FYI

Dentist blog from Delta Dental

Stress taking a bite of patients’ dental health

For many, 2020 ushered in feelings of isolation and fear, as well as new concerns about financial stability, safety, family and how to juggle all of it from home. For some dentists, the stress of the situation has become apparent in their patients’ oral health. As of March, over 70% of dentists surveyed by the American Dental Association (ADA) Healthy Policy Institute reported an increase in patients experiencing teeth grinding and clenching since before the pandemic. That number is up nearly 10% from fall of 2020. In fact, more than 80% of Americans have reported emotions associated with prolonged stress, according to a January study by the American Psychological Association (APA).

“Generally, manifestations of stress go away when the stressing event goes away. That’s where the pandemic comes in,” said Dr. Daniel Croley, DMD, chief dental officer for Delta Dental. “One of the ways that some people manifest stress is by clenching and grinding their teeth.”

Dental conditions related to stress go beyond teeth grinding, of course.

Stress-related conditions

Multiple studies have shown that emotions can play a significant role in periodontal disease. Thanks to an increase in inflammation from stress-induced conditions, the gums can become a hotbed for bacteria, leading to gingivitis. According to the ADA, dentists reported recent upticks in all of the following conditions:

  • Bruxism
  • Chipped teeth
  • Cracked teeth
  • Temporomandibular joint disorder (TMJ) symptoms
  • Caries
  • Periodontal disease
  • Xerostomia
  • Halitosis
  • Oral mucosal lesions

Delta Dental’s claim data also suggests a rise in stress-related conditions. Bite guards, commonly associated with treatment for bruxism and TMJ were prescribed 14.3% more by Delta Dental dentists in the second half of 2020 than during the same period in 2019.

Sleep and ergonomics

During the mad rush to convert homes to offices in the early days of the pandemic, couches and stools took the place of lumbar-supported work chairs. Ergonomic workspaces became less of a priority than merely having a functioning workspace and the resulting poor posture may also be to blame for some TMJ issues. If your patients have been working from home, suggest they read up on proper ergonomics for their workstation.

Likewise, stress and disrupted routines likely hurt the chances at restorative sleep, increasing nighttime teeth grinding. Insomnia and restlessness can result in bruxism and TMJ.

Mask mouth

On top of these stress-induced issues is yet another pandemic problem: mask mouth. The facemask has been a staple of pandemic life and has greatly contributed to the slowing of the virus but can come with unfortunate byproducts: bad breath, dry mouth and even gingivitis and tooth decay.

Dental professionals attribute mask mouth to dehydration and mouth breathing when wearing a face covering. Though the ADA found no substantial rise in these specific indicators, the symptoms are preventable through thorough brushings and more regular hydration. On the upside, masks can sometimes help wearers identify their own halitosis, which may stem from more serious problems.

Other reasons for the spike

It is important to note that not all of these conditions are caused solely by anxiety and tension. For instance, a broken tooth could come as the result of anxiety-induced teeth-grinding, but it could also be caused by an accident or prolonged dental problems. Unfortunately, most claim data does not include the cause behind the diagnosis. Without that, it is impossible to say with absolute certainty that stress is the sole reason for a spike in numbers.

“It’s logical to conclude that current stress is leading to those broken and chipped teeth,” Dr. Croley said. “We will monitor and see. As we see broader distribution of the COVID vaccine and our daily lives feel more typical of what we experienced pre-pandemic, we will see our stress subside and as a result the need for bite guards to treat grinding and clenching subside — but our bodies can take some time to re-acclimate. Going back to the typical is still a change from what has been our weird ‘normal’ over the past year, and any change can generate stress.”

Many patients may not realize the correlation between stress and oral health. Educating your patients about how mental health can affect their mouth when signs of stress are detected is an important first step toward solving the issue. The ADA has created a compilation of resources for recognizing and managing stress. These may be especially helpful if you are are working with anxious patients or experiencing stress yourself.

Connect remotely with your patients using Virtual Consult

There’s a new tool to help you connect with your Delta Dental PPO™ and Delta Dental Premier® patients. Say hello to Delta Dental – Virtual Consult. This new platform lets you check in with and diagnose Delta Dental members remotely, all with an emphasis on simplicity when it comes to scheduling.

