Does Dental Insurance Cover Night Guards?

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Purchasing a Night Guard Using Dental Insurance

updated for accuracy on 06/11/23

Has your dentist suggested you wear a dental night guard because you’re grinding or clenching your teeth?

You may initially balk at the dental office price, but you have good dental insurance and your custom night guard is surely covered. Right?

Many people assume that dental insurance would likely cover their night guard for teeth grinding (especially since it has been recommended by the dentist)!

“I was told my insurance wouldn’t cover me and that it’d cost me a whopping $650 for a night mouthguard!” -Sue Anderson, MA.

Dental insurance coverage varies depending on the specific insurance plan you have. In general, dental insurance may provide some coverage for a night guard, but the extent of coverage can vary widely. To determine whether your dental insurance covers a night guard, it’s best to consult your specific insurance policy or contact your insurance provider directly. They can provide you with the most accurate information regarding coverage, any limitations or exclusions, and any potential out-of-pocket costs you may incur.

Why doesn’t my dental insurance cover my night guard?

There could be several reasons why your dental insurance does not cover your night guard. Here are some possible explanations:

1. Exclusion in your policy: Some dental insurance plans have specific exclusions for certain treatments or appliances, including night guards. The insurance policy may not provide coverage for night guards or may have limitations on the types of appliances that are covered.
2. Non-medically necessary: Dental insurance plans often prioritize coverage for medically necessary procedures. While a night guard may be beneficial for teeth grinding or clenching (bruxism), some insurance plans may not consider it medically necessary and therefore do not provide coverage.
3. Waiting period: Dental insurance plans sometimes have waiting periods before certain services or appliances are covered. It’s possible that your insurance plan requires you to wait for a certain period of time before night guard coverage becomes available.
4. Deductibles or co-pays: Even if your dental insurance provides coverage for a night guard, you may still be responsible for deductibles or co-pays. These are the amounts you have to pay out of pocket before the insurance coverage kicks in.
5. Out-of-network provider: If you obtained your night guard from a dentist or provider who is not in-network with your dental insurance plan, the coverage may be limited or non-existent. In-network providers usually have pre-negotiated rates with the insurance company, ensuring better coverage and potentially lower costs.

To get a more definitive answer, it’s best to review the details of your dental insurance policy or contact your insurance provider directly. They can explain the specific reasons why your night guard may not be covered under your plan.

Is a night guard considered preventative care?

Night guards are typically not considered preventative care in dental insurance terms. Preventative care typically refers to routine services aimed at preventing dental problems, such as regular check-ups, cleanings, and X-rays. These services are often covered at a higher percentage or even fully covered by dental insurance plans.

Night guards, on the other hand, are primarily used to protect teeth from damage caused by grinding or clenching (bruxism), which is a habit rather than a preventive measure. While night guards can help prevent further damage to teeth and alleviate symptoms associated with bruxism, they are generally considered as a treatment for an existing condition rather than preventive care.

It’s important to note that dental insurance plans can differ in their coverage policies, so it’s always a good idea to review your specific plan or contact your insurance provider to understand how they categorize night guards and what coverage, if any, is available.

Does Medicaid cover night guards?

Medicaid is a health insurance program that provides coverage for low-income individuals and families. Coverage for night guards under Medicaid can vary depending on the state you reside in and the specific Medicaid plan you have.

In some cases, Medicaid may cover night guards if they are deemed medically necessary to address a dental condition such as bruxism (teeth grinding) that is causing harm or damage to your teeth. However, coverage policies can vary, and certain limitations or restrictions may apply.

To determine if Medicaid covers night guards in your specific situation, it’s best to consult your state’s Medicaid website or contact your Medicaid provider directly. They can provide you with accurate information about coverage eligibility, any necessary prior authorization requirements, and any associated costs or limitations.

What is the cost of a night guard without insurance?

The cost of a night guard without insurance can vary depending on several factors, including the type of night guard, the materials used, the complexity of the case, and the dental provider you choose. Generally, there are three main types of night guards:

1. Over-the-counter (OTC) night guards: These are pre-made night guards that can be purchased at pharmacies or online. They are typically the least expensive option and can range from around $10 to $50. However, OTC night guards may not provide the best fit or durability.
2. Boil-and-bite night guards: These are also available over-the-counter but require some customization. You soften the guard in hot water, bite into it to create an impression, and then it hardens to fit your teeth. Boil-and-bite night guards usually cost between $20 and $200, depending on the brand and quality.
3. Custom-fitted night guards: These night guards are professionally made by a dentist or dental laboratory to fit your specific teeth and bite. Custom-fitted night guards provide the best fit, comfort, and protection. The cost can range from $150 to $800 or more, depending on the materials used, the complexity of the case, and the geographic location.

Why is wearing a night guard so important?

Our teeth are one of the most important body parts because they assist in two major functions of the body; chewing and talking.

