endstream endstream endstream x�+�r A recent hot topic in the Facebook forum Dental Hygienists Talk, which has more than 10,000 dental hygiene members, revealed that some new hygienists are feeling confused, insecure, or lost when it comes to implementing a periodontal program in their office. endstream DentaQuest Partnership for Oral Health Advancement | 2400 Computer Drive, Westborough, MA 01581 Home care instructions (OHI) Home care instructions (OHI) Periodontal maintenance (D4910) is ongoing and therapeutic in nature, not preventive. �*T0T0 B�����fh����� �� endobj endobj �*T0T0 B�����f����� � � 31. 16 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> 73 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[2 3 564 754]/MediaBox[0 0 567 756]>> Dentists treating patients with chronic periodontitis, a severe form of periodontal disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association. endobj endobj 4. endobj �26S072PI�r � 70 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. 43 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/Annots[27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R]/MediaBox[0 0 567 756]>> x�}��N�@E�� endobj endobj endstream treatment, results, and recommended follow-up are essential, starting with the initial examination and continuing for as long potential complications, or … �*T0T0 B�����f����� � � The dental cleanings recommended after these treatments are called “periodontal maintenance care.” Periodontal maintenance involves a cleaning that is deeper than a normal cleaning in a dental office. 30 0 obj<>>> The guidelines have not been updated since 1999, so this is a pretty big deal! 4 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> endobj endobj 11 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream �26S072PI�r � endobj endobj Sometimes dental offices alternate using the periodontal maintenance code and the prophylaxis code with patients who have a three-month recall. endobj endobj endobj endobj Background: Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. x�+�r Use this ADA-published brochure to explain why regular, professional treatment is important in controlling periodontal disease. American Academy of Periodontology. Regular maintenance is recommended at least every 90 days in contrast to Prophylaxis for a healthy person, which is generally only recommend twice a year. 57 0 obj<>>> Although the CDT-4 definition of D4910 states that intervals for the procedure are determined by the clinical diagnosis of a dentist, it eliminates the words "periodontal evaluation" that were included in the CDT-3 definition, and does not make any mention of examination or evaluation in any other context. 64 0 obj<>>> 71 0 obj <>stream New and exciting things were happening at this past EuroPerio9 held in Amsterdam from June 20th-23rd, 2018. �*T0T0 B�����fh����� �� x�+�r 13 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> �*T0T0 B�����fh����� �� �26S072PI�r � endstream endobj �26S072PI�r � endobj It thus attempts to establish some guidelines that practitioners may use when calculating recall intervals. Properly maintain ventilation systems. Help patients understand that periodontal disease doesn’t always go away after one treatment. x�+�r x�+�r 32 0 obj<>>> Periodontal maintenance scaling is needed to maintain gum and bone health. This brochure explains that periodic periodontal maintenance appointments are different from regular cleanings and are necessary to help keep gums healthy and allow them to heal from gum disease. �26S072PI�r � endobj H�|W�r�:���-����oN\�V[u\U�C�0 IHHB! endobj J Periodontol 2001;72:1624-1628. endobj 54 0 obj<>>> �*T0T0 B�����f����� �� � endobj Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. Services (DHCS) restored optional adult dental benefits for members ages 21 and older with full-scope dental coverage. 68 0 obj <>stream 44 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream x�+�r endstream 31 0 obj<>>> endobj endstream 46 0 obj<>>> endstream endobj 4. endobj endobj J Periodontol 2003;74:1395-1401. 38 0 obj<>>> x�+�r It is the most conservative approach to prevent more extensive and aggressive treatment. and the patient’s insurance provided insurance coverage 2X/year and the patient is on a 3-4 month recall. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low. �*T0T0 B�����f����� �� � %PDF-1.4 �0��������U���+�,ғ�oJ��HReR�����c`��N=t0"�ɧ|��oτ�7vP~_�`v?�� {� �!�~�����y���c�F���F i��ꚏe!tBmB1nA��ڈ֤���XAM�Au�����ϊi�t�����#f���Xt=���,^u-��@^ ��9* �Z|��լ=��y|� x�+�r endstream Cohen RE, Research, Science and Therapy Committee, American Academy of Periodontology. 36 0 obj<>>> An appropriate periodontal maintenance program, specific to individual circumstances, has been recom- mended to the patient for long-term control of the disease, as well as for the maintenance of dental implants, if present. �26S072PI�r � 6 0 obj <>stream �26S072PI�r � 52 0 obj<>>> �26S072PI�r � The purpose of this paper is to provide an overview of the role of periodontal maintenance procedures in the treatment of periodontal diseases. 41 0 obj<>>> x�+�r (;>����= x��S��l�fz�{Bv�|��s�Nz���q�}2�6��`y��,��>/#֋���������4�� ���D�(�����/)��)Y�%�s%~T;���t�*�?��(��(Ls�&%�U��~R������y��w�� ��˥�����̞F�H|Da�i�:��w8��6N��S�~�����O���������m�ד�p'�;��=!`iX.������W�}���*�ƘQ�PL��_U��p�:vď�ދ��D��+9�����&��d����A�"�Z�S��Ԍw5�dv�%�����:����'a�mx����ًh����/Φ��-I#���܆��{(�`8xP�j��L��LQl�0��5�8���4)���� :�Ubg�ӪN�_f�A��N��E�R��`���uAd���g���I�� �P�>H�u8��z:3Q_+�Iu�"B1�"+mI�|z�ꪛ�m� �;������U�B�Z��F�����S)J�7���u=M�3Q �c������`�j�k'���e`!���d�h[Ϊ3�NUA�8BTb��=�r����r��`��܈%v����)�833b~�i���$ ����eA���h��Qfp,P��i��``�Em�h�!��{8<. endstream endobj endstream endobj �26S072PI�r � x�+�r 32. �26S072PI�r � 22 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> �26S072PI�r � Cohen RE; Research, Science and Therapy Committee, American Academy of Periodontology. 48 0 obj<>>> The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents an evidence-based clinical practice guideline and systematic review on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Ultrasonics are more effective at debriding pathogens than hand scaling, largely because of the lavage (either water or medicament) and the acoustic turbulence created by the tip. endobj 29 0 obj<>>> �26S072PI�r � 24 0 obj <>stream 2005;32(3):280-286. The bacterium that causes periodontal disease re-establishes 3 months after treatment. 66 0 obj<>>> 53 0 obj<>>> x�+�r As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. endobj The American Academy of Periodontology (AAP) announced new periodontal classifications for the AAP Guidelines. endstream 21 0 obj <>stream 10 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> endobj %���� endobj x�+�r Periodontal maintenance is often referred to as a dental deep cleaning, because it includes: Scaling – cleaning beneath the gum line to remove plaque, bacteria, and other build-up Root Planing – shaping the root of the tooth to remove leftover debris, and decrease the chances and/or amount of bacterial build-up in the future Principles of ethics and code of professional conduct. including limits related to the following dental services: Fluoride treatment Full mouth debridement Oral evaluations Prophylaxis Periodontal maintenance Periodontal scaling and root planing Sealant treatments Full-mouth or panoramic x-rays 7 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> endobj However, due to concerns expressed by clinicians to the ADA CDT code com-mittee, a clarifying statement was added to allow dentists to judge how each pa-tient is maintained. 1 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. However, some Medi-Cal adult �*T0T0 B�����f����� �� � �*T0T0 B�����f����� � � endstream Periodontal Maintenance (D4910) Effective January 1, 2018, the Department of Health Care . endobj This paper looks at the periodontal healing period, the risks of periodontal progression and current thinking about maintenance programmes. endobj �26S072PI�r � 5 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream 9 0 obj <>stream Periodontal maintenance. endobj 59 0 obj<>>> endobj This method saves a patient money as a prophylaxis is typically 100 percent covered, whereas periodontal maintenance may be covered partially or not at all. endstream 35 0 obj<>>> �*T0T0 B�����f����� � � endstream 45 0 obj<>>> Although treatment with locally applied antibiotics may be recommended in conjunction with periodontal maintenance, the cost of those medications is generally not included in periodontal maintenance procedures. endobj Periodontal Maintenance Kit IM-D4910 Hu-Friedy has created a collection of procedural instrument kits that follow American Dental Association (ADA) - Current Dental Terminology (CDT) Coding. 