Virtual Consult is a video-based platform for conducting limited oral evaluations virtually through a fully secure, HIPAA-compliant platform. It’s ideal for seeing patients remotely for urgent consultations, follow-up exams or general questions. With Virtual Consult, you can:

  • Schedule and have video appointments from anywhere you have an internet connection and a webcam or an iOS device
  • Connect with new patients
  • Safely prescribe e-prescriptions for pain or infection
  • See patients with urgent needs at any time, day or night

Virtual dentistry offers convenience for patients, and it’s a great safe, contact-free access tool for dentists, as well. If you have open time in your schedule or want to see patients after hours, Virtual Consult lets you see patients remotely. Diagnostic exams conducted through Virtual Consult are submitted to Delta Dental the same as in-office claims, so you don’t need to worry about learning a billing new system.

Provider enrollment in Virtual Consult is now open!  To learn more, fill out the Virtual Consult interest form and we’ll reach out to you.

DentaQual tells patients how high you score in the stats that matter

Beginning April 2, you can find a new quality rating system in the dentist directory: DentaQual. Here are a few points to help you understand how your DentaQual score helps new patients find you by objectively quantifying what makes you a great dentist.

What is DentaQual?

DentaQual is a ratings system developed by P&R Dental Strategies that showcases the quality of the care you provide to your patients. By providing a comprehensive, uniform metric, DentaQual boosts patients’ trust in your care and confidence in their outcomes. Your DentaQual score appears on your dentist directory listing and is updated monthly.

What makes DentaQual scoring objective?

P&R Dental Strategies is a neutral third-party dental informatics company that is not owned by any insurance carriers. DentaQual ratings are determined using treatment data only. Instead of relying on subjective patient testimonials, DentaQual is based on a statistical analysis of de-identified and aggregated claims data. The metrics that are scored are:

  • Treatment outcomes
  • Commitment to best practices
  • Cost-effectiveness
  • Patient retention
  • Treatment recommendations

All scoring is based on standard deviation from the norm, with the “the norm” representing the average level of quality in the dentist’s three-digit ZIP code region and specialty. DentaQual’s data comes from DentaBase, P&R Dental Strategies’ multi-payer, de-identified and aggregated claims database. DentaQual ratings do not include Medicaid claims data.

How can DentaQual help my practice?

Your DentaQual score serves as another resource to attract new patients. Unlike an online review you might find on social media, DentaQual’s objectivity means that the quality of your work as a dentist will be able to speak for itself. When it comes to online reviews, patients often review dentists like they would a restaurant, prioritizing personality and speed of service over quality of care.

Will every dentist in the Delta Dental network have a DentaQual rating?

Ratings will be applied to Delta Dental PPO™ and Delta Dental Premier® dentists in our 15 enterprise states and the District of Columbia. DeltaCare® USA dentists within those geographic areas who also participate in the PPO and Premier networks will also be rated. At this time, DentaQual scores will only be shown on the directory pages for dentists with enough available data to be rated. The data will be refreshed on a monthly basis, so if you don’t currently have a score, you may in the future as more data becomes available.

I’m in a group practice with other dentists and we all share the same patients. Will we have different ratings?

DentaQual scoring is based on claims data from the dentist who performs the treatment through his or her NPI. Because of this, your rating may differ from those of other dentists at the same practice.


If you have more questions about DentaQual or your score, please reach out to P&R Dental Strategies at DentaQual@pandrdental.com. You can also request a copy of your rating summary for reference.

Billing for orthodontics: your questions answered

Let’s get one thing straight — there’s a lot to know when it comes to orthodontic claims. No need to brace yourself for claim rejections, though! Use this handy guide to submitting orthodontic claims and you’ll be an ortho pro in no time.

How do I submit an orthodontic claim online?

You can submit claims online through Provider Tools. Register for an account, log in to your dashboard and select Submit claim. You only need to submit one claim at the time of the initial banding.

There’s no need to submit additional claims for monthly adjustments. Delta Dental calculates payment based on that first claim with complete treatment and fee information.

You can keep track of your claims by selecting My claims in the Provider Tools dashboard.

Graphic showing what you can do in Providers Tools, starting at the log in page and then the Provider Tools dashboard. It lists some things you can do in Provider Tools: fill in forms, make payments, file and view claims.

