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Is oral surgery covered by insurance?

Dental oral surgery may be covered by dental insurance depending on your plan and the type of surgery you need.

10 minute read

Oral surgeries are often used to correct major oral problems and reconstruct your teeth or jaw after an injury. Like other surgeries, oral surgeries are performed by trained medical professionals using aesthesia. Dental oral surgery can be expensive and dental insurance can help you cover the costs. But factors like what type of insurance you have and what type of surgery you need play a role in what your final cost will be for oral surgery.

Is dental oral surgery covered by medical or dental insurance?

Generally, at least a portion of the surgery cost may be covered by dental insurance. Whether or not dental oral surgery is covered by your insurance will depend on your specific type of plan and the coverage that you have, so you will need to check with your provider to find out if a specific procedure is covered.

If the oral surgery you need is considered medically necessary, your health insurance may pick up the cost of the surgery either in full or in part. Surgery for problems like sleep apnea, TMJ, or oral biopsies may be considered medically necessary. If you need to have oral surgery, check with your health insurance provider as well as your dental insurance provider.

Guardian Direct’s Dental Advantage Gold and Dental Advantage Silver plans pay 50% of oral surgery costs after a 12-month waiting period.

What is dental oral surgery?

Dental oral surgery is performed to fix jaw and mouth problems that can’t be fixed without extensive intervention. In most cases oral surgeries are outpatient procedures that are performed in an oral surgeon’s office and after oral surgery you can go home as soon as the effect of the anesthesia has worn off.

Dental oral surgery is a specialty within the field of dentistry. Oral surgeons receive additional education and training beyond the normal dental certification in order to be certified as surgeons. Often your dentist will refer you to a qualified oral surgeon if they determine that you need oral. If you choose an oral surgeon who is in your insurance network, you will usually pay a lower cost.

The most common types of dental oral surgery

Procedures that are needed to fix the look and function of teeth are often done by oral surgeons because they require advanced skills to complete successfully. Oral surgery can be recommended for any dental condition that is considered serious, but there are a few different types of procedures that almost always require oral surgery, including:

Wisdom teeth extractions

Normal tooth extractions can often be done by your dentist, but wisdom teeth extractions may need to be done by an oral surgeon. Wisdom teeth are a third set of molars that usually come in your late teens or early twenties. Most of the time wisdom teeth come in without any problems. But sometimes wisdom teeth don’t come through completely and get stuck in the gums. In other cases, they might not come through at all and remain totally hidden in your gums. They also can come in crooked and force the other teeth to shift and become crooked too. When your wisdom teeth don’t come in cleanly, surgery may be the best way to remove them.

Wisdom teeth can make it difficult for you to properly brush and floss, meaning that they might need to be removed so that you can practice good dental hygiene. Some dentists will tell patients that their wisdom teeth should be removed as soon as they come through even if they aren’t causing a problem to prevent the wisdom teeth from contributing to the growth of plaque and bacteria inside the mouth.

During a surgical wisdom tooth extraction, the oral surgeon will put you under anesthesia and perform surgery to remove the hidden, trapped, or otherwise problematic wisdom teeth.

Dental implants

If you have just one or a couple missing teeth, dental implants can be sturdy permanent replacements for natural teeth. To create a dental implant an oral surgeon may surgically place a small metal rod into your jawbone and then graft a piece of gum tissue over it temporarily.

After that metal rod is fused into the jawbone the dentist may add a small metal piece that will anchor the implant and then surgically attach gum tissue over it. Once that is healed the dentist can place a crown and attach it to the small metal piece that is anchored to the rod in the jawbone. The crown will be custom made to look like all of your other teeth in size and color so that no one will be able to tell that you have an implant.

Biopsies

If your dentist notices any discolored or unusual looking patches or lesions in  your mouth during one of your routine appointments, or if you notice that some irregular patches in your mouth have changed size or color your dentist may refer you to an oral surgeon for a biopsy. A biopsy can identify potentially serious health problems like oral cancer. In general, you should get a biopsy if you notice:

  • Inflammation in the mouth that doesn’t go away.   
  • An oral lesion makes it difficult to swallow or speak.
  • Bone lesions that are not specifically identified by clinical examination and X-rays, or any oral lesion that has the characteristics of a malignancy.

