Want to know how to explain the difference between Perio Maintenance vs Prophy?
Here is the only explanation you need to know, on how to finally nail Perio Maintenance vs Prophy patient verbiage!
Going through Dental Hygiene school is extremely difficult, and when you get into the real world, it’s like your mind goes blank. This can certainly be embarrassing when you are in front of the dentist or even the patient!
It seems as if all the little details you learned in school don’t make any sense in your brain, and now you cant spit anything out to your patient. I have been in your shoes! and many other hygienists have too!
But don’t you worry! I am here for you! 😉
As a Dental Hygienist, I am giving you from experience, what Perio Maintenance vs Prophy is, and how to start implementing this verbiage with confidence, for your patients right away!
You are going to learn all about, Perio Maintenance vs Prophy, from prophy code, prophy before SRP, periodontal maintenance guidelines, periodontal maintenance vs deep cleaning, and more.
After learning all about these: Perio Maintenance vs Prophy differences and more <3 you are going to be a pro, and extra prepared for the next time your patient asks you, why do I need perio maintenance OR why do I need a deep cleaning?
This post is all about Perio Maintenance vs Prophy + SRP. And, of course, ways to implement it into your daily workday flow, so that you sound like you have been doing it for years 😉
Perio Maintenance vs Prophy
Dental Prophylaxis Guidelines- D0110
According to the CDT (Current Dental Terminology), it states that D110 is…
“Removal of plaque, calculus and stains from the tooth structures and implants in the permanent and transitional dentition. It is intended to control local irrational factors.”
“…includes scaling and polishing of tooth structures (and implants), with the removal of plaque, calculus, and stains. The removal of all calculus and plaque above CEJ is part of a prophylaxis.“Phseudo” pockets, may be present, but there should not be bone loss or loss of attachment.”
CEJ (cemento-enamel junction): aka where the enamel ends and root starts OR you can think of the separation of crown and root of the tooth.
“Phseudo” pocket: means a fake pocket, meaning 4-5mm. pocket with no bone loss, mainly due to inflammation.
Preventive in Nature
A dental cleaning for a patient who does not have bone loss, and is considered healthy
For a patient who has localized and/or mild gingivitis
This patient will typically come every 6 months.
SRP Dental Code – Scaling and Root Planning – D4341 – D4342
According to the CDT (Current Dental Terminology), it states that SRP is…
“instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature.
“Root-planing is the definitive procedure designed for the removal of cementum and dentin that is rough and/or permeated by calculus or contaminated with toxins or micro-organisms. Some soft-tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of presurgical procedures in others.”
Meaning: probe depths (space between tooth and gum) of 4mm. or more, x-rays showing evidence of bone loss, BOP (bleeding on probing), and may or may not have calculus on x-rays.
See Examples Bellow
1. Above is an easy pt. to diagnose perio, you can see this from a mile away.
2. This example above is a little more challenging to the eye.
For this next example, look at the both x-rays, 2A + 2B.
As seen in the triangle and circle areas on the x-ray (2B), think of bone pulling back of tooth when we start to see beginning stages of bone loss. And in the circle areas, it’s more advanced since bone is pulling from both sides of the tooth, and it also looks more wedge-shaped, think of a slice a pizza 🙂
HOW TO EXPLAIN IT TO YOUR PATIENT:
In simple terms, let you patient know, why they need a deep cleaning. Most of the time you will be saying, its been a while, bleeding, pocketing, boneloss, and calculus under gum, all tell me that we need to spend a little extra time in each section to get your gums back to health. We will clean out these pockets you can no longer reach at home, by trying to reduce the pocket size/inflammation.
OR Like this 🙂
At this point, Mr. Smith, you need a little extra love, tlc in each area, you will also need to be numb so we can make this procedure more comfortable for you. Think of it like an oil change and rotation of tires 😉 we sometimes just need a little tune-up to get the wheels going again. You can also say this can happen with time, as we age because it’s true as we age so do our teeth and bone! 😉
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Periodontal Maintenance Guidelines
According to the CDT (Current Dental Terminology), it states that D150 is…
“…instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or continuing periodontal disease appears, additional diagnostic and treatment procedures must be considered.”
“Following periodontal therapy“: meaning: SRP, Osseous Surgery, & Gingival Flap Surgery
When a hygienist performs Periodontal Maintenance, she will go down further into space, in between the gum and tooth. Past the CEJ, since there is bone loss present.
If the patient needs anesthesia or any other type of numbing/sensitivity relief + sub-scaling during the appointment, it will be done at no extra charge to the patient.
Depending on your office’s perio protocol, you might perio chart every 3 months. At my office we do it case by case, depending on the severity of bone loss and if the patient is showing signs of active gum disease ie. BOP.
The reason why your patient needs a cleaning every 3 months, is because pathogens that cause gum disease will repopulate in the gum pocket as early as 12 weeks post the last cleaning.
These gum-disease pathogens live on the calculus, on the biofilm that is attached to the root surface of the tooth-even without calculus, on the inside of the gum tissue, and basically anywhere in the pocket.
Keep in mind, pathogens that cause gum disease, thrive in areas that lack oxygen, aka under the gum.
HOW TO EXPLAIN TO PATIENT:
Mr. Smith, now that we have done your deep cleaning we recommend you to come back in 3 months. This way we can re-evaluate your gums and try to figure out an appropriate recall. At this point you will need a little extra love at each appointment, we will start to see you more often unless we think it is appropriate to go longer in between recalls.
(Which this sometimes can happen, a patient will bounce back well, post srp, most cases it’s due to we starting treatment very early).
In Conclusion – Perio Maintenance vs Prophy
I have come across SO MANY, Dental hygienists who do not know the difference between Perio Maintenance vs Prophy. And many Dental Hygienists will perform exactly the same procedures for prophylaxis as they do for periodontal maintenance.
So its no wonder patients will make a bigger deal when they have to pay for the difference.
It’s important to educate your patient as to why they need a prophy, periodontal maintenance, or SRP. This way you can inform the patient with both knowledge and facts of why they specifically need these procedures done.
This post was all about Perio Maintenance vs Prophy + SRP. And, of course, ways to implement it into your daily workday flow, so that you sound like you have been doing it for years 😉
Don’t forget to leave a comment bellow!
I would LOVE to hear from you!
XOXO, Trish ❤
Source: Current Dental Terminology. (2021). American Dental Association. https://cdtapp2021.ada.org/
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