What information do I need to include on an orthodontic claim?

You can refer to pages 5–4 and 5–5 in our dentist handbook for general Delta Dental policy around orthodontic claims. Each plan may require different information, so make sure to look at your patient’s coverage in Provider Tools for specific requirements. While you’re there, you can also submit and track claims using the Submit claims and My claims tools!

For orthodontic claims, submit a single claim at the time of the initial banding with the following information:

  • a description of the dentition
  • the procedure code with a description of appliance and treatment
  • the banding date and estimated number of active treatment months
  • the total fee you intend to collect for services (including the initial down payment and monthly fee)

If applicable, you should also include the amount paid by a previous dental carrier, the name and procedure code of appliances used to control a harmful habit and any dual coverage information. You don’t need to submit x-rays or radiographs for claims unless specifically asked to do so by Delta Dental.

How are orthodontic claims paid?

Our allowances for orthodontic procedures include all appliances, adjustments, insertion, removal and post-treatment stabilization (retention). Calculations are based on the all-inclusive total treatment plan amount, subject to any deductible, the appropriate payment percentage and maximum amount.

Our first payment is 50% of the total amount payable. The remaining 50% is paid 12 months later.

For most plans, the orthodontic maximum is a lifetime maximum. Also, if the total amount payable is $500 or less, we pay the full amount in one payment when the claim is processed

Are there exceptions to the two-payment schedule?

Yes. If the patient’s plan has specific provisions for a different payment method, we will pay accordingly. Also, if treatment ends before our second payment is due, advise us that the bands were removed and the treatment has been completed. You may call Customer Service or submit a claim that includes this information.

How should fees for x-rays and study models be submitted?

Submit fees for these records along with the banding information or on a separate claim. If submitted separately, indicate on the claim that these records are in conjunction with orthodontic treatment. You don’t need to x-rays or study models to Delta Dental unless specifically requested.

Are retainers and harmful habit appliances covered?

Yes. Allowances include all appliances, adjustments, insertion, removal and post-removal stabilization (retainers).

Harmful habit appliances are covered if a patient’s plan includes a specific provision for minor treatment to control harmful habits. The provision must be in conjunction with orthodontic treatment (procedure code D8210) and/or separately (procedure code D8220).

Retainer repairs and replacements are not covered.

How do I submit claims for Invisalign, lingual braces or SureSmile?

Some plans cover alternative appliances like Invisalign, lingual braces or SureSmile. You can check if your patient’s plan covers clear aligners by visiting Provider Tools, clicking on My patients and selecting Check eligibility and benefits next to the name of the patient. Click Orthodontics under Benefit details to view limitations, age limits and coverage levels. There is no unique procedure code for clear aligners, so reference the CDT codes used for conventional treatments, D8010 through D8090.

Submit claims for clear aligners as a separate line item from the orthodontic treatment code and fee. Make sure to enter a complete description of the service, including reference to Invisalign, lingual braces or SureSmile.

How is payment determined when a patient switches to a new orthodontist?

We calculate remaining benefits based on the date of the first adjustment with the new orthodontist. The new orthodontist should submit a claim using the first adjustment date as the starting date of treatment, along with a notation that the patient has transferred from another office.

Are orthodontic benefits ever prorated? How?

Yes. Prorating occurs when an event affects the patient’s orthodontic coverage. New Delta Dental coverage after treatment has begun, an increase in existing coverage, a change in eligibility or a change of orthodontists might spur proration.

When Delta Dental prorates payments, we subtract the total fees for any treatment months that occurred before the patient’s effective date with Delta Dental from the total orthodontic treatment fee. Our amount payable is then based on the remaining treatment fee, the remaining number of treatment months and applicable payment percentage and maximums.

Why was my claim rejected?

Claims can be rejected for a variety of reasons. The most common rejections are for incorrectly entered patient information, like enrollee IDs or patients submitted as dependents. Make sure to include all relevant information on your claims, like multiple banding dates, multiple case fees and the correct length of treatments. Excluding this information may lead to a rejected claim We also see rejections for claims using CDT codes that have been deleted or revised, so stay on top of the latest CDT updates!

