I had an infected tooth removed along with some of the bone.  The periodontist gave me a plastic mouth guard (similar to the mouth guards that football players and other athletes wear.)  In the mouth guard is a plastic tooth to fill in the space where my incisor was removed.  This was to keep my teeth from moving while I waited for the bone and tissue regeneration to be completed before having a permanent denture put in. In the paper work to the insurance company they called this mouth guard a partial denture.  Now the insurance company says that I already have a denture and that my policy won't allow for another denture until five years have passed.  Is this mouth guard with the plastic tooth truly "a denture" that could be considered a permanent solution?  I can't chew with it in.  In fact, the plastic is so thin that I don't think it will hold up for even a year let alone 5 years.

Dr. Pasch: Without seeing this so called, "night guard" I have no idea what it truly is.  You can't diagnose over the phone or the Internet and I can't give you an accurate answer without seeing the devise.  A denture is a denture, there is no such thing as a temporary denture.  All dentures are made similarly, whether they are worn temporarily or long term, therefore the cost for a denture will not vary based on how long you intent to wear it.     Most dental insurance companies will only pay 50% - 80% of the cost for new dentures once every 5 years if it is a good policy, once every 10 years if it is a terrible policy.  They do not care if you require a new one in one year because of bone loss and gum shrinkage.  Perhaps the periodontists staff thought they were doing you a favor putting in the code for a denture in order to receive payment for the appliance so that they would not have had to bill you.  Call the periodontists office and ask the insurance coordinator, the receptionist or the dentist how much the appliance actually costs if you had paid privately rather than the insurance company.  However, I'm not sure that that office can correct this for you retroactively, it would appear like insurance fraud if they did.  They probably thought they were helping you at the time to decrease your out of pocket expense.    

My suggestion to you in the future due to the awful nature of dental insurance.  It does not work like health insurance at all.  I never recommend that someone purchase dental insurance.  It is a nice employee benefit however.  In order to maximize your benefits, be compliant with preventative care, such as cleanings and check-ups and never submit for a denture repair before sending for approval for a much needed new denture, they will invariably deny the new denture if they have paid for a recent repair or a reline on an old one.  You are always better off, relining and repairing an old one out of pocket and submitting for a new one once you're entitled.  Dental insurance helps but it by no means pays for a majority of major dental work since the yearly maximums are so low.     

I'm sorry if I'm not giving you the answer you wanted and I wish you the best of luck.  If you're ever in NYC, please stop by and introduce yourself.  We will be relocating our office in July to 224 West 35th Street between 7th and 8th Aves. in Manhattan on the 16th floor.