During a biopsy an oral surgeon may perform one of six different types of biopsy to see if the patch in your mouth contains cancer cells. The different types of biopsies that the surgeon might choose to do are:

  • Aspiration biopsy: To perform this common type of biopsy the oral surgeon will use a local anesthetic and a needle with a syringe. They will draw some of the cells into the syringe and test them to see if they are cancerous.
  • Incisional biopsy: For this type of biopsy the dentist will remove a small part of the tumor or irregular patch of tissue and test it. If there are multiple patches within the mouth that need to be tested. the surgeon will need to take a small patch of each one.
  • Cytology: Cytology is a secondary type of biopsy that is usually performed with an excisional or incisional biopsy. Cytology is primarily used to determine if there is an infection present as well as to confirm the presence of certain types of cells.
  • Punch biopsy: A punch biopsy is just like it sounds. The dentist will use a punch tool for both incising and excising tissue in the mouth.
  • Brush biopsy: When an oral surgeon does a brush biopsy, they apply firm pressure with a circular brush and rotate the brush ten times, causing light abrasion. The cells that it picks up are made into a slide that the dentist can examine.
  • Excisional biopsy: This type of oral biopsy is performed for small oral lesions. If the lesion is small the dentist can often remove it.

Jaw surgery

Dental oral surgery can correct some jaw problems that cause significant problems with speaking and chewing. If your jaw didn’t develop properly, it can have trouble closing the way that it should. That can make it difficult for you to chew or speak properly. An oral surgeon can realign your jaw or correct any overgrowth that has occurred during the jaw formation so that you can speak and chew without pain or other problems.

If you experience a jaw injury as a result of a car accident, a fight, or any kind of blow oral surgery might be required to repair the damage so you don’t suffer long term problems that make it difficult to speak or chew. Correcting a jaw injury can also help prevent tooth loss.

People who experience TMJ, or temporomandibular joint problems, often have oral surgery to fix the TMJ to eliminate the symptoms associated with TMJ like frequent headaches, facial pain, trouble chewing, and bruxism or teeth grinding.

Oral surgery is also something that people who wear dentures might need in order to make sure that their dentures fit the way they are supposed to. You may experience pain or have trouble keeping your dentures in place if your jaw isn’t aligned properly.

Sleep apnea correction

In most cases, sleep apnea can be managed by using a CPAP machine or other interventions. But those options aren’t always the best option to permanently fix sleep apnea. Oral surgery to remove part of the soft tissue at the back of the mouth can eliminate sleep apnea by opening up the airway and making it possible for people to breath better when they are sleeping.

Reconstructive surgery

Sometimes an accident or injury knocks out teeth or causes so much damage to the jaw that reconstructive surgery is needed. Car accidents and sports accidents are the most common causes of needing reconstructive oral surgery, but occasionally people who have neglected their teeth for a very long time need reconstructive surgery to ensure that they are able to eat properly and to fix the look of their teeth and mouth. 

 

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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Sources:

Individual Dental Insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York or by one of its wholly owned subsidiaries.  Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides DENTAL insurance only. Dental provider networks vary by state, by market and by plan type. Rates are guaranteed for one year for your policy of benefits initially selected. Policies renew annually. Products Underwritten by Guardian Life Insurance Company of America: DENTAL PPO PLANS: Policy Form IP-DEN-16 ET. AL. DENTAL HMO PLANS: FLORIDA Policy Form IP-1-MDG-DHMO-FL-OFF-17 NEW YORK Policy Form IP-MDG-NY-FP-OFF-17. Products Underwritten by Managed Dental Guard, Inc. DENTAL HMO PLANS: NEW JERSEY Policy: IP-MDG-DHMO-NJ-17 TEXAS Policy: IP-1-MDG-DHMO-TX-17. Products Underwritten by First Commonwealth Inc. through its Illinois subsidiaries* DENTAL HMO PLANS: ILLINOIS. Policy: IP-FCW-DHMO-IL-17*First Commonwealth Insurance Company — (IL), First Commonwealth Limited Health Services Corporation — (IL), First Commonwealth of Illinois, Inc.

Guardian Direct plans are underwritten and issued by The Guardian Life Insurance Company of America or its subsidiaries, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. GUARDIAN® is a registered service mark of The Guardian Life Insurance Company of America® ©Copyright 2019 The Guardian Life Insurance Company of America.

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.
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