Adjunctive Dental

Dental benefits are available under the separate TRICARE dental programs.

Limited adjunctive dental services may be covered when related to other covered medical care. 

Prior authorization is required for all beneficiaries before receiving any adjunctive dental treatment to ensure the services will be covered. The prior authorization requirement is waived only when essential adjunctive dental care involves a medical emergency, such as facial injuries resulting from a car accident.

Some of the adjunctive dental procedures TRICARE may cover include:

  • Removal of teeth and tooth fragments to treat and repair facial trauma, or for example, treatment of a fractured jaw. However, restoration is not covered. 
  • Total or complete ankyloglossia (tongue-tie) to alleviate difficulty swallowing or speaking. (Partial ankyloglossia is not covered.)
  • Dental or orthodontic care directly related to the medical and surgical correction of a severe congenital anomaly.
  • Dental care in preparation for, or as a result of, inline radiation therapy for oral or facial cancer.

The following are special circumstances covered under the adjunctive dental care benefit:

Facility services required to safeguard the life of the patient – Some patients have medical conditions that could become life-threatening during routine dental procedures (for example, tooth extraction for a hemophiliac). TRICARE covers the facility services and supplies. Under this category, TRICARE does not cover the professional dental services or anesthesiology.

Children age five or younger or beneficiaries with severe disabilities – Children age five and under, and beneficiaries with severe developmental, mental or physical disabilities undergoing routine dental procedures. TRICARE covers the facility services, supplies and anesthesiology services. Under this category, TRICARE does not cover the professional dental services and anesthesiology services rendered by the attending dentist. TRICARE will cover anesthesiology services rendered by a separate anesthesiology provider.

Note: Acute anxiety, behavioral issues or extensive dental treatment do not qualify a patient for adjunctive dental care.

If covered, the type of location where the services are provided will determine cost information: outpatient office setting, ambulatory surgery center or inpatient hospital setting.

It is important to remember the TRICARE medical benefit does not cover routine, preventive, restorative, emergency, prosthodontic, or periodontic dental care that is not related to a medical condition. Some examples of dental care that is not covered include:

  • Treatment of dental caries and periodontal disease
  • Emergency room visits for dental conditions, for example, dental pain
  • Tooth extraction, including impacted wisdom teeth
  • Provision of implants, crowns, dentures, and bridges

For example, the removal of broken teeth to treat a fractured jaw due to a car accident is a covered adjunctive dental care service because the care is related to a medical condition (the fractured jaw). However, care for accidental injury to the teeth alone or emergency room visits for dental pain are considered non-adjunctive dental care and are not covered by the TRICARE medical benefit.