test 7 Flashcards
what four things should you keep in mind while treatment planning for gingivitis AND periodontitis
- ADA CDT Codes
- Linking the care plan to the dental hygiene diagnoses
- Selecting intervention strategies
- Establishing an appointment schedule
what are the basic features of an ADA CDT code
what does the first number represent
what are the most frequently used code categories in hygiene and what do they mean
- starts with a D, followed by 4 numbers
- first number represents the category for each procedure
- 0 = diagnostic; 1 = preventive; 4 = periodontics; 9 = adjunctive/general services (occasionally used)
D0 -
D1 -
D2 -
D3 -
D4 -
D5000-D5899 -
D5900-D5999 -
D6 -
D7 -
D8 -
D9 -
D0 - Diagnostic
D1 - preventive
D2 - restorative
D3 - endodontics
D4 - periodontics
D5000-D5899 - prosthodontics, removable
D5900-D5999 - maxillofacial prosthetics
D6 - implants
D7 - oral surgery
D8 - orthodontics
D9 - adjunctive general services
what ASSESSMENT codes do we use that start with D0***; what do they mean? (5)
which (3) do we most commonly use at ODU
- D0120: periodic oral evaluation with an established patient
- D0140: limited oral evaluation that is problem focused
- D0150: comprehensive oral evaluation (new or established patient)
- D0170: re-assessment
- D0171: evaluation of dental hygiene treatment
ADA EVALUATION OF “D0150” - COMPREHENSIVE ORAL EVALUATION (NEW/ESTABLISHED PATIENT)
It is a thorough evaluation and recording of the ______ and _______ hard and soft tissues. It may require the _______ of information acquired through additional __________.
Additional diagnostic procedures should be reported _________. This includes an evaluation for _________ where indicated, the evaluation and recording of the patient’s ______ and _______ history, and a ______ health assessment.
It may include the evaluation and recording of _______, ________ or __________ teeth, restorations, existing prostheses, occlusal relationships, periodontal conditions (including periodontal _______ and/or ______), hard and soft tissue anomalies, etc.
It is a thorough evaluation and recording of the EXTRAORAL and INTRAORAL hard and soft tissues. It may require the INTERPRETATION of information acquired through additional DIAGNOSTIC PROCEDURES.
Additional diagnostic procedures should be reported SEPARATELY. This includes an evaluation for ORAL CANCER where indicated, the evaluation and recording of the patient’s DENTAL and MEDICAL history, and a GENERAL health assessment.
It may include the evaluation and recording of DENTAL CARIES, MISSING or UNERUPTED teeth, restorations, existing prostheses, occlusal relationships, periodontal conditions (including periodontal SCREENING and/or CHARTING), hard and soft tissue anomalies, etc.
*ORAL EXAM, DENTAL CHARTING, PERIOASSESSMENT
D0170 - RE-ASSESSMENT
Assessing the status of a __________
Done at each visit after _________ is completed.
Evaluate for changes in: (5)
Assessing the status of a PREVIOUSLY EXISTING CONDITION
Done at each visit after INITIAL ASSESSMENT is completed.
Evaluate for changes in:
- health history
- oral exam
- dental chart
- perio assessment
- GOALS
D0171 - EVALUATION OF DENTAL HYGIENE TREATMENT
“__” of ADPIED
A very thorough evaluation of the patient’s ____
Ideally ___ weeks after completion of ____ therapy (national board)
SODH allows ___ weeks due to ___________
Following the _______ phase of ______ therapy on new patients with moderate-severe _____ or any stage of _________
“E” of ADPIED
A very thorough evaluation of the patient’s ORAL HEALTH
Ideally 4-6 weeks after completion of INITIAL therapy
SODH allows 2-8 weeks due to SCHEDULING DIFFICULTY
Following the ACTIVE phase of INITIAL therapy on new patients with moderate-severe GINGIVITIS or any stage of PERIODONTITIS
what RADIOGRAPHIC codes do we have that start with D0*** (we use all of these) what do they mean
D0210- intraoral- complete series of radiographic images (FMS)
D0220- intraoral- periapical first radiographic image
D0230-intraoral- periapical each additional radiographic image
D0272-bitewings- two radiographic images (horizontal or vertical)
D0274-bitewings- four radiographic images (horizontal or vertical)
D0277- vertical bitewings- 7-8 radiographic images
D0330- panoramic radiographic image
radiographic needs are based on :
selection criteria
what PREVENTIVE codes do we use (D1***)
what do they mean
*D1110- prophylaxis- adult (ages 13+)
*D1120- prophylaxis- child
*D1130- recare
*D1206- topical application of fluoride varnish
D1208- topical application of fluoride- excluding varnish
*D1330- oral hygiene instructions (always used)
D1110 - PROPHYLAXIS (ADULT 13+)
Removal of ____, ______ and _____ from the tooth structures in the ______ and ______ dentition. It is intended to control local _______ factors.
