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Will Dental Insurance Cover Mouth Injuries?


Millions of teeth are knocked out every year in athletic events. Injuries affecting the face and mouth account for a significant number of common sports injuries. If you are active in sports, or if you have children who are, you may be wondering if your dental insurance covers mouth injuries. The answer depends on what kind of coverage you have, and the type of injury you experienced.

Dental Coverage For Mouth Injuries

Dental insurance coverage typically applies to preventative treatments and oral health maintenance such as cleanings, fillings, and crowns. However, if you require extensive reconstruction after an injury, your dental plan may cover it. Your health insurance probably will not cover the reconstruction unless it is medically necessary. Coverage can vary widely by provider and plan type. Our helpful agent will be happy to review your health insurance and dental insurance policies with you to help ensure you have the coverage you need.

Health Insurance Coverage For Mouth Injuries

Certain health insurance plans will cover some types of oral injuries, such as:

  • Jaw dislocations and fractures
  • X-rays and diagnostic testing after an injury
  • Tooth repair or replacement, provided tooth loss or damage is not caused by decay or chewing, but rather by a sudden injury to the mouth

What Should You Do If A Tooth Is Knocked Out?

If a blow to the mouth causes a tooth to pop out, take the following steps to help preserve the tooth:

  • Do not touch the root of the tooth – it is easily damaged.
  • If possible, place the tooth back in the socket for the best chance of preservation.
  • If you cannot place the tooth in the socket, put it in milk – never water. Milk contains nutrients that help keep tooth cells alive. Water destroys them. If the tooth is dirty, wash it with milk.
  • If your tooth is knocked out, go to the emergency room immediately. If it is cracked or broken, ensure you see your dentist within 24 hours after the injury.

How To Minimize The Risk Of Mouth Injuries

Although baseball and basketball are the sports most likely to cause dental injuries, they can occur in any athletic activity, including swimming, gymnastics, soccer, and martial arts. Thankfully, mouthguards can help minimize the risk of oral injuries. These protective devices alone prevent hundreds of thousands of mouth injuries every year. Mouthguards are available in several forms, including:

  • Low-cost stock mouthguards off the shelf
  • Mouth-formed guards that are molded to the athlete’s teeth, providing customized protection
  • Mouth protectors custom-made by a dentist

What Does Dental Insurance Cover?

Most dental insurance policies emphasize diagnostics and prevention, typically covering two exams and cleanings plus X-rays per year, along with fluoride treatments for children. However, the main benefits come from coverage for costlier procedures, such as fillings, crowns, and root canals. Most dental plans offer 100-80-50 coverage. If you have this type of plan, you are covered:

  • 100% for routine preventative and diagnostic care
  • 80% for fillings and root canals
  • 50% for crowns, bridges, and major procedures

Beyond routine treatments, coverage is capped at $1,500 per year with most plans. Cosmetic dental procedures are rarely covered by dental insurance or health insurance.