Periodontal
maintenance is the step in a perio treatment plan meant for maintaining someone
who has established a renewed/healthy periodontium. I wasn’t sure what it was
until hearing Dr. Stevens explain it. A patient with perio problems, namely
generalized deep pockets, will undergo Phase 1 treatment (Scaling and Root
Planing). The patient will then return for a Phase 1 Eval. The phase 1 eval is
basically the same thing as perio maintenance, but it occurs at a different
time of a patient’s treatment plan.
If the
phase 1 eval shows that many deep pockets still exist, then Phase 2 treatment
(some type of surgery) is necessary. . . Once phase 2 is complete and the
patient has been evaluated and deemed to have a healthy periodontium (under
those circumstances at least), then the patient is put on perio maintenance.
Forced to come back every 3 months, just to make sure their periodontium
remains relatively healthy. Understanding this process will help answer
questions Dr. Stevens may have.
The Starting Check
Dr. Stevens will ask you
questions. Probably lots of them depending on how confident you sound/his
mood/whatever. MAKE SURE that you know everything about your patient before
going up to get your starting check. You not only should know your patient’s
medical history, but you should also know their entire perio history.
Why are they even here? They are in Perio maintenance so
they obviously were diagnosed with perio disease and at least had to go through
phase 1 treatment and phase 1 eval. So some things you need to be aware of:
- What was the original problem? Look at their
Perio worksheet and initial probing depths to figure out why they were admitted
into perio treatment.
- Did they ever have a Phase 1 Eval?
- It happens. A
patient that I am seeing next week had scaling and root planing, but there is
no evidence of a follow up evaluation. Now they are in perio maintenance and haven’t
even had probing depths recorded since the very first visit. So make sure you
know what phase of treatment the patient is in . . . or what they are actually supposed to be in.
The Exam
The perio faculty are
looking for a couple of things from the exam:
- Probing depths
- It is okay if your PD’s don’t match up exactly
with ones from the previous exam. Remember, it’s all students recording this
stuff. Who is to say they are right and you are wrong? The most important thing
is to make sure your depths are consistent. Check a couple of spots more than
once if you’re really worried about inaccurate depths.
- Gingival Recession
- Bleeding on Probing
- Plaque Index
- Occlusion
- Dr. Stevens may ask about the occlusion. Try to
at least record the overbite and overjet and what classification they are.
What Comes Next?
If your perio exam reveals
that the patient still has generalized deep pockets, then perio maintenance is
NOT where they need to be. Perio Maintenance will not do them any good because
you don’t solve the issue of deep pockets.
So according to Dr. Stevens, if you find that they still
have generalized deep pockets, you need to work them up a new treatment plan.
Depending on how long it has been since they have had Phase 1 treatment, your
treatment plan may consist of more scaling and root planing, or possibly even
Phase 2 treatment. The patient I was helping with had not had any treatment in
about a year, so Stevens suggested more scaling and root planing to start off.
If your patient has deep pockets, you will NOT proceed with
a prophy. You can do it if you want to, but as Lauren mentioned, they will be
returning soon for SC/RP and insurance won’t cover both, so don’t code for it
or whatever. You will just write up a Tx plan, show it to your coordinator,
discuss it with the patient, get their approval, and then make sure they get
another appointment.
If their probing depths look good, then you can proceed with
a prophy and then tell them to come back in 3 months.
Wham Bam,
Joe