______ in nature
for patient with ________ or _______
Removal of PLAQUE, CALCULUS, and STAIN from the tooth structures in the PERMANENT and MIXED dentition. It is intended to control local IRRITATIONAL factors.
PREVENTIVE in nature
for patients with HEALTHY PERIODONTIUM or SLIGHT GINGIVITIS
D1120 - PROPHYLAXIS - CHILD
Removal of ______, _______and ______ from the tooth structures in the ________and ________dentition. It is intended to control local _________ factors.
In SODH: for what kind of patients
Removal of PLAQUE, CALCULUS, and STAIN from the tooth structures in the PRIMARY and MIXED dentitions. It is intended to control local IRRITATIONAL factors.
In SODH: for children 12 and under REGARDLESS of oral health status
D1330 - ORAL HYGIENE INSTRUCTIONS
This may include instructions for ____ care. Examples include tooth brushing technique, ____, and use of special oral hygiene ____.
OHI is given at ______ appointment following the ______ of the assessment
It is ___ entered in the treatment plan ________ for patients who require _______ appointments
Only treatment plan OHI _______
This may include instructions for HOME care. Examples include tooth brushing technique, FLOSSING, and use of special oral hygiene AIDS.
OHI is given at EVERY appointment following the COMPLETION of the assessment
It is NOT entered in the treatment plan REPEATEDLY for patients who require MULTIPLE appointments
Only treatment plan OHI ONCE
D1206 - TOPICAL APPLICATION OF FLUORIDE VARNISH
recommended for patients with: (4)
- moderate caries risk
- high caries risk
- extreme caries risk
- low caries risk with dentinal sensitivity
D1130 - RECARE
Entering your patient’s ____ interval
Recare interval depends upon ________
Common recare intervals:
Entering your patient’s RECARE interval
Recare interval depends upon PATIENTS NEEDS
Common recare intervals:
- 3 MONTHS
- 4 MONTHS
- 6 MONTHS
what is code D4346 for
scaling in the presence of generalized moderate or severe gingival inflammation - full mouth, after oral evaluation
D4346 - SCALING IN THE PRESENCE OF GENERALIZED MODERATE OR SEVERE GINGIVAL INFLAMMATION - FULL MOUTH, AFTER ORAL EVALUATION
the removal of ____, ________, ____ from ______ and_________ tooth surfaces when there is generalized moderate or severe ______ in the absence of _______.
Indicated for patients who have _____, _______ gingiva, generalized ______ pockets, and moderate to severe ______ on probing.
Should not be reported in conjunction with _______, _____ and ________ planning, or ________ procedures.
Plan for patients with _______
the removal of PLAQUE, CALCULUS, and STAIN from SUPRA and SUBGINGIVAL tooth surfaces when there is generalized moderate or severe GINGVAL INFLAMMATION in the absence of PERIODONTITIS.
Indicated for patients who have SWOLLEN, INFLAMED gingiva, generalized SUPRABONY pockets, and moderate to severe BLEEDING on probing.
Should not be reported in conjunction with PROPHYLAXIS, SCALING and ROOT planning, or DEBRIDEMENT procedures.
Plan for patients with MODERATE OR SEVERE GINGIVITIS
CALCULUS CLASSES
how are dental hygiene therapy fees calculated in the SODH clinic?
why do we add a calculus stage?
is this how fees are collected at most private practices?
- fees for dental hygiene therapy are based on the patient’s calculus classification (calc 1-5)
- must add a calculus classification into ALL patients 13 and up so a fee will be generated (kids are calculated differently)
- NO
what is the dental hygiene diagnosis for all patients with gingivitis
Unmet human need for SKIN AND MUCOUS MEMBRANE INTEGRITY due to GINGIVITIS evidenced by BLEEDING ON PROBING
Steps to developing a treatment plan in axium (6)
- Tx history, + tab
- dental Txs on the left
- quick list (incomplete); full list (broken into categories); search (search by code or description)
- select treatment; (highlight, click plan, modify to phase and sequence); (double click, phase and sequence, click plan)
- each treatment should have a phase and sequence. phase = appointment number. sequence = order of steps in the appointment
- repeat until all recommended treatments are entered with phase and sequence
DEVELOPING A CARE PLAN IN AXIUM
___________ is always planned first (1:1)
___________ is only planned once (the first time it is completed)
____ class is planned after adult _______
Reassessment is only planned after a full ________ is completed
______ is always the last item of the last appointment (NOT a ______ appointment).
Recare does not plan the patient’s ________; it allows you to enter the patient’s ________ (3,4, or 6 months) when swiped complete
COMPREHENSIVE ORAL EVALUATION is always planned first (1:1)
ORAL HYGIENE INSTRUCTION is only planned once (the first time it is completed)
CALCULUS class is planned after adult PROPHYLAXIS
Reassessment is only planned after a full ASSESSMENT CHECK is completed
RECARE is always the last item of the last appointment (NOT a SEPARATE appointment).
