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You Decide: Prophylaxis or Periodontal Maintenance?

The following is a guest post by Debbie Seidel-Bittke. If you are interested in guest posting for Dental Heroes, please sign up here.

All throughout the day, we treat them one by one. Each individual patient is treated in a different way. This is our standard of care. Will you agree with this statement? If you don’t agree, then let’s make a “Red Letter Day”- – today!

What is the difference between a Prophy and a Periodontal Maintenance?

Are you scaling more than twenty minutes during a regular continuing care appointment? If you are then it is probably more than just a Prophy.

Periodontal Maintenance

When a patient completes phase one treatment for non-surgical periodontal therapy, they are now and forever considered a “Periodontal Patient”. If you have Diabetes or high blood pressure, you will always be evaluated by your doctor to prevent progression of the disease. A patient diagnosed with cancer, high blood pressure and/ or Diabetes, doesn’t just get treated and then never see their doctor for regular preventive measures. This is the same protocol for patients diagnosed with Periodontal Disease.

One reason hygienists may choose to eliminate the periodontal maintenance appointment is for financial reasons. In the United States and other countries a billing code is used and more money is charged for the service. In the United States code D4910 (Periodontal Maintenance after scaling and root planing has been completed.) is a much higher fee than the fee for code D1110 (Prophylaxis. This means no disease is present.) The other reason dental professionals do not provide the periodontal maintenance appointment or bill appropriately is that many third-party payers do not cover the periodontal maintenance appointment at frequent intervals. (Example: Less than six months interval.)

When we understand the research regarding periodontal pathogens we will understand how to communicate to our patients “Why” they need to return in most likely twelve weeks. The research, the science, reports that periodontal pathogens will repopulate a healthy and recently scaled sulcus as early as nine to twelve weeks, post maintenance.1 A patient can brush and floss all day long and this may not be enough to remove the periodontal pathogens. These pathogens are what will cause tooth loss in periodontal patients.

Following a 10-year study, researchers found that patients who received regular periodontal maintenance had significantly reduced probing depths and lost fewer teeth than patients who did not have periodontal maintenance procedures. Here are the arguments to use regarding regular twelve week periodontal maintenance for your periodontal patients. This is the information to communicate to patients. It is our role as a healthcare provider to read the research, know the science, and share it with everyone who needs to know.

It still happens each day in many dental hygiene treatment rooms throughout the world. No matter how much time is spent removing plaque and calculus, the office still charges the same fee for what are actually a different procedure and a different diagnosis. The problem that is seen most likely is that the hygienist is not individually assessing patients for periodontal disease. The other problem is that the hygienist will do an assessment but there may be a lot more calculus present than is considered a regular prophylaxis procedure. If it has been awhile and if you live in the United States, look at the CDT Codes and read the description for D1110. No matter where you live, review the billing code description. Exactly what type of plaque and calculus does this billing code refer to? Does the code say this is a procedure for a preventive or a disease state? Read this description and see for yourself that (For example, in the United States) CDT Code D1110 refers to a healthy dentition, small amounts of plaque and calculus. If you are spending more than twenty minutes scaling, then you are not adequately treating this patient. Scaling calculus for more than twenty minutes is not the description of a prophylaxis. In the presence of moderate to heavy calculus you have more than a CDT Code D1110. (The Prophylaxis code for insurance billing purposes in the United States.)

No one wants to spend more money! People will pay for what they want not always what they need. It is our job as a healthcare professional to be an advocate for prevention. We need to share the research and the science behind the disease and how to prevent it, with our patients. We are the experts and we want to be an advocate of optimal oral health for our patients. We have a responsibility to spread the word that without good oral health a person will not have a healthy body.
“Working as a team of healthcare professionals, we can conquer the disease process. Together we can make a difference in our world!

Can you effectively explain to your patients why they need to return for non-surgical periodontal treatment? Do you know what to say when a patient returns with heavy calculus? What do you say when the patient had scaling and root planing last year and returned today with a 6-mm pocket? That pocket was there prior to scaling and root planing a year ago but what do you say when it occurs again at the periodontal maintenance appointment?

Tell Your Patients the Truth

You told your patient about the research and science behind the disease and you also need to tell them that periodontal disease is episodic. The disease process can and will most likely return at some point. This is why your patients need to continue coming back every twelve weeks, (or at frequent and the appropriate intervals.) even if they seem healthy for many years after the scaling and root planing is completed.

As mentioned previously, when a patient has Diabetes or high blood pressure, the doctor will ask the patient to be examined frequently because the disease is likely to return. Today, it is all about prevention. Prevention needs to be your message to the patient. When there is a new area of bleeding upon probing (BOP) or a new 5-mm pocket, now is the time to sit the patient upright in the chair and discuss early intervention. This will most likely mean prevention in the future. In dentistry today, during the twenty first century, we no longer “wait and watch”. Waiting is not the standard of care. What are your “waiting” for?

Look for part II of this post tomorrow…

What to look for in Part II tomorrow

In part II of this post, we’ll learn the difference between Prophylaxis and Periodontal Maintenance. We’ll then discover an effective way of communicating the difference to our patients. We’ll see you tomorrow!

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