2 0 obj <>stream paratively little evidence to demonstrate how often such reviews should take place. 49 0 obj<>>> endobj 15 0 obj <>stream x�+�r endobj endstream Access cutting-edge continuing education courses, Find evidence to support your clinical decisions. �*T0T0 B�����f����� �! endobj endobj 40 0 obj<>>> dental implants. A 3-4 month Periodontal Maintenance Therapy Appointment/Recare is a Soft Tissue Management Program that is a non-surgical approach to Control Periodontal Disease. endobj Nonsurgical Treatment of Chronic Periodontitis Clinical Practice Guideline (2015) A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents an evidence-based clinical practice guideline and systematic review on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. 30. Active periodontal treatment may be reported as D4341, D4342, D4240, D4241, D4260, or D4261. 12 0 obj <>stream x�}�� endstream �*T0T0 B�����f����� �� � 69 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/Annots[45 0 R 46 0 R 47 0 R 48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R]/MediaBox[0 0 567 756]>> �*T0T0 B�����f����� �� � �*T0T0 B�����f����� �� � It includes removal of bacterial plaque, calculus, from supra and sub-regions, and SITE specific SRP where indicated, as well as polishing the teeth 1. endobj �26S072PI�r � endobj endobj Position paper. Periodontal maintenance includes localized, non-surgical procedures necessary to keep the disease under control. x�+�r 5. Dental Hygienist’s Guide to Delivering an Effective Periodontal Program. �26S072PI�r � Typically there is a ninety day exclusion period following active treatment. American Dental Association. Learn about ADA CERP recognition, look up CERP recognized CE providers and find CE courses. 62 0 obj<>>> Together. endobj D4910 Periodontal Maintenance Follows the completion of active therapy to treat periodontal infection for the lifetime of the dentition or implant replacements and includes removal of plaque biofilm and calculus from supra and subgingival sur- faces. 17 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream 55 0 obj<>>> endstream 50 0 obj<>>> �*T0T0 B�����f����� �� � Take advantage of endorsed, discounted business products, Access oral-health information for the public and ADA Find-A-Dentist. endobj endobj Radiographs (according to ADA guidelines) Prophy/perio maintenance Prophy/perio maintenance Treatment plan Provisional treatment plan . endobj endobj endobj Position paper: periodontal maintenance. x�+�r �*T0T0 B�����f����� �� � �26S072PI�r � by Karoline Biami, RDH. CHICAGO — Dentists treating patients with chronic periodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association (ADA). CDC provides the following recommendations for proper maintenance of ventilation systems and patient placement and volume strategies in dental settings. 25 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> 61 0 obj<>>> A{���D���D� “once a periodontal patient, always a periodontal patient.” That phrase is true, in the sense that periodontal dis-ease is chronic and must be controlled. 2003;74(9):1395-1401. This was a long time coming as both the […] x�+�r �26S072PI�r � x�+�r endstream Explore CODA's role and find accredited schools and programs, Learn about the examinations used in licensing dentists and dental hygienists, Learn about recognized dental specialties and certifying boards. 47 0 obj<>>> endobj By definition, the 4910 periodontal maintenance code is defined as the procedure following periodontal therapy and continues at varying intervals determined by the clinical evaluation. endobj �26S072PI�r � endobj �*T0T0 B�����f����� � � endobj Preshaw PM, Heasman PA. Periodontal maintenance in a specialist periodontal clinic and in general dental practice. The need for periodontal maintenance treatment after active therapy due to the potential for disease recurrence. This procedure includes removal of plaque and tartar from above and below the gum line, all the way down the length of each tooth to where the root, gum, and bone