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School world vs. real world: Perio Maintenance

So in school we were taught “once a perio maint, ALWAYS a perio maint.” If a new pt comes in and says they had SRP done 20 years ago, they should get a perio maint cleaning instead of prophy. Right before graduating from hygiene school, we started to get into a little muddy waters. Our perio professor started talking abou the term “reduced periodontium.” And we had discussions about a compliant 3mrc perio maint pt, great home care, with no bop, and numbers 1-3mm being able to “graduate” from perio maint to prophy on a reduced periodontium as a “reward” for compliance. Although we were told this would be a very very rare occourance. Teachers and students were split on the issue and I was left thoroughly confused.

Fast forward to the real world: private practice. So, I don’t know a thing about insurance, but when I was first hired I would talk a lot to our office manager and front desk staff about insurance so I could learn more about it. I was told that most insurance companies stop reimbursing for perio maint visits 2 years after the pt’s last perio therapy (SRP or Arestin). So, if a pt had SRP 3 years ago and they have been perio maint every since, insurance will likely not cover their perio maint cleaning unless they have another SRP or Arestin. (I want to make it clear that by NO means was I asked or told to SRP pts every 2 years, it was just a conversation we had about insurance and what it does/doesn’t cover) She explained it to me by saying insurance looks at it like you’re either getting better (can be changed to a prophy) or your getting worse and need perio therapy again. Which kind of makes since to me…

Just brainstorming here, really, please tell me your thoughts on the matter



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I’m by no means an insurance guru, but did the front office staff/office manager mean that only 2 perio maintenance are covered by insurance per year? I’ve never heard of periodontal maintenance only being covered for only 2 years after definitive periodontal therapy. There are so many dental insurance carriers and plans, but I’ve never come across this.
 
To your original question, if once perio maintenance, always perio maintenance; I suspect this thought came about because periodontitis cannot be “cured” only maintained, but what about those that have been maintaining for some time? It does seem fuzzy! According to the American Dental Association (ADA), how long a patient stays on perio maintenance is up to the clinical judgment of the dentist.
 
The ADA states, “This is a matter of clinical judgment by the treating dentist. Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. However, if the treating dentist determines that a patient’s oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate.” (CDT 2009/2010 page 157)
 
So, while many perio patients will need perio maintenance for a lifetime, there is some discretion given for dentists to return a patient to prophy status. Meaning, if a perio maintenance patient has been periodontally stable for a few years, according to the ADA, they can be put back to prophy status if the dentist deems it appropriate. Keep in mind that if a perio maintenance patient returns to a prophy, they cannot go back to periodontal maintenance without undergoing definitive periodontal therapy again.
 
As with anything in dentistry, there is no cookie-cutter answer and all patients should be treated on an individual basis.

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