{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
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How do you explain difference between “regular cleaning” and “deep cleaning”

I have a friend, who is non-dental related, that was told he needed a “deep cleaning.” He wants to schedule an appointment with me since we’re friends but he asked why I couldn’t just do the “free cleaning” at the first visit and he would return for the “deep cleaning” at a later date. I told him the previous hygienist took measurements around his gums and determined he needed SRP due to deep pockets amount other things. He was still really confused and asked if I clean below the gums during a regular cleaning and I said yes… I explained how legally it also comes down to how it is charted and I cannot chart a prophy after an SRP (we use 4910 code). Again he was confused and said, so after I get a deep cleaning I will never be able to get my free cleaning since insurance typically doesn’t cover the code 4910? am I wrong?



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4 Answers

This is my answer to a previous question:
Complete a full Perio charting with PD, AL, Furcation, Mobility, Bleeding, Suppuration. If three or less you will complete Selective S/RP and 4 or more in a quad you will do a Quadrant S/RP. Sub-gingival calculus will not always be heavy or even evident on radiographs. Look for bone loss, look for what the total attachment loss added with the probing depth will give you the big picture of disease. If the pt only had 4mm in posterior, but also had 3mm of recession…….THAT is warranted for S//RP quadrant or selectively defendant on how many teeth have attachment loss. Add 4 to 3 = 7mm of total attachment loss and a true history of disease of the patient. Explain what you are doing when Perio charting. 3,2,1 mm is healthy and anything 4-12 mm is bone loss and an infection in the gums and needs a procedure called scaling and root planing and the next measurement will be recession. Recession of Zero is perfect and 1-12mm is gum receding and Negative 1-12 means the gums are very swollen and could create a fake pocket. Explain what furcation, mobility, bleeding and suppuration is. Let the pt hear the explanations and each and every number and also explain that recession will be added to the PD reading which could just mean they have severe gingivitis without bone loss or they have Perio disease. Perio disease can be active and not active. That’s the blurred line……if the pt has 3mm, no bleeding, suppuration etc…but have severe recession with no active diseased pockets and never has had S/RP you cannot charge out a Perio maintenance 4910 because it will be denied by insurance unless they do not have insurance. A patient can also have had S/RP in past and have no active diseased pockets, but severe recession and should be coded Perio maintenance 4910……never Adult Prophy because the history of bone loss and attachment loss is the evidence of previous disease and could turn back into active disease very quickly. I could go on and on……sorry. I know I had a hard time when I was starting out because I didn’t want to upset my patient by diagnosing disease or financially. I got more courage and decided it was never my fault they have Perio disease and it must be treated correctly or I am supervising neglect. I use to let pts tell me they will improve home care etc… They still has the disease and most never would improve their home care and I’d be back educating about needing S/RP. Some yo have to prepare especially existing pts that things are changing over period of 6 month to year, but finally do agree to what the diagnosis is and want to treat it.

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Tell him more and more insurance companies are covering 2-4 PM (4910) per year. He needs to take this issue up with his HR Department. His company picks out the dental plans. He needs to accept responsibility for the health of his mouth. A healthy adult cleaning is above the gum line only and if he has 4-12mm pocketing that is a destructive disease that needs to be properly treated and maintained or he could loose a tooth or several teeth. He can always go for a second opinion, but I would stress that second opinion be with a Periodontist. Then he can decide if he wants to be treated for his Perio disease with you, his initial dentist or with the periodontist.

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I think you want to know how to explain the difference between the cleanings. Am I correct? It may be easier to explain if you compare it to something else. For example, would you want to have sealant placed, which is preventive, when you really need root canal therapy, which is treatment? You could use car repair or any other example you can think of. Doing a prophy when SRP is needed doesn’t help the patient or make their condition better. You have to help patients understand that a prophy is preventive and used when the mouth healthy, SRP is treatment for perio disease. I like to keep it simple. All those numbers and unfamiliar terms confuse people.

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I always start out the conversation by explaining exactly what “probing” is. We have a helpful Arestin poster in our hygiene rooms with a picture of a probe going into a pocket along with a millimeter guideline of what’s healthy and what’s not. I explain how 4mm and above with bleeding tells us that there are signs of active infection in the mouth. I link this with discussing the amount of calculus (I say tartar because people understand that terminology better) I have found in the mouth. Usually people that need deep cleanings have a history of putting off their appointments because they simply do not understand the importance of regular check ups. I continue to explain how over time, bacteria has built up and hardened underneath the gumline that needs more attention than I can give in just one visit. That we need to take the time to carefully remove all of this bacteria that is irritating the tissue and restore the health of the gums.

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