NEW YORK (MainStreet) -- Finances may play a bigger role than fear when it comes to avoiding the dentist's chair. Under the Affordable Care Act, dental coverage is required for children but not for adults, and according to the CDC, 45 million Americans do not have dental insurance. Working adults are visiting the dentist at the lowest rate since 1996, when the American Dental Association began tracking dental care utilization, while dental visits for children continue to climb.

"There are a lot of patients that for many reasons, whether it's fear or finances, say I'm just not going to see the dentist right now," says Dr. Mark Wolff, professor and chairman of NYU's Department of Cariology and Comprehensive Care and associate dean for predoctoral clinical education. He warns that this can be a formula for financial disaster. "When you have bleeding, when you have swelling, when you have pain in a tooth, there is guaranteed nothing cheap about what's about to happen," he says. Delaying treatment can ultimately lead to a gaping hole in your budget as a condition worsens over time and becomes more expensive to handle.

Seeking urgent care for a dental condition is indeed expensive, averaging $749 per emergency room visit. That cost is nearly three times greater than annual dental insurance premiums for an individual, which range from $223 to $280, depending on the type of coverage.

Even for those who have dental insurance, it's important to monitor out-of-pocket expenses. Dental plans usually have a maximum coverage amount of $1,000, so taking a proactive approach can minimize costs if you need expensive work done. Finding affordable dental care is possible with a little effort.

Visit an Accredited Dental School

To cut dental costs by up to half, visit an accredited dental school for your next appointment. Students perform cleanings and procedures with supervision, and quality control is taken very seriously. "It's one of the few environments where another dentist actually checks the dentist's work," Wolff says.

Getting an appointment is relatively easy for routine care. "You can walk into our school and and get into our orthodontic clinic, get into our routine dental clinic pretty much on demand," he adds. And if you need to see a specialist, that can be arranged as well, although scheduling might take a bit longer.

Wolff cautions patience for those receiving care at a dental school. "The dental student is going to be working a little bit slower," he says. "They will be working under supervision. There will be many checks along the way." Allocate more time for the appointment, but at least you'll have more money in your budget.

Use Online Tools To Compare Prices

Nobody likes to receive medical bills, but unexpected bills are even worse. Before heading to the dentist, estimate your dental costs by using an online tool like the FAIR Health Dental Cost Look Up. The interactive tool provides detailed pricing information for various services, as well as the out-of-pocket costs that patients can expect with or without insurance.

"You can be highly educated and still be completely mystified by the way in which dental and medical insurance works," says Robin Gelburd, president and CEO of FAIR Health. "Some services are considered diagnostic and preventative which may be reimbursed at 100%, but a basic procedure could be 70% or 80%, and major procedures could be 50%." She recommends checking with your insurance provider or HR department to find out how services are categorized under your plan. Data from FAIR Health can also be utilized for filing insurance appeals.

For those without insurance, Gelburd recommends using the tool to make sure your dentist's fees are reasonable. Confirm the prices before making an appointment, or use the data to negotiate better rates after the procedure has been performed. "Dental care can be expensive so it's important for consumers to understand they way in which to navigate it," Gelburd adds. Consumers have a lot more control over their health care bills than they often realize.

Use a Dental Discount Plan

Dental discount plans are simpler than insurance plans, with straightforward pricing and less paperwork. For less than $10 a month, patients gain access to a network of dentists who offer discounts of 20% to 60% on a variety of dental services.

Consumers could ask their dentist for discounts without joining a dental savings plan, but many patients shy away from haggling. "Some dentists will give discounts for low income patients or senior citizens, but a lot of dentists won't, and a lot of people don't fit into the category the dentist is willing to discount," says Allen Erenbaum, president of the Consumer Health Alliance. "The dental savings programs makes it extremely easy because the dentist has already agreed to provide the discount, and the consumer gets it by showing their card."

While dental insurance plans often have a maximum benefit amount, dental savings plans are unlimited. "The more extensive your services are the more expensive they tend to be and the more you'll save," adds Erenbaum. "Anybody who would otherwise pay out of pocket for dental care is going to save money with a dental savings plan."

Before signing up, make sure there are plenty of dentists available in your area and that you'll have access to any specialists you may need to see.

Maintain Good Dental Hygiene

Many dentists will tell you the cheapest cavity is the one you never have. Practicing good dental hygiene is one of the best ways to reduce out-of-pocket costs. Wolff says it's possible to see a dentist once a year, or even every other year if you've never had a cavity, avoid sugar and brush with a fluoride toothpaste. 

Choosing the right dentist can be a challenge, especially if you've let too much time pass since your last cleaning or need extensive services. If a dentist recommends an expensive treatment that you aren't sure about, Wolff recommends getting a second opinion. If the dentist doesn't support a second opinion, then you're better off seeing someone else entirely. "Make sure you aren't being sold something," he says. "It's not a sales pitch. you have to have the sense that this dentist is working with your best interest in mind."