When is a 'cleaning' not a cleaning?

When is a "cleaning" not a cleaning, but a root planing or periodontal maintenance? You and your office staff understand the differences in these services, but do your patients?

Carol Tekavec, RDH

When is a "cleaning" not a cleaning, but a root planing or periodontal maintenance? You and your office staff understand the differences in these services, but do your patients? Confused and unhappy patients are complaining to state dental boards about these procedures in record numbers! Many patients believe they are being unfairly charged for services they have not received. Many are upset about insurance coverage. It is up to the office staff to help them understand.

What follows are some "patient-friendly" answers to common questions:

1) What is a "regular" or standard cleaning?
A "regular" cleaning — where only the portions of the teeth above the gum are cleaned (D1110 as defined by the ADA) — is recommended for persons who do not have any bone loss, periodontal disease, or infection around their teeth. There should also be no bleeding, mobility of teeth, receded areas where the gums have pulled away from the teeth, or gaps where the spaces around the roots are exposed. The mouth should be healthy with no gum or bone problems.

2) How often do I need to have my teeth cleaned?
The old system of everyone having their teeth cleaned twice a year has fallen out of favor. Most dentists and hygienists are now setting up a patient's cleaning schedule based on individual needs. This may be as often as four times a year.

3) What is periodontal disease?
Periodontal disease is very common, but does not always have distinct symptoms. It is an inflammation and infection of the supporting structures of the teeth, which includes the gums, bone, ligaments, and root surfaces that can eventually result in a loss of teeth. You may notice that your gums bleed easily, that you have a bad taste in your mouth, that your gums appear red or swollen, that your teeth appear longer or seem to have shifted ... or you may not notice anything at all.

4) What is a root planing procedure?
Patients with periodontal disease may require root planing to remove diseased deposits from the roots of the teeth. Other treatment, including surgery, may be required. Root planing removes bacteria and its toxins, tartar, and diseased deposits from the surfaces of tooth roots. Scaling (using dental instruments or an ultrasonic "machine" scaler to scrape away deposits) is required for the full length of the root surface, down to where the root, gum, and bone meet.

5) What is periodontal maintenance?
After the disease process is under control, a "regular" cleaning is not appropriate anymore. Instead, you will require special ongoing gum- and bone-care procedures, also known as periodontal maintenance, to keep your mouth healthy. Periodontal maintenance is different in scope from a "regular" cleaning, even though a hygienist may perform both services. Perio maintenance can include a medical- and dental-history update, radiographic review, dentist exam, gum and bone exam and periodontal probing, a review of home care, and scaling and root planing, polishing, and irrigation of the gums as needed. The dentist's exams and X-rays are currently not included in the ADA Code D-4910 and are billed separately. Typically, an interval of three months between appointments may be needed.

6) Will my insurance pay for these procedures? If not, why not?
Most plans will pay for root planing for patients with a defined amount of bone loss on a "once every two years" basis. The majority of plans also will pay for two "regular" cleanings a year or two periodontal-maintenance procedures a year. Insurance can help you pay for treatment that you need; however, it was never designed to pay for everything. Most plans typically pay a minimum, regardless of what you may need as an individual. It is a mistake to let benefits be your sole consideration when you make dental decisions.

To view a brochure about this topic, go to www.steppingstonestosuccess.com and click on "What is the difference between a "regular" cleaning, a root planing, and periodontal maintenance?"

Carol Tekavec, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-4, co-designer of a dental chart and an informed consent booklet, and a national lecturer. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com.

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