Oral Surgery
Oral surgery refers to surgical procedures performed in or around the mouth and jaw by a licensed dentist, oral surgeon, or maxillofacial specialist. It includes both minor procedures, such as tooth extractions, and more complex surgeries involving the jawbone, soft tissue, or dental implants.
How It Works
Health and dental plans treat oral surgery differently depending on where it is performed and the reason for treatment. Routine extractions and minor surgical procedures are usually covered under dental benefits, while more extensive operations related to injury, disease, or medical necessity may fall under extended health benefits. Public coverage varies by province. Under the Canadian Dental Care Plan, oral surgery services remove teeth and roots, surgically remove tumours and cysts, make surgical incisions including draining, and treat broken jaw bones, though the plan covers only a portion of the cost, follows its own fee schedule rather than provincial fee guides, and bills any difference above its fees directly to the patient. The CDCP covers many services without preauthorization while others require it. In Québec, the public plan covers certain hospital-based oral surgery such as biopsies, abscess drainage, fracture reduction, removal of a cyst or tumour, and temporomandibular joint treatment, along with related exams, anesthesia, and x-rays. In Ontario, in-hospital oral and maxillofacial surgery requires that hospitalization in an acute care public hospital be medically necessary and that the work be done by a dentist appointed to that hospital's dental or medical staff.
Example:
Suppose you have a private extended health and dental plan in Ontario and need impacted wisdom teeth removed. A routine surgical extraction is typically processed under your dental benefit as a basic or major service, often subject to coinsurance and pre-authorization. If the surgery instead has to be done in a hospital because it is medically necessary, it may be coordinated through provincial coverage and your medical benefit rather than the dental side. Out-of-pocket amounts you pay for the surgery, including implant or bone-graft work, can later be claimed as a medical expense on your CRA tax return if they were not reimbursed by insurance.
What to Watch For:
Some oral surgery procedures may require pre-authorization, especially when performed in a hospital or under general anesthesia, so confirm whether anesthesia, facility fees, and follow-up care are included under your benefit. Because plans classify these procedures differently, check whether yours treats a given surgery as a dental or medical expense, as this affects which benefit applies. Keep in mind that public plans like the CDCP set their own fee schedules and cover only part of the cost, leaving the remainder to you. If you intend to claim costs on your taxes, note that the CRA allows dental implants and related oral surgeries, such as bone grafting or sinus lift surgery, as eligible medical expenses when performed by a licensed dentist or oral surgeon to restore oral function or replace missing teeth, but purely cosmetic dental work cannot be claimed.
