Akwesasne Dental Clinic; located in the Kanonkwatsheri:io Health Facility Tel: 613-575-2341 Fax: 613-575-2346 The Akwesasne Dental Plan Dental Examinations There are several type of dental examinations that you may require in the course of dental treatment. These are as follows: If you see your dentist on a regular basis, you will be given a recall examination. If you have a problem such as a toothache and you need to see a dentist, you will be given an emergency examination. Every five years, it is a good idea to have a complete examination. That covers the whole mouth including the teeth. If you have problems with your gums such as bleeding, orr crowded teeth, you will be given a minor specialist examination. If you are going to need teeth straightening (Orthodontics) you will be given a Major specialist examination. If you are under 17 years of age, you qualify for up to four examinations per year. If you are 17 and older, you qualify for up to three examinations per year. X-RAYS You are entitled to six normal x-ray films in a twelve month period. If you require more than this, a series scan is permitted once in any sixty month period. Special films are also covered if the dentist feels that they may be necessary. PREVENTIVE Scaling, cleaning, and fluoride applications are a benefit under the plan but are limited to frequency. The limitations may vary with age. RESTORATIVE (FILLINGS) Normal white and silver fillings are covered under the plan but some time restrictions may apply if any of them need to be replaced. Gold and tooth colored crowns are limited to one crown per 3 years and there use will depend on the general condition of the mouth. ENDODONTICS ROOT CANAL TREATMENT These services are limited to one treated tooth per 3 years and will depend on the general condition of the mouth. PERIODONTICS GUM TREATMENT This is the equivalent of one hour treatment per year and any gum surgery that may be required must have special approval. DENTURES The plan covers you for one denture per arch (one set) per 8 years. FIXED BRIDGES In some cases, a special gold bridge to replace a missin tooth may be used to replace a missing tooth instead of a removable partial denture but this requires special approval and will depend on the general condition of the mouth. ORTHODONTICS - TOOTH STRAIGHTENING This service is limited to individuals under 18 years of age and requires special approval in all cases. Your Akwesasne Dental clinic has all of the required specialists on staff to provide you with the services covered by our new plan. Information Patients need to report: Patient's Name Seen by Address Providers Name Patient ID# Address D/O/B Phone # Health # Date of Service Insurance Company Name Treatment Band # Date of Next appointment Phone # Reported By: Date: Work# Other Information For Inquires or questions pertaining to dental program Tel: 613-575-2341 Fax: 613-575-2346