meet. x�+�r periodontal charts • If the patient has been approved for frequent recalls for periodontal maintenance, patient must have a history of having scaling and root planing performed with a probing depth of 5mm or greater in at least one quadrant. �*T0T0 B�����f����� � � endobj 8 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream January 2005. �26S072PI�r � American Academy of Periodontology. J Clin Periodontol. endobj endobj Your patients may not know the difference between a routine cleaning and periodic periodontal maintenance. J Periodontol. endobj 33 0 obj<>>> endobj The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Clinical Indications Medically Necessary: Periodontal maintenance is a nonsurgical treatment considered medically or dentally necessary, following periodontal therapy,that continues for the life of the dentition or any implant replacements and provides treatment and continuing care of patients with a history of/and ongoing periodontal disease. �*T0T0 B�����f����� � � |: 39 0 obj<>>> endobj In addition, you should be using thin ultrasonic inserts on low power for at least 75 percent of the scaling in a periodontal maintenance visit. 37 0 obj<>>> If the hygienist is doing a periodontal maint. Periodontal maintenance should always follow definitive periodontal therapy for a period of time, typically one year or longer. Antibiotics for Dental Pain and Swelling Guideline A panel of experts convened by the ADA Council on Scientific Affairs presents clinical recommendations concerning the use of antibiotics for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. endobj You also may have had periodontal surgery. Tips for minimizing claim denials for periodontal maintenance: • If there are unusual circumstances that require a different interval of treatment than the one specified in the patient's plan documents, the dentist should provide documentation with the endobj 34 0 obj<>>> 63 0 obj<>>> 26 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream endobj 20 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream 18 0 obj <>stream 42 0 obj <>stream � 74 0 obj <>/ExtGState<>/ProcSet[/PDF/Text]/Font<>>>/Subtype/Form/BBox[0 0 567 756]>>stream endobj w����.������d� q*pMR��3��K��EnY�"��֭"9պX�:��A�o$sE���L� ZģM�G"�*ͳ9yv��`�V�c��̧���߮}3��y$� Periodontal Maintenance and insurance. 51 0 obj<>>> Position paper: periodontal maintenance. �*T0T0 B�����f����� � � Copyright © 2020 American Dental Association. 65 0 obj<>>> 67 0 obj<>>> 58 0 obj<>>> endobj endobj 23 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream endstream 14 0 obj <>>>/Subtype/Form/BBox[0 0 567 756]>>stream endstream x�+�r endobj x�+�r 56 0 obj<>>> 28 0 obj<>>> 19 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/CropBox[6 3 561 750]/MediaBox[0 0 567 756]>> m��3a���EZ�N|��-�/�(eX���.��=��� ��k?���y ��.�U�Q3ͣ��zx��ϛL�y�ܖ�G2G7!���Dý��>�V�9(��b�ٽ�j{���Q2(�_Zv^�+��� Commission for Continuing Education Provider Recognition, Joint Commission on National Dental Examinations, National Commission on Recognition of Dental Specialties and Certifying Boards, Nonsurgical Treatment of Chronic Periodontitis. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Guidelines for periodontal therapy. Scaling and Root Planing (SRP) precedes being placed on a regular maintenance routine, and may also be … 33. Meet, Play, Learn atADA’s annual meeting. Periodontal charting must be current within one year to support periodontal maintenance visits for Investing in better oral health for all. Access news, member benefits and ADA policy. endobj 27 0 obj<>>> Position paper. 60 0 obj<>>> The list of dental benefits included Periodontal Maintenance (D4910) as a new benefit. endobj endobj �26S072PI�r � Aap guidelines active treatment, typically one year or longer attempts to establish some guidelines that practitioners may use calculating. 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Reviews should take place periodontitis, SRP showed a moderate benefit, and the patient’s insurance insurance! The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis,! Doxycycline hyclate gel and minocycline microspheres ) were expert opinion for overview of the of! With a diode laser not been updated since 1999, so this is bacterially-induced!