Third Molar Exclusion: What Does it Mean for Removal?

As a patient, knowing your benefits impacts your choices. Of course, you want to take into account every penny spent towards your health. Your dentist recommended a third molar extraction. Before you arrange the appointment and follow-up appointments, scan your insurance plan.

If you see a "third molar exclusion," the insurance company will not pay for the procedure.

Third molar (wisdom tooth) extractions have been subjected to many studies over the years. Dental insurance plans take guidelines from these studies to help shape their plans.

This procedure is sometimes opted out of plans for two compelling reasons:

1. Third molars do not have symptoms. Without evidence of the molar actually creating an unhealthy environment in your mouth, your insurance plan will not cover it.
2. Third molar removal studies are faced with scrutiny. In fact, observers have correlated third molar removal with periodontal disease.

Probable Evidence for Third Molar Removal

There are many parameters around reasons to take out third molars (and have the procedure covered by insurers), including:

• The patient has swelling and pain documented as a direct cause of the third molar's presence.
• Periodontal disease present in the second molar that's caused by the third molar's position.
• Various medical therapies and conditions that directly affect the patient due to the third molar. This depends on the patient.
• A severe impaction, or an injury involving jaw trauma.
• Surgeries related to reconstructive surgeries and any other surgery inflaming the mouth as a direct result of the third molar.
• Prevalent cavities and fractures.
• Third molars shifting and crowding neighboring teeth.
• A cyst near the third molar.
• Severe pericoronitis caused by poorly erupted wisdom teeth.

Communication with your dentist and insurance company—and organization and attention to detail—can help you. Be sure to follow directions and pay attention. Cutting down confusion and completing your third molar extraction benefits future extractions. Trying to reconcile what's best when faced with an insurance related issue is a challenge. If your insurance will not cover it, you should consult with your dentist. Perhaps a payment plan can be worked out. The crucial result is that your oral health is under control.