens when you don’t clean your teeth properly and ignore your dental hygiene. The bacteria in your mouth typically multiplies and starts to eat away at your teeth, slowly eating through the enamel of the tooth, and all the way down to the root. When the tooth loses structural rigidity because of the holes in it, the tooth can break or collapse and if there is too much damage from the decay the tooth will need to be extracted and replaced with an implant

When cavities develop in areas that a dentist cannot access to place a filling or a crown, such as the backside of a wisdom tooth or between teeth that are not in normal alignment with the others, an extraction may be needed to relieve ongoing problems and pain.

How do dentists extract teeth?

Other than having your baby teeth pulled, you may have never experienced a tooth extraction and are nervous about the procedure. Your dentist will go over the procedure with you before and after they pull the tooth.

After taking the X-rays, scans, and other typical diagnostic tests needed to see the position of the nerves and roots of the tooth, your dentist may put the tooth and gums surrounding it to sleep. They might use a simple injection of a local anesthetic beside the tooth. This type of numbing puts the tooth and gums to sleep quickly.

For more complex tooth extractions, such as pulling a tooth that is still under the gums and bone or that must be removed by cutting it into several pieces first, you might need a stronger form of anesthetic. 

Once the area is numb or sedation has taken effect, your dentist may use specialized sterile instruments to loosen the tooth from the gums and bone using a gentle rocking motion⁴, much like getting a root-bound plant out of a pot for replanting in a garden. Once the membranes that attach the root of the tooth to the surrounding tissue and bone have been loosened, the dentist typically uses a set of forceps, designed to fit over the top of the tooth, to grip it firmly and slip it out of the mouth.

Finally, the dentist typically packs the open socket (hole) that remains after the tooth comes out with gauze or other material designed to assist in healing. Stitches, made of a material that naturally dissolves in the mouth after a few days, may or may not be necessary. 

Tooth extraction aftercare

After a tooth extraction, taking care of the area can help ensure best possible healing and avoid complications. Tooth extraction healing can take from several days to several weeks, depending on the type and degree of difficulty of the surgery as well as your overall physical health.

Follow all written and oral instruction your dentist gives you after completing your surgery. As a general rule, and under the supervision of your dentist, patients who have had a tooth pulled should avoid these activities⁵: 

  • Drinking through a straw for at least 24 hours

  • Rinsing vigorously with any type of liquid such as saltwater

  • Drinking any type of beverage containing alcohol

  • Using a mouthwash that contains alcohol

  • Smoking 

Your dentist will typically place a thick layer of sterile gauze over the extraction site for you to bite on and provide you with an additional supply to use for the first 24 hours. 

If you need to rinse your mouth after brushing, do so very gently with plain water to avoid disrupting the blood clot and causing a dry socket. You may want to eat soft foods for a few days following a tooth extraction. During this time, chewing solid food might not only be uncomfortable but also impossible due to the temporary inability to open your mouth wide enough or to manipulate food particles with your lips and tongue normally. Furthermore, solid foods can work their way into the socket, even if stitches are in place. 

If swelling occurs, you can help reduce the swelling by applying ice. If the swelling doesn’t go down call your dentist and let them know that the swelling isn’t going down.

Under the supervision of your dentist, continue to brush and floss the other teeth as usual. Avoid brushing the teeth and gums close to the extraction site for several days to ensure that you do not injure the site accidentally. 

Making sure you recover normally and quickly from a tooth extraction is the goal for both you and your dentist. Following his instructions can help you get back on your feet as quickly as possible. 

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Avoiding teeth extractions

No one wants to have a tooth extracted. Dentists, for the most part, do not like having to pull teeth. But sometimes a tooth extraction is an unavoidable fact of life. Helping prevent dental disease from becoming so serious that an extraction is necessary is the best way to avoid having to get a tooth pulled.

Brushing and flossing daily can help avoid needing a tooth extraction. Every day, food debris and bacteria form a sticky covering on your teeth called plaque. If you do not remove the plaque every day, it typically thickens and hardens on the teeth. Over time, this hard coating, called tartar or calculus, continues to grow between the teeth and under the gums.

Once the tartar has taken hold under the gums and on the roots of the teeth, it may lead to an infection that may begin to cause the bone to deteriorate, a condition known as advanced gum or periodontal disease. Advanced gum disease is one of the leading reasons that dentists sometimes have no other choice than to pull a tooth⁶.

Daily cleaning of your teeth and gums can help prevent not only gum disease but also decay. As the plaque accumulates on the teeth, the bacteria typically begin to feed on the tooth enamel, causing holes and weak places to appear on the tooth surface. If left untreated, the decay may continue to expand into the inner nerve chamber of the tooth. This is when the pain to hot, cold, and sweets occurs and, in the worst cases, the nerves become inflamed and infected. The result of this deep decay is typically that you and your dentist must decide either to do a root canal and try to save the tooth or to extract it.

You can help avoid having to get a tooth pulled using the simple steps of daily brushing, flossing, and seeing your dentist for regular check-ups and cleanings. During routine visits, your dentist can identify small cavities and early gum disease typically before those conditions become more serious.

Help keep your teeth for a lifetime and avoid having teeth extracted by practicing good daily oral hygiene and having regular checkups. But if you do need to have a tooth pulled, a dental insurance policy can help make it more affordable.

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.


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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.10/22)

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