Hi and welcome, or welcome back. You are listening to the Perio Patient Podcast, a podcast for my patients – past, present, and future, and anyone else who cares to listen. My name is Dr. Ben Young and I am a periodontist in solo private practice in San Antonio, Texas. I’ve worked in the military, dental schools teaching at both undergraduate and graduate levels, and now have been in private practice for many moons. This is episode 99 and the title is What is a Deep Cleaning?
Before we get to the main topic today, let me to remind us all what the purpose of this podcast is.
It’s really very simple.
There is not enough time in the middle of a day at the office to sit and chat as much as I would like. I love what I do and find from it a lot of interesting topics. From your end, a podcast like this provides you the luxury of listening to me on many topics you might find interesting. You can if you so desire, even responding to me by making comments either where you get your podcasts are by sending me a message directly. And best of all I think is you can turn this off to do other things and then come back as you wish. That’s what I do with podcasts I listen to. I love this freedom to listen when I choose because I think adults learn best when they have specific questions they want answered. This is the big different actually between adult learning and child learning. Adult learning seeks answers. Child learning needs information for future use. Child learning is furnishing the house. Adult learning is figuring out where we put the screwdriver.
Today’s topic is inspired, as are many, from interactions with patients who come to me for periodontal evaluations. During our conversations I often hear people talk about having had a “Deep Cleaning.”
This has become a very popular term so I will not discourage its use, except to say, I think, dear patient, you need to understand what it is.
To do this, I will talk about it specifically and also compare it to other cleanings people can have.
And the reason this is important to you, which is what every adult wants to know first, has to do with cost and frequency of cleanings allowed by insurance companies.
Personally, in my own life, I have found that sometimes businesses keep things murky when it comes to providing information to customers and in healthcare, to patients.
It isn’t always for sinister reasons, but it is also very convenient to pass over complicated material by dumbing it down enough to where customers and patients aren’t even aware that they need to understand something a little better.
In the legal world, this standard to appropriate disclosure of information before purchases and procedures is called “Informed Consent.” This acknowledges that no one can really give their permission to have something done whether on their personal property or bodies without understanding the risks, benefits, alternatives, and risks and benefits to those alternatives, in clear words ahead of time.
To begin with, just like in medicine, dentists in the United States document treatment using established codes. Each of these codes has a definition. The purpose of all of this is to standardize at least the language around care. Care itself, what I do to treat patients may be very different from someone else to a limited extent. Both of us, if we are to use particular dental codes must meet whatever the definitions of those codes describe.
We often believe that these codes were created by the insurance industry. This is untrue. They were generated and are maintained by the American Dental Association. We dentists create and maintain this coding system through our national organization. This obviously means that we can add, remove, and modify, these codes. However, it also means there is some bureaucratic and possibly political red tape we must jump through to make such changes. This is what it is. It has its good points and bad points.
Now, what is Deep Cleaning. According to dental codes it is a procedure known as Scaling and Root Planing.
Scaling and Root Planing requires first a diagnosis of periodontal disease.
A diagnosis of periodontal disease requires pocket measurements, a full series of diagnostic x-rays and an explanation to the patient that they have periodontal disease. For this reason, practitioners have to obtain informed consent from the patient. Just saying to someone they need a deep cleaning perhaps might be common, but it is not enough.
Because if someone has periodontal disease, there is the risk of continued bone loss around teeth in the future and we now need to know whether or not treatment is working. So, following a deep cleaning, there needs to be an examination using probing measurements.
So what is the code for “deep cleaning” or scaling and root planing?
There are two codes and each is describing one quadrant of care. This means if you need scaling and root planing in all areas of your mouth, you will have a code for each quadrant or four codes.
The scaling and root planing codes fall in the 4000 numbers which are assigned to periodontics.
If scaling and root planing involves 4 or more teeth in a quadrant the code is D (dental) 4341.
If the scaling and root planing involves 1 to 3 teeth in a quadrant the code is D4342 (don’t ask me why it is a higher number for fewer teeth – code assignments are arbitrary.
D4341: 4 or more involved teeth in the quadrant
D4342: 1 to 3 involved teeth in the quadrant
Again, what are the requirements to have this procedure:
You must have Active periodontal disease. Pocket depths must be 4 mm or greater.
Healthy pockets are 1 -3 mm in depth. If there is bleeding but the pockets are still 1 – 3 mm, then this is gingivitis – inflammation of the gums without affecting the surrounding bone and attachment between bone and tooth. This diagnosis has nothing to do with calculus or mineral deposits. Finally, this level of cleaning includes everything less as well. What I mean by this is that cleaning and polishing crowns to remove calculus and stain are included.
If you are using insurance, you really should not have to worry about this because the insurance company will not pay twice for a single procedure – they will take the most advanced code that qualifies.
What if someone comes in who has not been to see a dentist for years and because of this it is not possible to take accurate probing measurements?
So briefly, what are some other cleaning codes? I won’t go into too much detail.
First, sticking with periodontal treatment and periodontal patients, there is a maintenance cleaning code. This is for routine care following active treatment. If you do not understand the difference, then go back and look at my 15-minute YouTube video A Tooth Has Four Parts. It explains periodontal disease from the perspective of how you, as the patient needs to understand it and manage treatment for it through your daily home care and managing appropriate appointment intervals.
For patients who do not have periodontal disease and are adults, there is an Adult Prophylaxis or cleaning code. It is D1110 – not necessary you know this number specifically but note it is not in the 4000’s so is not a periodontics code. It is in the 1000’s which is a code for examinations and other procedure that are considered preventive in nature.
For children there is a Chile Prophylaxis D1120.
• Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. D4346. This is the removal of plaque, calculus, and stains in a patient who has generalized (more than 30% of the mouth) moderate to severe inflammation (swollen, bleeding, inflamed gums, pseudopocketing). No evidence of attachment loss. This code can be used in permanent, primary, or transitional dentition and there is no age limit.
It is therapeutic (not preventive) in nature.
Full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit. D4355:
Well that’s it for today. I hope that was useful. You might want to pass this information on to your friends and family members who could benefit knowing a little more about these particular dental treatment codes. If you have any questions or comments, be sure to drop me a line. To learn more about me in general visit: Benjamin W Young . com.
You have been listening to the Perio Patient Podcast and I am still Dr. Ben Young. Thank’s for listening. Bye for now.
Why are frogs so happy? They eat whatever bugs them.