There are two things every dentist should consider when evaluating whether to add a patient service. The first and most obvious is: how will the practice be paid for the new service? Is there a CDT code? Will the procedure be covered by insurance? Will patients have to pay out of pocket? The second, and often secondary, question is: How will the service fit into the current patient appointment structure? Will this require a longer hygiene visit or separate appointment time? Who will be responsible for presenting the procedure to the patient? Which team member will complete the procedure? Now that codes are available for the two services mentioned below, consider how you can successfullyimplement these services into your practice to improve patient health and practice profitability.
Gingival inflammation—Code 4346
Gum health has traditionally been difficult for dental offices to address. In patient priorities, it falls far behind cavities, sensitivity and pain, and even a white, bright smile. Despite this, we know that addressing inflammation is critical to a patient’s overall health and needs to be treatment planned accordingly. Recognizing this, the 2017 current dental terminology (CDT) included a new code designed to fill the gap between a prophy, and scaling and root planing. The D4346 code reports scaling in the presence of generalized moderate or severe gingival inflammation, full mouth, after oral evaluation. This code acknowledges the importance of addressing gingival health before patients deteriorate to the point of periodontal disease.
In the past, these patients have typically been treated with a prophy and home-care education. For many, this will not be sufficient to reduce gum inflammation, and patients will eventually progress to periodontal disease. When the overall health implications of periodontal disease are shared with patients, most want to know how they can “fix” the current inflammation.
1. Identify patients who need treatment for gingival inflammation. Patients must have generalized—not acute— inflammation, and no bone loss.
2. Educate patients about the importance of addressing inflammation in the mouth. Periodontal disease increases the risk for diabetes and heart disease, in addition to other systemic diseases.1,2Prevention of periodontal disease is one of the most important steps patients can take to protect their overall health.
3. Calculate applicable insurance benefits and present the treatment plan. Identify the long-term costs if treatment is not completed.
Diabetes screening—Code available in 2018
One consequence of sustained gingival inflammation and the development of periodontal disease is the increased risk of insulin resistance.3Given the well-established connection between oral health and diabetes, the ADA and Code Maintenance Committee announced the addition of a new code in 2018 that will report the in-office measure of hemoglobin A1c, a blood test that provides information about a person’s average circulating blood sugar levels during the preceding three months.
“People with poorly controlled diabetes are at greater risk for dental problems,” Ronald Riggins, DDS, Code Maintenance Committee chair, said. “High blood sugar may cause dry mouth and make gum disease worse.”
1. Identify patients at risk for diabetes. Risk factors for diabetes include family history of diabetes, high cholesterol, elevated blood pressure, overweight and obesity, and periodontal disease. Develop your own screening tools to assess these risk factors and others, or use the “Diabetes Detection in the Dental Office” screening tool. This tool was developed by Total Health University cofounder, Susan Maples, DDS, and validated by Michigan State University researcher, Saleh Aldasouqi, DDS.
2. Educate patients about the connection between oral health and diabetes. Patients need to understand that you cannot safely and successfully treat periodontal disease without knowledge of associated health conditions.
3. Check at-risk patients for diabetes. Hemoglobin A1c tests can be performed in the dental office with a simple finger stick. In just a few minutes, the test provides the patient’s average blood sugar level for the past two to three months and classifies it as either normal, prediabetes, or diabetes. Patients can then be referred to a medical provider for a definitive diagnosis.
Key to the successful implementation of both of these codes is the ability to communicate the importance of oral health and its impact on overall health.
Author’s note: For help educating patients and motivating them to accept treatment, ask a Henry Schein representative about Total Health University (THU). THU is an online training and coaching system that helps dental teams integrate total health patient education protocols and systems into the practice.
1. Gum disease and heart disease. American Academy of Periodontology website. https://www.perio.org/consumer/heart_disease. Accessed June 28, 2017.
2. Gum disease and diabetes. American Academy of Periodontology website. https://www.perio.org/consumer/diabetes.htm. Accessed June 28, 2017.
3. Periodontitis and diabetes: A two-way relationship. National Center for Biotechnology Information website. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/. Published November 6, 2011. Accessed June 28, 2017.
With more than a decade of marketing experience in the health-care industry, Jen McGuire now leads the marketing of Henry Schein Dental’s Business Solutions. Jen developed and launched dentistry’s first wellness program, Total Health Beyond the Mouth. Contact her at (800) 372-4346 or at [email protected].