I recently received a phone call from one of my former dental hygiene students. She graduated almost a year ago and has yet to find a permanent position. To keep her skills up while she’s actively job seeking, she stays busy temping – a daunting work environment for a newbie right out of school. During our phone conversation, she shared with me her confusion of what’s expected during a prophy appointment. She proceeded to tell me story after story of various practices where she was “expected” to do prophies on patients, irrespective of periodontal status. Does that sound familiar to some of you reading this?
As a hygiene coach with Inspired Hygiene, the scenario detailed above is extremely common. Prophy-heavy practices are almost always the result of two things:
One of the best ways to ensure your practice is delivering the best standard of care in the hygiene department is to develop standard of care documents. Practices with standard of care documents typically yield better case acceptance as well as higher levels of team calibration.
CDT code description
One of the most common procedures performed in the hygiene department is the prophylaxis (D1110). To many coding experts, the D1110 is also one of the most misinterpreted codes in all of dentistry. As defined in the CDT procedures book, a prophylaxis is described as a preventive procedure – not a therapeutic one. Therefore, patients presenting with bleeding 4’s and 5’s with radiographic bone loss are defined as having periodontal disease – and as a result, periodontal disease would not be appropriately treated as a prophy.
How to clear up the confusion
Here are 2 great resources for dental professionals looking for clarity on the hygiene codes.
The Prophylaxis appointment
Before we discuss what happens during a prophy, it’s important to review what the APP definesas health versus disease. Click here to review the AAP parameters of care. Getting clear on what the AAP considers early perio (bleeding 4mm pockets with radiographic loss of crestal bone) and how to treatment plan early, moderate and advance periodontal disease is critical for appropriate diagnosis and treatment planning of prophies versus periodontal therapy.
Here is a step-by-step outline of the appointment flow for healthy prophylaxis patients:
Putting these steps into practice
Granted, the routine prophylaxis has become just that – routine; but considering the AAP’s estimates of the incidence of periodontal disease, it begs the question, “Do you currently have patients in recare that are already beyond the healthy-prevention state?” Regardless if you’re a relative newbie to the profession of dental hygiene, or you’re a seasoned pro, enrolling existing recare patients into active periodontal therapy is a necessary step in order to adequately treat their chronic periodontal infection.
Are you curious about your own numbers?
As a courtesy to DentalPost.net clients, Inspired Hygiene is pleased offer a free download of the Inspired Hygiene Perio Calculator Tool. This free download allows you to determine your baseline perio percentage. Are you performing mostly prophies in your practice? The perio tool will help you answer that question. If the answer is “yes”, you may want to consider some of the resources detailed in this article. For offices wanting more information on how to implement a perio program, please visit inspiredhygiene.com to sign up for our free weekly e-zine where we email you practice tips, like the ones detailed in this article, every week in our electronic newsletter. Good luck!
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