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Dental Accident

A dental accident is a sudden, unexpected event that causes injury to the mouth, teeth, or jaw, resulting from an external force rather than from decay, chewing, or normal use. Examples include being struck in the face, falling and hitting your mouth, or suffering an impact during sports. Dental accident coverage helps pay for the repair or replacement of natural teeth damaged in such incidents.

This type of coverage is typically included under extended health benefits rather than standard dental coverage. It is designed to cover emergency treatment and restorative work that is medically necessary due to trauma. Eligible expenses may include examinations, X-rays, fillings, crowns, root canals, or tooth replacements caused by the accident. Most insurers require treatment to begin within a set timeframe, such as 90 or 180 days after the incident, though ongoing work may continue for up to a year or more if approved.

Example:

If you slip on ice and break a front tooth, your dental accident benefit may cover the cost of repairing or replacing the tooth, up to the plan’s per-incident or annual maximum.

What to Watch For:

Report the accident to your insurer as soon as possible, and keep detailed records from your dentist or oral surgeon. Routine dental issues such as broken fillings, biting injuries, or damage from eating hard food are not considered accidents. Check your plan’s definition of “accidental dental injury” and confirm how long you have to start treatment after the event.

Related Terms

Deductible

A deductible is the fixed dollar amount you must pay each benefit year before your plan starts reimbursing eligible expenses. Think of it as your yearly participation in costs - once met, your plan covers claims according to its coinsurance. Some individual health plans in Canada have no annual deductible, while others apply one only to certain benefits (often $25–$100 per person).

Dental Fee Guide

A dental fee guide is a provincially issued schedule that lists the standard or recommended prices for dental procedures. Each province and territory in Canada publishes its own guide annually, outlining suggested fees for everything from cleanings and fillings to crowns and dentures.

Dental Insurance

Dental insurance is a type of health coverage that helps pay for the cost of preventive, basic, and major dental services. It is designed to make oral care more affordable and to encourage regular checkups that prevent costly procedures later on. Dental insurance is offered through group employee benefits, individual plans, or conversion plans for people leaving workplace coverage.

Dentist

A dentist is a licensed healthcare professional who diagnoses, treats, and helps prevent conditions affecting the teeth, gums, and mouth. Dentists play a key role in maintaining oral health through preventive care, restorative treatments, and patient education. Common services include cleanings, fillings, crowns, root canals, extractions, and oral examinations.

Dependent

A dependent is a person, usually a family member, who qualifies for coverage under someone else’s insurance plan. Dependents are typically the spouse or children of the primary insured person, also known as the plan member or policyholder. Some plans may also cover other individuals who rely on the plan member for financial support, such as a common-law partner or a child with a permanent disability.

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