Can I just have a regular cleaning?

You come into the office….the dentist and hygienists scare you with words like Periodontal disease, bacteria and infection.  You undergo a “deep cleaning” – Periodontal scaling and root planing.  They ask you to come back in a couple of months so they can monitor and maintain the disease.  You do as requested, but find out that the visit may be covered at a lesser percentage by your insurance and if they are seeing you more frequently, some of these visits may not be covered.  Frequently, patient’s in this situation ask, “Can’t I just get the cleaning that is covered by my insurance?”

Regular Cleaning vs Periodontal Maintenance
Patients often ask why they are having “periodontal maintenance” when all they want is to have their teeth cleaned. If your dentist or hygienist has recommended that you be scheduled for periodontal maintenance, or if you have noticed that there is a difference in billing for these procedures, here is a brief explanation:

Prophylaxis, or Regular Cleaning
A regular cleaning is recommended for patients who do not have bone loss, periodontal disease, or infection around the teeth. There should be no bleeding, mobility of the teeth, receded areas, or gaps where the spaces around the roots of the teeth are exposed. In other words, the mouth should be healthy with no bone or gum problems. A regular cleaning, or prophylaxis, removes soft plaque, tartar, and stains from the teeth above the gum line, and only slightly below.

A regular cleaning is usually done 2 to 3 times a year, depending on how quickly stain, plaque, and tartar accumulate. It is considered a preventive procedure by your insurance carrier, since regular cleanings will help prevent periodontal disease.

Periodontal Maintenance
If you have periodontal disease that has resulted in bone loss, gum “pockets” deeper than 4 millimeters, bleeding gums, exposed root surfaces, or if you have had periodontal surgery or root planning to treat periodontal surgery or root planning to treat periodontal disease, a regular cleaning is not appropriate. Periodontal maintenance scaling is needed to maintain gum and bone health. This procedure includes removal of plaque and tartar from above and below the gum line, all the way down the length of each tooth to where the root, gum, and bone meet. Rough areas of the roots are smoothed if needed, pocket depths are carefully monitored, and inflamed pockets may be irrigated with antibacterial medicines if necessary.

Periodontal maintenance is considered a basic service by your insurance carrier, and may be subject to a yearly deductible. PM is usually performed 3 to 4 times a year, depending on several factors: how quickly the plaque and tartar accumulate, how much bleeding or inflammation is present, how stable the present condition is, how well you are able to maintain your teeth at home on a daily basis, and any health risk factors you may have.

We know that there is a relationship between chronic inflammation in the gums and overall health, especially heart disease and diabetes. Keeping the gums and the bone surrounding your teeth as healthy as possible is an important part of your regular dental visits or hygienist.

Do I have to have Periodontal Maintenance forever?

The ADA reports, “This is a matter of clinical judgement by the treating dentist.  Follow-up patients who have received active periodontal therapy are appropriately reported using the periodontal maintenance code.”  The actual ADA code book reads, periodontal maintenance will be completed following active periodontal therapy “for the life of the dentition.”  It is safe to assume once a periodontal patient, always a periodontal patient.  In the sense that periodontal disease is chronic and must be controlled.

If you have any questions or concerns, you may always contact Johns Family Dentistry at 253-848-3723.