Periodontal Scaling and Root Planing Policy

UnitedConcordiaspolicyforclaimssubmissionofperiodontalscalingandrootplaning(PSRP)
(D4341,D4342)requiressubmissionofdiagnosticmaterialsfromallgeneraldentistsandnon
periodontalspecialists,regardlessofthepatientsage.

Therequireddiagnosticmaterialsinclude:
Fullmouthduplicateradiographsordigitalimages
Fullmouthcharting,including6pointspertooth

ForPSRPtobeconsideredforabenefit,thediagnosticmaterialsmustdemonstratethe
following,consistentwithprofessionalstandards:
Clinicallossofperiodontalattachmentand/or
Radiographicevidenceofcrestalbonelossorchangesincrestallaminaduraand/or
Radiographicevidenceofrootsurfacecalculus

Ifthesecriteriaarenotevidentuponprofessionalreview,theclaimforPSRPcannotbe
approved.

Bonelossmustbeevidentontheradiographstojustifythepresenceofcalculusandbacterial
depositsonrootsurfaces.Scalingofcalculusandbacterialdepositsfromenamelsurfaces,
whethersupragingivalorsubgingivaldoesnotconstituterootplaning.

Clinical Clarification of Periodontal Scaling and Root Planing

TheADACurrentDentalTerminologydescribesperiodontalscalingandrootplaningas:

Thisprocedureinvolvesinstrumentationofthecrownandrootsurfacesofthe
teethtoremoveplaqueandcalculusfromthesesurfaces.Itisindicatedfor
patientswithperiodontaldiseaseandistherapeutic,notprophylactic,innature.
Rootplaningisthedefinitiveproceduredesignedfortheremovalofcementum
anddentinthatisrough,and/orpermeatedbycalculusorcontaminatedwith
toxinsormicroorganisms.Somesofttissueremovaloccurs.Thisproceduremay
beusedasadefinitivetreatmentinsomestagesofperiodontaldiseaseand/oras
apartofpresurgicalproceduresinothers.

TheJournalofPeriodontology,May2000(Supplement),p.853,furtherstates,inpart,thatthe
conditionsnecessaryforrootplaningmustbecharacterizedbyalossofclinicalattachment
duetodestructionoftheperiodontalligamentandlossoftheadjacentbonesupport.
Additionally,theremustbeinflammationofthegingivaextendingintotheadjacent
attachmentapparatus

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TheADACurrentDentalTerminologydescribesadentalprophylaxisas:
Removalofplaque,calculusandstainsfromthetoothstructuresinthepermanentand
transitionaldentition.Itisintendedtocontrollocalirritationalfactors.

Giventhesedescriptions:
PSRPisperiodontaltreatmentthatinvolvesinstrumentationofrootsurfacesand
removalofdeposits,toxinsandmicroorganismsfromrootsurfaces.
Ifbonelossisnotevidentand/ordepositsinvolveenamelsurfacesonly,whether
supragingivalorsubgingival,PSRPisnottheappropriateproceduretoreport,sinceroot
surfacescouldnothavebeenplaned.

Whenthedeposits,toxinsandmicroorganismsareremovedfromenamelsurfaces
only,thedentistmaywanttoconsiderwhethertheservicerenderedmoreclosely
relatestothedefinitionofeitheraprophylaxis(D1110)orafullmouthdebridement
(D4355).
Incaseswhereacomprehensiveoralevaluationcannotbecompletedwithoutpreliminary
debridement,D4355canbereported,whichisdescribedasgrossremovalofplaqueand
calculusthatinterferewiththeabilityofthedentisttoperformacomprehensiveevaluation.

Itshouldbenotedthat:
PocketdepthsarenotthesoleindicatorsforPSRP,sincepocketscanexistinthe
absenceofbonelossduetoinflammationofthegingivaltissues(i.e.,pseudopockets).
Apatientwithpocketdepthsof4,5oreven6mmcanhavecalculusonenamelsurfaces
only,withnoboneloss.Removingthiscalculusfromenamelsurfaces,even
subgingivallydoesnotconstitutePSRP,nomatterhowdifficultortimeconsumingthe
removalmaybe.
Aprophylaxisistheappropriatecodetoreportwhenremovingcalculus(supragingivally
and/orsubgingivally)fromtheteeth,evenwhenthecalculusextendsbelowthegum
lineandthereisnoboneloss.

Itisvitallyimportantthatpatientsbeencouragedtotakeanactiveroleinthemaintenanceof
theiroralhealthandthepreventionofdentaldisease.Apatientwhoisnoncompliantwith
homecareinstructionsmayrequiremorethanthecontractedlimitofprophylaxisallowedper
year.Patientswhorequireadditionalprophylaxisareresponsibleforthefeesassociatedwith
allservicesthatexceedthelimitsofthedentalbenefitprogram.

Pleasereadonforexamplesofacasethatwouldbeapproved,aswellasacasethatwouldbe
denied.

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Thefollowingisanexampleofacasethatwouldbeapproved.

Theradiographclearlydemonstratesboneloss.Typicallythebonelevelisatorclosetothe
partofthetoothwherethecrownandrootmeet.Thereisalsoradiographicevidenceof
calculus(smallnodulesevidentonrootsurfacesbetweentheteeth)inallareasofthe
mouth.Thispatienthasperiodontitis,whichisadiseasethatresultsinbonelossleavingroot
surfacesofteethexposedtotheoralenvironment.Thisallowssaliva,foodparticles,and
bacteriatoattachtorootsurfaces.Whenthatoccurs,itisnecessarytoremovetheseirritants
fromtherootsurfaces,thusthetermrootplaning.Scalinginthiscaseisprovidedonthe
crownsurfacesofteeth.

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Thefollowingisanexampleofacasethatwouldbedenied.

Theradiographdemonstratesnoclearboneloss.Thebonelevelisatorveryclosetothe
junctionofthecrownandroot.Thereisevidenceofcalculus(thosesmallnodulesnoted
betweentheteeth)butthosenodulesareonthecrownofthetooth,nottheroot.Theroot
surfacesoftheteethareNOTexposedtotheoralenvironmentandaresafefromsaliva,food
particles,andbacteria.Asaresult,therootscannotbeplaned.However,thecrownsofthe
teethAREexposedandsubjecttocollectingtheseirritantscommonlycalledbypatientsas
tartar(thescientifictermiscalculus).Calculusoncrownsurfacesdoesirritatethegum
(gingival)tissuecausingthetissuetoswell,turnred,andbleed.Thiscalculusmustberemoved
fromcrownsurfacesbyscalingandispartofaroutineprophy,evenwhenremovingcalculus
frombelowthegumlinesincepartofthecrownofthetoothisbelowthegumline.

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