How You Can Afford Emergency Wisdom Tooth Removal

My 17-year-old son, out of nowhere, had a terrible toothache late at night. I suspected it was his wisdom teeth, but I wasn't overly worried. 

We had dental insurance, and I would get him in early the following day for an evaluation. Little did I know that an unexpected dental bill was in my immediate future.

Here's what you should know about dental insurance covering emergency wisdom tooth extractions and how to cover the cost if you're insurance does not.

The Impact of Wisdom Teeth

An estimated 5% to 37% of people don't have wisdom teeth and thus never experience complications from them.

But for those with wisdom teeth, they "are third molars and are the last set of teeth to erupt," Dr. Lesline Davis, DDS, dental surgeon, and public health consultant, told Health. "They erupt between ages 17 to 21, but some people don't develop wisdom teeth at all."

Some of the first signs of a wisdom tooth needing removal are pain, swelling, and jaw stiffness. That pain occurs because the wisdom teeth that have partially come through the gums can allow bacteria to enter the gums and cause an infection. 

Also, wisdom teeth can become wholly or partially impacted. Impacted wisdom teeth are difficult to clean, which increases the chances of dental cavities or localized gum infection. Impacted wisdom teeth may also cause pain, swelling, cyst formation, and damage to other teeth.

What Does Your Dental Insurance Cover?

Dental coverage is an essential health benefit for children. But for adults, health insurance plans are not mandated to provide dental coverage as part of plans for anyone over 18 years old.

Depending on the severity of the oral surgery needed to remove the wisdom tooth or teeth, you can possibly bill your medical insurance. However, billing depends on the dentist's insurance codes when filing the claim. Medical insurance will only help cover the cost of the oral surgery if they consider it "medically necessary" for your overall health and wellness.

Insurance may cover wisdom tooth removal and pay for any hospitalization or general anesthesia for the surgery. But it's also possible it won't. The key here is the correct use of Current Dental Terminology (CDT) as established by the American Dental Association (ADA) for identifying procedures provided to patients for oral treatment.

It's possible that insurance will cover wisdom tooth removal and pay for any hospitalization The advent of the Patient Protection and Affordable Care Act, effective as of 2010, has allowed dental insurance to cover many essential services. But unfortunately, wisdom tooth removal isn't considered in that group.

Most dental plans you can purchase through the Health Insurance Marketplace will cover 100% of the cost of preventative care—such as cleanings, check-ups, and X-rays. Those dental plans will also cover about 80% of essential treatments like fillings and 50% of complex procedures like root canals and crowns.

But with the known complications that can arise from untreated wisdom teeth, it's unfortunate that policy has yet to meet that medical necessity.

Dr. Davis explained that an untreated, impacted wisdom tooth could "lead to serious complications, such as a swelling of the jaw and face that compromises breathing and requires hospitalization to treat and infection spreading to your brain and to your bloodstream, which both can lead to death. It is important to note that this risk exists even if the pain subsides."

Low-Cost Oral Surgery Options

If your dental insurance plan is a part of a health maintenance organization (HMO), it will cover wisdom tooth removal in young patients if recommended by your dentist. 

The catch is finding an oral surgeon who accepts your health insurance. In my son's case, the same state-subsidized dental coverage that covered his braces was almost useless for wisdom tooth removal. I spent an entire day calling every oral surgeon in New York before finding one that would take his health insurance. But the earliest appointment was weeks away. 

Ultimately, I paid $900 out-of-pocket to remove my son's wisdom tooth. I decided against having him sedated fully because of the additional cost.

Alwaine Fenton, a registered dental hygienist, told Health that numerous training facilities and care credit companies offer affordable dental care rates.

What about reduced-cost oral care and surgery options for adults? Well, Fenton recommended the more popular choices of using federally-funded community health centers and United Way. United Way is seen as a one-stop shop for many social services, including dental care.

Also, Fenton mentioned being a big advocate for getting dental care, including wisdom tooth removal, from dental schools.

"Even though students are practicing or training and may work slower with procedures taking longer to complete, there is reduced cost for dental treatment," explained Fenton. "And students are closely supervised by licensed dentists."

Dental schools have incredibly high standards to maintain accreditation issued by the Commission on Dental Accreditation (CODA). What's more, if a resident specializing in oral surgery performs your wisdom tooth extraction, they have graduated from dental school. So, they have completed the education needed to become a dentist. 

Also, dental schools tend to have flexibility regarding the types of dental insurance they accept. You may even pay lower out-of-pocket costs at a dental school than at a private practice. 

However, there are some disadvantages to using dental schools. For example, Fenton mentioned that anyone needing emergency treatment would have to wait a long time for an appointment. 

Still, Fenton reiterated that "an accredited dental school or dental hygiene school for quality and low-cost dental treatment is great because they are held to high treatment standards of the (ADA) and the American Dental Hygiene Association (ADHA)."

Another option for wisdom tooth removal is clinical trials. Some people hear the term "clinical trials" and assume increased risks, but that's not necessarily true. 

Based on Food and Drug Administration regulations, clinical trials are held to the strictest standards regarding compliance. In 2013, the Food and Drug Administration published a draft guidance that advised how a study sponsor must meet obligations to monitor or oversee a clinical study.

A Quick Review

Access to information is your best bet with most medical procedures without excellent health insurance coverage and a big budget. 

While not everyone will need a wisdom tooth extraction, it is good to know about and explore your options so that you can plan in case an emergency arises.