Recare does not plan the patient’s NEXT APPOINTMENT; it allows you to enter the patient’s RECARE INTERVAL (3,4, or 6 months) when swiped complete
UPDATING A CARE PLAN IN AXIUM
what happens if we start a treatment but do not finish it
what happens if we plan a treatment but don’t start it
if you start a treatment but don’t finish it, it stays in the appointment you started it in
if you plan a treatment but don’t start it, update your plan by moving it to the next appointment
what is the basic sequence of care for patients with gingivitis (9)
- health history
- AB rinse
- assessment (EOE/IOE, dental charting, perio assessment, radiographs if needed, humans needs, treatment/care planning, informed consent)
- assessment check
- oral hygiene instruction
- scaling
- extrinsic stain removal
- fluoride if applicable
- referral if applicable
what periodontic codes do we need to know; what do they mean
D4341 - periodontal scaling and root planning (4 or more teeth per quadrant)
D4342 - periodontal scaling and root planning (1-3 teeth per quadrant)
D4910 - periodontal maintenance
D4341 - PERIODONTAL SCALING AND ROOT PLANNING (4 OR MORE TEETH PER QUADRANT)
This procedure involves instrumentation of the ____ and _____ surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with ________ disease and is _______, not _________, in nature.
___________ is the definitive procedure designed for the removal of ______ and ______ that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms.
Some _____ tissue removal occurs. This procedure may be used as a ______ treatment in some stages of ________ disease and/or as a part of pre-surgical procedures in others
This procedure involves instrumentation of the CROWN and ROOT surfaces (supra and subging) 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 PLANNING 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 microorganisms.
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 pre-surgical procedures in others
D4342 - PERIODONTAL SCALING AND ROOT PLANNING (1-3 TEETH PER QUADRANT)
This procedure involves instrumentation of the ____ and _____ surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with ________ disease and is _______, not _________, in nature.
___________ is the definitive procedure designed for the removal of ______ and ______ that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms.
Some _____ tissue removal occurs. This procedure may be used as a ______ treatment in some stages of ________ disease and/or as a part of pre-surgical procedures in others
This procedure involves instrumentation of the CROWN and ROOT surfaces (supra and subging) 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 PLANNING 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 microorganisms.
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 pre-surgical procedures in others
HOW TO DIFFERENTIATE BETWEEN D4341 AND D4342
Both codes are used for ______ periodontitis
Count the teeth in each ______ that are ________ involved
Look at: __,___,____,_____,___,___, don’t count _____!
If there are 1-3 teeth, treatment plan ______
If there are 4 or more teeth, plan _______
You may need to treatment plan:
Both codes are used for ACTIVE periodontitis
Count the teeth in each QUADRANT that are PERIODONTALLY involved
Look at: POCKET DEPTHS, CAL, RBL, BLEEDING, FURCATIONS, MOBILITY. Don’t count PSEUDOPOCKETS!
If there are 1-3 teeth, treatment plan D4342
If there are 4 or more teeth, plan D4341
You may need to treatment plan: D4341 in all quadrants, D4342 in all quadrants, or a combination in each quadrant
D4910 - PERIODONTAL MAINTENANCE
what is the recare interval?
This procedure is instituted following __________ and continues at varying intervals, determined by the ________ evaluation of the ______, for the life of the dentition or any implant replacements.
It includes removal of the bacterial plaque and calculus from ______ and ________ regions, ________ scaling and root planning where indicated, and ______ the teeth.
If new or recurring periodontal disease appears, additional _______ and _______ procedures must be considered.
3-4 month recare interval
This procedure 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 planning where indicated, and POLISHING the teeth.
If new or recurring periodontal disease appears, additional DIAGNOSTIC and TREATMENT procedures must be considered.
PERIODONTAL MAINTENANCE
planned after a patient receives __________
Periodontal disease is _____, no further loss of ______
typically _____month recare intervals
periodontal maintenance is planned after a patient receives PERIODONTAL THERAPY
Periodontal disease is STABLE, no further loss of ATTACHMENT
periodontal maintenance is typically 3-4 MONTH recare intervals
ALL patients with periodontitis have a human needs deficit in:
An unmet human need for SKIN AND MUCOUS MEMBRANE INTEGRITY due to PERIODONTITIS, as evidenced by GENERALIZED BLEEDING on probing, MAX PROBING DEPTH of 6 mm, and CAL of 7 mm.
what is the basic sequence of care for patients with periodontitis (9)
Health History
AB rinse
Assessment (EOE/IOE, dental charting, perio assessment, radiographs [if applicable], human needs, treatment/care planning, informed consent)
Assessment check
Oral Hygiene Instruction (OHI)
Scaling-UR, LR, UL, LL
Extrinsic stain removal
Fluoride (if applicable)
Referral (if applicable)
WOKRING END DESIGN
what is the face to lower shank angulation of area-specific curets compared to sickles/universal curets
sickle scaler - 90 degree (tilt toward tooth to angle)
universal curet - 90 degree (tilt toward tooth to angle
area specific curet - 70 degree (self angulating!)
