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Gross Debridement vs. Prophy

I’ve been working for what I like to refer as an ‘old school’ dentist. A new young dentist bought the practice. It’s an answered prayer. Now I’m building a Perio program. I seriously did prophies on every patient or that’s what they were charged out to be. I only had 30 minutes with my patients. So no probing the full mouths. What I’m asking now: what do you consider a gross debridement and a prophy? What would be the characteristics of the 2? Can you charge out for a gross debridement before you’ve done a prophy on the patient?



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Clinical teams typically recommend debridements to new patients who arrive with heavy amounts of calculus on their teeth. When the calculus is too heavy to get accurate periodontal measurements—which prevents the dentist from completing a comprehensive exam—full mouth debridements come to the rescue. FMDs are not therapeutic. Treatment-wise they can actually cause the tissue to tighten up making it harder to adequately remove calculus subgingivally at a later time. The ADHA has a great position paper on the difference between SRP/prophy/PM:
http://www.adha.org/resources-docs/7115_Prophylaxis_Postion_Paper.pdf

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I am not a fan of FMD. I honestly see it more of a “practice builder” than anything. I do understand the idea about making it easier to get probing depths, but I have rarely seen a patient where I am not able to get most of perio data needed, along with using the radiographs to determine whether or not SRP is necessary.
When you remove the calculus and biofilms from around the gingiva, you remove the stimulus for inflammation. When the gingival margin tightens up, you can create a perfect little “oven” in the sulcus to cook up a pretty serious infection. The patient can end up in pain and believe that you caused it, and well…in essence, you did. If they have enough calculus to do a FMD, chances are, they have bone loss and an SRP would be indicated.
In this same vein, I used to work for a man who wanted me to always do a prophy on the day that SRP was diagnosed. The ONLY purpose for this was that most insurances would pay for this and it was a money maker. This to me is unconscionable. I left that office.

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Most of the time if the patient needs an FMD….. They have perio and need S/RP either selectively or full quadrants. The dentist can do an exam and then after S/RP the dentist can come back and finish the exam that was already charged out the first exam appt. most insurance only pay a FMD once in a lifetime and under Basic with the deductible applied. If you remove calculus around the gum line the tissue will tighten and cause more trauma to scale later or the calc you pop off you have to go sub-gingival and are then really doing S/RP…….. Just schedule back and do the S/RP…….unless the occlusal surfaces are covered and you can’t see to start the exam.

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If I had a patient with really heavy supra calculus that impeded me from getting accurate probe depths and kept the dentist from being able to do a comprehensive exam I would do an FMD and have them come back a week later for a fine scale and probing. So basically if it will take a longer time than you have scheduled for a regular propy because of all the supra calculus but there isn’t enough bone loss/sub calculus for SRP than I do an FMD and then charge out for an 1110 prophy at their fine scale appointment.

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Wow looking at these posts makes my head spin.I probe at every appt on perio maintain patients…their re care is either 3 -4 mos regardless of probings BC previous disease was assessed as in a SRP….this is to maintain tissues and prevent further distruction
Secondly ,at new patient apps , I take a complete FMX if not current, photos, blood pressure and pulse,probings said verbally and recorded….then we sit up…they review the perio status form with me. This is where they are informed of bleeding, mobility,loa, and mm of probings…if SRP full quad is needed we propose the treatment…they see the chart on the monitor in front of them…. if limited is needed that too is proposed. Dr will complete the comp exam and recommend proposed treatment …then it is done …our pt is informed and srp form is given to them to read at home …if pt has been seeing previous dentist 6 mos and this is now being dx .with perio disease. ..understand they have not been given the information about health implications and should be educated..I seldom have a patient decline…best of luck

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Gross debrisment is always before the prophy….its when a new patient comes with heavy tenacious calc and you cant give them what they need in the typical time….Debrisment is done first as well as charting etc….couple weeks later a prophy is scheduled to fine scale and complete the details….insurance wont cover debrisment if you over-use…most have a time frame that its allowed….after the prophy, and if needs indicate further perio, you can request DSRP from the ins co and proceed with that in a few months…then you may get perio maintenance appts okay’d also which gives them an extra prophy a year covered…it generally has to all be pre approved and perio charting submitted

However, they dont have to be perio to use debrisment…just overdo qualifies them for a debrisment….you just cant over-use it on the same client….Most new patients with heavy buildup get debrisment, perio or not… 🙂

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I use gross debridement only to remove heavy calculus that prevents me from getting accurate probing depths. I do not like to do them unless absolutely necessary as it makes it difficult to fine scale due to tissue tightening.

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I would love to use the code for a FMD for my new patients that come in with a lot of supra-gingival calc and I can’t get accurate probe depths. I always need more time with these patients and there is no way everything is coming off in that one appt (60 min). But the problem is insurance. Usually insurance companies won’t cover a FMD if a Comp exam has been completed first or in the same day as the FMD. They look at it as if it should have just been a prophy and if a patient really needed an FMD then the dentist shouldn’t have been able to complete the exam. It’s so dumb.

What we do at our office is debrid on the first appt and then have a follow up appointment in 4-6 weeks to finish fine scaling. We call it a Gingivitis prophy. We have to explain to the patient that there was just too much tartar to get off in one appointment and they will need to return to get their gums healthy again. Our patients are very receptive to this. Just make sure they know it’s their fault their gums are like this. They have to take responsibility.

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Years ago, there was a code for a “difficult prophy” that covered situations where the calculus and stain was heavy, but SRP could not be justified. This worked great until offices began to overuse and misuse it. The insurance companies caught on and it is no longer an option.

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