Does Medicare Cover a Dental Abscess

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 09/12/2018

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A dental abscess is caused by a bacterial infection in a tooth and, if untreated, can spiral from a painful toothache to potentially fatal septic shock. Learn how to identify and prevent a dental abscess and whether Medicare covers dental treatment for a dental abscess.

What is a dental abscess?

According to the Mayo Clinic, a dental abscess occurs when bacteria enters the tooth and causes an infection at the root. Pus then starts to collect and forms a bulge.

Signs that you could have a dental abscess include:

  • Severe toothache
  • Pain when chewing
  • Sensitivity to hot or cold foods
  • Fever
  • Inflammation in your lymph nodes
  • Swelling in your face
  • Salty liquid in your mouth accompanied by a putrid odor and taste (this occurs when the dental abscess has burst)

If you think you may have a dental abscess, it’s important to see your dentist immediately, or go to urgent care. If left untreated, the infection behind your dental abscess could spread.

Dental abscess risk factors and prevention

Good dental hygiene is the best way to prevent a dental abscess from forming. According to the Mayo Clinic, this includes:

  • Brushing your teeth at least twice a day and flossing every day.
  • Seeing your dentist regularly for cleanings.
  • Switching out your toothbrush regularly, since worn-out brush heads don’t clean as effectively.
  • Minimizing sugary foods and snacking.
  • Drinking fluoridated water.

Dental abscess treatment

A dentist can diagnose a dental abscess during an oral exam. After a dental abscess has been diagnosed, X-rays or a CT scan can check if the infection has spread, according to the Mayo Clinic.

Dental abscess treatment may vary, depending on the infection’s severity. It may involve:

  • Draining the dental abscess: treatment of a dental abscess usually first involves your dentist making a small incision and draining the pocket of pus that has collected.
  • Root canal: if your tooth can be saved, you may need a root canal. During this procedure, your dentist removes the infected “pulp” inside of your tooth, cleans the inside, and then seals it. Your dentist may add a dental crown to strengthen the tooth.
  • Tooth extraction: if the dental abscess has caused so much damage that your tooth can’t be saved, your dentist may pull the tooth to stop the infection.
  • Antibiotics: antibiotics may be needed if the infection has spread, or if you have a weak immune system.

Does Medicare cover dental abscess treatment?

Original Medicare, Part A and Part B, doesn’t cover most routine dental care, including cleanings, fillings, extractions, crowns, and root canals. Medicare covers some dental services only if it’s an integral, medically necessary part of a covered service. For example, Medicare may cover tooth extractions if you need radiation treatment in your jaw, and your doctor needs to remove teeth in order for you to receive the (covered) treatment.

Medicare may cover treatment related to your dental abscess if the infection spreads beyond the infected tooth. According to the Mayo Clinic, an untreated dental abscess or an abscess that doesn’t fully drain may result in the infection spreading to other areas, such as your jaw or neck. In some cases, the infection can progress to sepsis, which is when your body’s immune response to an infection causes widespread inflammation and blood circulation issues. In some cases, organ failure or septic shock follow, when your blood pressure drops dangerously low.

If the infection from your dental abscess spreads and requires hospitalization, Medicare Part A generally covers inpatient hospital and skilled nursing facility services. Medicare Part B generally covers outpatient care, including doctor services and lab tests to diagnose and treat your dental abscess and related complications. Medicare Part D may cover prescription drugs if your doctor prescribes antibiotics for your infection.

Please note that while Original Medicare doesn’t cover routine dental care, some Medicare Advantage plans include routine dental coverage and may cover services related to your dental abscess. Benefits vary by plan, so check with the specific Medicare Advantage plan to find out if root canals or extractions would be covered if needed to treat your dental abscess.

As mentioned, regular dental exams and cleanings may prevent a dental abscess from forming, or catch it before it gets serious. I can show you Medicare Advantage plans with routine dental coverage, if you like. To arrange a time to talk by phone, or to receive an email with plan options, see the links below. To start looking now, click the Compare Plans button.

For more information on dental abscesses:

Mayo Clinic, “Tooth abscess,” accessed October 15, 2017. https://www.mayoclinic.org/diseases-conditions/tooth-abscess/diagnosis-treatment/drc-20350907

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