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Treatment of D4342 vs D4341?

I am seeing more use of the D4342 code for scaling and root planning versus D4341. In cases where a patient has not had a cleaning for over a decade I am apprehensive about only scaling 1-3 teeth and leaving other teeth in that quadrant with a biofilm that just has not resulted in a probing depth greater than 3 mm. Dentists that I work with have no problem treatment planing limited scaling, even saying that treating all the teeth in the quadrant would be over treatment. Is anyone out there seeing this type of limited tx planning? How do you handle this clinically–do you turn down the ultrasonic scaler after you have treated the prescribed teeth? If I am not scaling deeper than 3 mm does that automatically constitute adult prophy status only to those particular teeth? I am struggling with ethically feeling this is right based on what I have learned in school about always going below the gumline. Some hygienists in my office say when they see this they just do all the teeth in the quadrant. I am not sure I am comfortable with that either. Part of me even feels angry and expected to take care of all teeth in a quadrant while only being compensated or given credit for treating a limited number of those teeth. Anyone else struggling with this?



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2 Answers

In my office, we treat all the teeth in that quad. The 4341 or 4342 is determined on how many teeth have the probing depths and bone loss to qualify as SRP. I personally do not feel comfortable only treating the 1-3 or 1-4 teeth and my doctors I work for would never want me to only treat those teeth. With that said, I always explore all the teeth in the quad before starting so I know where the calculus is before I start. I am not going to be going deep into a pocket if there is no calculus present. I will go slightly below the gumline to flush out any bacteria that is there, but I am not going to be doing scaling that is as involved as the other teeth that really need it.

I have worked in an office though that said only touch the 1-3 or 1-4 teeth that need the SRP and leave the other ones. I just cannot justify that because I don’t feel that is the best treatment for the patient. Also, the patient is paying a lot of money per quad, so they deserve to have all those teeth cleaned.

Hope that helps!

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You are the dental hygiene expert in your office! Feel confident giving recommendations on treatment and the reasons to back it up. If you respectfully assert yourself, dentists will defer to you for hygiene diagnosis because most will acknowledge that prevention education and experience is limited in dental school.
If you find that, indeed, there are only 1-3 teeth that need NSPT in a quad, then use the ultrasonic or prophy angle to remove biofilm (de-plaque) on the remaining teeth in the quad. This does not take a lot of time and does not involve subgingival scaling. Best of luck.

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