Taking care of the teeth is not an option, but a priority. So when a certain problem that could potentially put the health of your beloved teeth at risk occurs, it would be wise do your best to prevent damages before long term issues occur, as the cost for restorative dental work can be thousands of dollars.

Teeth grinding leads to the destruction of one’s dental anatomy because of the continuous clenching and grinding of the teeth. People who suffer from this problem usually experience it at night when sleeping. Once you discover this, you need to visit a dentist who will most likely prescribe a night guard for you.

What Is a Dental Night Guard? 

A dental night guard, also known as an occlusal splint or bite guard, is a removable oral appliance designed to protect your teeth and jaw while you sleep. It is commonly used to manage various dental conditions and habits, such as bruxism (teeth grinding) and temporomandibular joint disorder (TMJ).

Night guards are typically made of a soft or hard, durable material, such as EVA or Copolyester or even acrylic thermoplastic material. They are custom-fitted to your teeth to ensure a comfortable and secure fit. The night guard is designed to be worn over either the upper or lower teeth, creating a barrier between the upper and lower jaws.

The main purpose of a dental night guard is to provide a cushioning effect and prevent the teeth from grinding against each other during sleep. By creating a barrier, it helps alleviate the negative effects of bruxism, which can include tooth wear, jaw pain, headaches, and damage to dental restorations.

In addition to protecting the teeth, a night guard can also help relax the jaw muscles, reduce muscle tension, and stabilize the jaw joint. This can be particularly beneficial for individuals with TMJ disorder, as it helps alleviate pain, clicking or popping sounds, and jaw stiffness.

What are my options for getting a night guard affordably?

If you’re looking for affordable options for getting a night guard, here are a few alternatives to consider:

1. Dental schools: Dental schools often offer reduced-cost or discounted dental services to patients as part of their training programs. Contact dental schools in your area to inquire about the availability of night guard services at lower costs.
2. Community health clinics: Community health clinics or dental outreach programs may provide dental services at reduced prices or on a sliding fee scale based on income. These clinics aim to make dental care more accessible and affordable for individuals who may not have dental insurance.
3. Dental discount plans: Dental discount plans are membership-based programs that offer discounted rates for various dental services, including night guards. These plans involve paying an annual fee in exchange for reduced rates at participating dentists. While the discounts can vary, they can help lower the cost of a night guard.
4. Online dental labs: Some online dental labs offer direct-to-consumer services for custom-fitted night guards at more affordable prices compared to traditional dental offices. These labs typically send you an impression kit to take molds of your teeth at home, which you then send back to them for the creation of a custom night guard. However, it’s important to research and choose a reputable online dental lab to ensure the quality and fit of the night guard.
5. Payment plans and financing options: Many dental offices offer payment plans or financing options to help make the cost of a night guard more manageable. These arrangements allow you to spread out the payments over time, which can be helpful if you’re unable to pay the full cost upfront.

When exploring these options, it’s important to prioritize the quality and fit of the night guard. While affordability is essential, a properly fitted and durable night guard can provide better long-term benefits and protection for your teeth.

How does ordering a dental night guard online work?

Ordering a dental night guard online through Sentinel Mouthguards is a convenient and straightforward process. Here’s how it works:

1. Visit our website: Start by visiting the Sentinel Mouthguards website (sentinelmouthguards.com) to explore our night guard options and choose the one that suits your needs.
2. Select your night guard: We offer a range of night guards designed to address various dental concerns, including bruxism and TMJ disorder. Browse through our product options, read the descriptions, and select the night guard that best matches your requirements.
3. Customization options: Once you’ve chosen your night guard, you’ll have the opportunity to customize it further based on your preferences. This includes making your night guard thinner or thicker based on your grinding and clenching needs.
4. Order and impressions: After finalizing your customization options, you can place your order on our secure website. We will then send you an impression kit, which includes detailed instructions and all the materials necessary to create impressions of your teeth.
5. Make your impressions: Using the impression kit, follow the provided instructions to make accurate molds of your teeth. The process is straightforward and typically takes just a few minutes.
6. Return your impressions: Once you’ve made your impressions, use the prepaid shipping label included in the kit to send them back to us. We recommend using a trackable shipping method for added security.
7. Custom fabrication: Upon receiving your impressions, our experienced dental technicians will use them to create a custom-fitted night guard specifically tailored to your teeth and bite. We utilize high-quality materials and advanced manufacturing techniques to ensure precise and comfortable results.
8. Delivery and fit: Once your night guard is fabricated, we will promptly ship it back to you along with detailed instructions for proper fit and care. Our night guards are designed to fit snugly and comfortably, providing optimal protection while you sleep.

By ordering a dental night guard online through Sentinel Mouthguards, you can enjoy the convenience of personalized, professional-grade protection without the need for multiple dental appointments. We take pride in delivering high-quality night guards that are both effective and affordable, ensuring you receive the best possible value and experience.

Sentinel Mouthguards® accepts payments using your FSA (Flexible Spending Account) or HSA (Health Savings Account) card.