Upcoming Provider Tools webinars in April

This spring, you can polish your skills in using Provider Tools to manage tasks more effectively. Reach higher productivity by attending an information-packed one-hour webinar to learn:

  • How to set up your account
  • How to use Provider Tools to manage patient interactions
  • How to submit claims in real time and track them
  • How to sign up for direct deposit
  • And more valuable practice management tips!

In addition, you will not want to miss the introduction to Delta Dental – Virtual Consult, a new virtual dentistry tool that you can use for one-on-one, real-time video appointments with patients.

Take advantage of this opportunity — register today!  Here is the webinar schedule:

Thursday, April 8, 10 am PT / 1 pm ET

Wednesday, April 14, 9 am PT / 12 pm ET

Tuesday, April 20, 10 am PT / 1 pm ET

7 tips for serving deaf and hard-of-hearing patients

Happy National Deaf History Month! If you haven’t heard of this awareness month, it runs from March 13 to April 15. Nearly 15% of adult Americans report trouble hearing, so you may have patients who have hearing issues and aren’t even aware of it. If you don’t know American Sign Language (ASL) yourself, you may be at a loss for where to begin. Fortunately, there are plenty of steps, from the simple to the more complex, that you and your staff can take to help your deaf and hard-of-hearing patients feel at ease.

Simple steps

  • Have office protocols for serving deaf and hard-of-hearing patients. With a little bit of planning and forethought, you and your staff will be ready to welcome your deaf and hard-of-hearing patients from the moment they make an appointment until the moment they schedule their next one and head home. Make sure that your patients can schedule appointments without having to make a phone call, such as by text message, email or social media. You should also think about little touches for when your patient arrives, such as offering a dental cup to patients who may want to remove their hearing aids while they’re in the chair. (Hearing aids can be shockingly expensive and are definitely not something your patients want to lose!)
  • Speak slowly, clearly and directly facing your patient. This helps your patient read lips, as well as avoiding the possibility of carrying on a conversation with a patient’s “bad” ear. Given that you and your staff will likely be wearing a mask because of COVID-19, speaking slowly and clearly even more essential (you can also use clear facemasks).
  • Go the extra mile to make your patients feel comfortable. Patients who are experiencing hearing loss from old age may be embarrassed that they can’t follow conversations as closely as they used to. If you notice that a patient isn’t quite hearing you, apologize and repeat yourself with a focus on slow, clear communication.
  • Encourage your patients to talk openly with yourself and their other doctors. As a dental professional, you may notice a patient’s sensitivity to sound (or lack thereof) or other issues before the patient does. If you suspect that some of your patients may have hearing issues they’re not aware of, encourage them to consult their physician or a specialist.

These are all great steps that any practice can follow to better serve patients who are deaf and hard of hearing. If you have patients with greater needs, or you simply want to develop your practice’s capabilities, there’s even more you can do.

Taking it to the next level

  • Add more electronic text throughout your practice. The prevalence of text-based tools like email, online messaging and chat apps has been a game changer for many people who are deaf and hard of hearing. Increasing your digital presence and making your practice available through multiple venues both helps new patients to find you and existing patients to contact you through their preferred method. If your practice regularly posts videos on YouTube or other services, make sure that the videos are captioned.
  • Take American Sign Language (ASL) classes or add someone to your staff who knows ASL. Having staff members who know languages other than English is both a great way to reach a wider part of your community and a nice perk when it comes to updating your Find a Dentist directory listing. If you already have staff who are fluent in ASL, make sure you mention that on your directory listing! If your staff doesn’t have anyone who knows ASL, you can find classes at local universities, colleges and community colleges, as well as more specialized institutions like schools for deaf people, deaf service centers or interpreter training programs. If you’re not ready or able to sign up for classes, you can always learn a few key phrases online.
  • Make use of Delta Dental’s Language Assistance Program (LAP). The LAP is a free service that your Delta Dental patients can use to get professional interpretive services (along with phone assistance, written materials and more). This includes ASL interpreters who can come to your office to assist in communication.

More than 35 million people in the United States report having trouble hearing, whether they suffer from mild hearing loss or are completely deaf, so thinking about how to serve this population is well worth your time. Whether you want to master ASL or you just want to begin accepting appointments by email in addition to the phone, taking steps to make your practice more inviting to patients who are deaf and hard of hearing is well worth your time.

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