Perio Protocols

Complete perio charting should be completed on:

• All new patients over 18 years and older.

• 1 time yearly for all adult patients

• Before beginning SRP if no chart within 3 months

• First perio maintenance after SRP.

• All existing patients should have a full perio chart recorded (starting at age 18)

• Perio maintenance recalls must be perio charted every appointment

  **1 time per year start with a new perio chart in Open Dental, note should state FULL perio chart

  **If not annual full charting appointments only update areas where there is a significant change, note should state UPDATED perio chart which is just pocket depths and bleeding.

A complete perio chart includes:

• perio depths

• recession

• mobility

• furcation

• suppuration

• bleeding

Gingivits Therapy

*4346: D4346 – Scaling in the Presence of Gingivitis – is a therapeutic service performed after evaluation and diagnosis of gingivitis to remove all deposits and allow tissue healing. LBR and Cervitec are recommended in conjunction with this service.

Following 4346 cleanings, pt will be seen at 3 months for reevaluation to see if pt needs another D4346 or can return to a 3 or 6 month prophy. If bone loss begins to occur patient would move to SRP protocol.

SRP Protocol

If uncertain of treatment needed or concerned about order of treatment to be complete (fillings, extractions, etc. and SRP) consult the dentist and come up with a comprehensive plan.   If you are confident, treatment plan everything and mark the priority of each step for the patient to complete.

SRP Codes available for use:

• D4342 – SRP 1-3 Teeth.

  1. Good to do up to 2 quads of 1-3 teeth and still charge out a D1110

  2. As always, gather your diagnostic information first if you need to re-appoint patient to finish cleaning

• D4341 – SRP QUAD

  1. If doing more than 2 quads in one appointment a narrative might be needed for insurance. Such as “patient drives 60 miles to our office and cannot get off work, elects to have all treatment completed same day”

• If doing 3, 1-3 teeth or full quad – provide a narrative as to why you are completing the treatment in that manner for insurance

• If doing one quad or localized area of SRP and re-appointing, try to start on one of the lower sides if possible.  Helps the next person (or yourself) with the numbing process in the next appointment.

SRP should be recommended upon the following clinical findings:

• Heavy supra calc and inflammation do not necessarily warrant SRP, patients need to have at least TWO of the following clinical findings…

  1. Radiographic bone-loss

  2. Probing Depths = 5+ mm

  3. Bleeding upon probing

  4. Radiographic/Clickable subgingival calculus

      

     • New standards state that when bleeding is present, there is active infection and it should be treated.

     • Evaluate long standing short recare patients for SRP.  The old protocol would start with shorter recalls and we have since moved away from this where there is active infection.

     • SRP and post SRP recare appointments (at least the first post SRP appointment) should be attempted to be scheduled with the same hygienist in order to consistently monitor the patients periodontal progress.

     • Implant Care

       1. These are two clear signs of active infection surrounding implants

          • Amount implant of exposed in xray (if roughly 1/3 of implant is still in bone)

          • Bleeding

          • Schedule for a consult with Dr. Bill if any of these occur

     • What to do when patient declines SRP treatment?

       1. Unfortunately, once we have identified infection in the mouth, we are obligated to treat and cannot continue to do preventative treatment (prophy).

       2. The state has ruled that when infection is present and not treated, I could potentially lose my hygiene license.

       3. If you were my family member, this is the treatment I would recommend and insist you move forward with.

          • Our office policy is such, that if active infection is identified, the patient will accept appropriate treatment or else the patient no longer believes in us as their dental provider. We cannot and will not continue to do preventative treatment once there is already active infection.  Just like we won’t do a filling when a crown is needed.

       4. We can continue to see you when you are in pain, however I cannot do a preventative treatment any longer.  You have active infection that needs to be treated.

       5. There will always be exceptions to this rule – work with the dentist who is doing hygiene checks if you are uncertain.

     • Most insurance companies allow SRP every 24 months although if it is needed we do it.

New research is showing that osseous surgery is not the solution it was once thought. We have found great success in SRP followed by PerioProtect trays in most cases.

In rare circumstances you might find a situation that needs to be flapped and cleaned. Our doctors can help with these solutions and are comfortable handling those surgeries.

It’s extremely rare we refer to the periodontist. When in doubt the doctor who is doing the exam can help with the appropriate treatment plan.