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Proof of perio/perio main

I’ve had two patients argue they would not have perio main done. They wanted what their insurance covered. After speaking with the Dentist, she refused to give them prophies because of ADA guidelines. They both asked for proof but I had no paperwork as to why nor could I think of any website they could go to. Does anyone have paperwork to give to patients explaining perio disease and to why they need perio maint and not a prophy? Any suggestions as to how to explain to patients about periodontal disease? Patients not understanding this and how their insurance works is so frustrating.



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2 Answers

Hooray for your dentist!! A simply Google search of “perio maintenance vs prophy” gives many resources for a patient. A great summary from an article in RDH Mag is “The D1110 prophylaxis is only for people who do not exhibit any of the signs and symptoms of periodontal disease, including bone loss, bleeding, mobility, exudate, and recession. D1110 is, thus, a preventive procedure for patients who don’t yet have periodontal disease and should only be used with patients who are periodontally healthy. As the CDT definition says, D1110 is for “the removal of plaque, calculus, and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”
The D4910 code, on the other hand, is a post-therapeutic procedure used to maintain the results of periodontal therapy, not to prevent disease in healthy patients. The CDT definition for D4910 states that it can only be used “following periodontal therapy and continues at varying intervals … includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site-specific scaling and root planing where indicated, and polishing the teeth.”
(http://www.rdhmag.com/articles/print/volume-31/issue-4/features/d110-and-d4910.html)
So a prophy is preventive in nature for people with no disease and PM is maintaining the perio pathogens that have previously caused disease (attachment loss). Here is a link to a brochure for patients (I’m sure there are many out there): http://www.steppingstonestosuccess.com/products/broc-pro.htm
While explaining preventive vs already diseased, use visual aids. Show a picture like the one at this link: http://www.mydentisttarzana.com/periodontics-tarzana/. I keep a picture saved to my desktop in my operatory to show patients, then I show them their boneloss on their radiographs. You can find a picture you personally like if you Google “gingival sulcus” and then click images, for an image search. I also have the patient hold a mirror (or intraoral camera, if you have one) any recession, furcations, inflammation, etc. they have and actually point out the “disease.”

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Great advice! Thank you so much and those pamphlets are awesome!

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