{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
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SRP Considerations

When is it best to diagnose quadrant scaling on a patient in private practice?



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2 Answers

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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If there are more than 4 teeth with 5mm or higher probing depths, there is generalized BOP and generalized sub calc. These are what I use for baseline standards.

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