What material does Sentinel Mouthguards® use to make my custom mouth guard?

The material used is Proform by Keystone Industries which is a dentist-grade night guard material available in splint (hard) version or soft. The splint material is made of copolyester and the soft material is an EVA (ethylene vinyl acetate). All of our mouth guard material is BPA, MMA, Gluten, Phthalate, Latex and Silicone free. Learn more about the safety of our dental materials here.

Our night guards are made using a special machine called a Drufomat Scan. The Drufomat Scan uses high heat and high pressure that connects to an air compressor to thermoform the night guard plastic around the stone cast of your teeth.

This machine is superior to the standard vacuum-forming machine that are still widely being used today.

Trained lab technicians will construct, trim, and polish the custom night guard. A stone mold check is performed several times throughout the process to ensure the best fit possible. This involves testing the newly constructed appliances by placing it onto the stone cast of your teeth.

The process is repeated until the night guard fits snug on the teeth, but not too tightly.

How do I stop grinding and clenching my teeth?

There is no ultimate fix for stopping nighttime grinding and or jaw clenching.

Stress seems to be the #1 reason for bruxism sited by dental professionals. Since a cure for this disorder has not been found, the best option is to protect your teeth from further damage with a night guard. This will alleviate the damages associated with teeth grinding or jaw clenching (including teeth wear/breakage, teeth flattening, headaches, jaw pain).

How can I use my insurance to buy a night guard?

Every dental insurance coverage varies in terms of the extent of services provided.

There are those that provide full coverage for bruxism treatment. Some offer partial coverage. Some offer bruxism treatment coverage but not the night guard dental kits or lab fees, while others do not make any payments on your behalf for any procedures in regards to bruxism.

Some insurances that partially cover the cost of bruxism treatment will fully pay for the treatment of tempo-mandibular joint disorders also known as TMJ syndrome. Check with your insurance provider to learn your options.

What are the symptoms of teeth grinding and jaw clenching?

Pain is a side effect of bruxism. The symptoms also include headaches, jaw clicking, pain in the ears, jaw joint pain, sore and stiff jaw muscles, as well as pain in the temple among others. Some individuals self medicate or drink alcohol to lessen their pain, but pain pills and alcohol cal exacerbate the disorder.

Let’s be clear: If you are grinding or clenching your teeth at night you should be wearing a well fitted, professionally made custom night guard to prevent further pain and damage.

Is a night guard purchased online covered by my FSA/HSA?

Sentinel Mouthguards does accept FSA and HSA.

The eligibility of a night guard purchased online for coverage under a Flexible Spending Account (FSA) or Health Savings Account (HSA) can depend on certain factors. FSAs and HSAs are tax-advantaged accounts that allow individuals to set aside pre-tax money to pay for qualified medical expenses.

To determine whether a night guard purchased online is covered by your FSA or HSA, you should consider the following:

1. Eligible medical expense: Night guards are generally considered eligible expenses for FSAs and HSAs if they are prescribed by a healthcare professional to treat a specific dental condition, such as bruxism (teeth grinding) or temporomandibular joint disorder (TMJ). The night guard must be for medical treatment rather than cosmetic purposes.
2. Supporting documentation: To be eligible for reimbursement from your FSA or HSA, you may need to provide supporting documentation, such as a letter of medical necessity or a prescription from your healthcare provider. This documentation helps demonstrate that the expense is medically necessary.
3. FSA/HSA plan guidelines: It’s important to review the specific guidelines and rules of your FSA or HSA plan. These can vary depending on your employer or the financial institution managing the account. The plan documents should outline which medical expenses are eligible for reimbursement.
4. Online purchase requirements: Some FSA or HSA plans may have specific requirements for online purchases to be eligible for reimbursement. This could include purchasing from specific vendors or providing additional documentation to validate the expense.

To get a definitive answer about the eligibility of an online-purchased night guard for coverage under your FSA or HSA, it’s best to consult your plan documents or contact the administrator of your FSA or HSA. They can provide you with the specific guidelines and requirements related to reimbursement for night guards.

The Final Verdict 

Will Dental Insurance Cover My Night Guard?

Check to see if your dental insurance plan will cover the cost of your dental night guard. Also, many of our customers have used their HSA/FSA accounts to purchase the Sentinel Night Guard. You may need to provide them with a detailed Sentinel receipt as proof of medical purchase.

If you cannot receive dental insurance benefits for your dental night guard, don’t despair. There are less expensive options.

Please avoid over the counter or store bought guards.

These cheaply made, mass produced guards can sometimes cause more harm than good.

It will be more costly if you decide to have one that is custom made to fit your dental formula perfectly, but the benefits will be beyond what you expect from a night guard, thanks to its perfect fit.

Do you have a dental insurance story you’d like to share with us?

Please comment below! We would love to feature your experience in our blog to help others dealing with this costly dilemma.