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Can you do SRP if calculus is not visible on x-rays?

I had a patient come in this week. He hasn’t had a cleaning in 5-10 years. I took FMX and Pano. Bone loss was noted but no visible calculus. I did my perio charting 4-5mm generalized with heavy BOP. I explored and I felt moderate sub g calculus and heavy supra on lower linguals of anteriors. My question is can you perform and code out SRP even though calculus isn’t visible on X-rays?



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9 Answers

Yes and it sounds like you should! Calculus does not always show up radiographically.

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Absolutely!

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Yes! 4-5mm with BOP indicates perio infection despite no radiographic calculus. SRP would be the tx plan to eliminate the infection and prevent any further bone loss.

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YES!

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Definitely, insurance companies may give you a hard time I treat my patients according to what they need.

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Yes, absolutely. Usually an explanation of treatment justifications and the visible bone loss is enough for an insurance company. It might also help to take intraoral pics of the clinically visible calculus.

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Remember also we do inadvertent Gingival curettage during the S/RP procedure. Removing the endotoxins, biofilm, diseased tissue etc… from the root surfaces and pocket. Probing depths, bone loss, attachment levels, furcations, mobility, bleeding and any exudate should be charted on the Perio Charting and sent to insurance when submitting a Pre-D or the insurance claim. Radiographic bone loss etc will be visible and numbers on the Perio chart show the health of the pt mouth. Just because the calculus isn’t evident on radiographs all the other signs and symptoms of active disease process is there. It’s the soft bacteria that causes the disease process.

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It’s important to remember that xrays and Pano’s only give us a 2D image of the structure. The xrays aren’t showing what is in the facial and linguals. And it is possible to have perio without actually calculus buildup. Perio is the result of bacteria that has gotten subgingivally and remains there for a period of time. SRP will disrupt that bacteria biofilm. Perio is determined by more than just seeing radiographic calculus present; we use Probing depths, BOP, and attachment loss as well.

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I would definitely be doing SRP on that patient! Calculus doesn’t always show up unless it is a large “wing” on the tooth. The best treatment for that patient would definitely be SRP. As long as you provide the perio chart for insurance, most insurances will pay out on it, especially if it has been that long since their last cleaning.

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