Straight talk about the prophylaxis: myths and realities

One of the best ways to ensure your practice is delivering the best standard of care in the hygiene department is to develop a series of written standard of care documents. Practices with standard of care documents typically yield better case acceptance as well as higher levels of team calibration. One of the most common procedures performed in the hygiene department is the prophylaxis (D1110). To many coding experts, the D1110 is also one of the most misinterpreted codes in all of dentistry.

CDT Code Description
As stated in the 2012-2013 CDT procedures book, a prophylaxis is defined as: “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”

Interpreting CDT Code Into Clinical Practice Prophylaxis At its core, a prophylaxis is meant to prevent or protect against disease. It is not meant to treatactive infection. Therefore, if a patient presents with signs of active infection, this patient is no longer appropriately treated with a prophylaxis.

Signs Demonstrating Active Infection
According to research estimates, up to 75% of Americans have some form of periodontal disease. The signs of active infection include:
• Gingivitis Infection
o Probing depths 1-3 mm but the patient has a bleeding response on 15 or more sites during full mouth perio charting
• Periodontal Disease Infection
o Bleeding pockets of at least 4 mm demonstrating evidence of radiographic bone loss

Appointment flow for healthy prophylaxis patients • Medical History Review • Blood Pressure Screening • Open Ended Questions Regarding Patient Questions/Concerns • Necessary Radiographs o Radiographs are prescribed based on ADA guidelines of risk-based prescribing. To view the ADA’s prescribing protocol visit the website.(1) • Extraoral Exam o Hygienists must explain what this procedure is. “Mrs. Jones, I’m now going to be doing your external head and neck exam. In just a moment, I’ll be doing the intraoral exam.” • Intraoral Exam o Hygienists will explain what they’re doing in order for patients to be fully informed. A patient can certainly feel the hygienist doing the tongue pull but many times they have no idea what the basis for that procedure is. Informing patients of not only what you’re doing but also why reinforces your practice’s commitment to an exceptional standard of care. Here’s what the narrative might sound like prior to performing the intraoral exam, “Mrs. Jones, I’m going to be doing your intraoral cancer exam. When Dr. Smith comes in to do your exam, she’ll also be repeating this procedure.” • 6 point Probing o All numbers charted and all bleeding sites charted at least once annually. It is a good idea to place this perio charting protocol in your practice’s Standard of Care document. o Hygienists inform the patient of what the periodontal screening is. Tell the patient you’ll be calling out each number. Normal readings are typically between 1-3 mm and healthy gums don’t bleed. Tell the patient this procedure is a screening for periodontal disease. o Be sure to review the results of the periodontal screening with the patient once full perio charting is completed. o Consult with the dentist to determine periodontal disease status or to confirm periodontal health. • Restorative Assessment • All Necessary Intraoral Photos o Capture image of inflamed tissue o Capture image of heavy bleeding upon probing o Capture image of faulty restorations • Customized Patient Education • Prophylaxis o Based on CDT Codes, D1110 – not to be performed on patients unless they are healthy • Prophy on healthy patients (1-3 mm probing depths with less than 15 sites of bleeding) • Using ultrasonics or piezo electric instruments for calculus removal and subgingival biofilm disruption • Site specific hand scaling for supragingival stain and hard deposit refinement • Selective polishing • Flossing • Topical Fluoride Varnish for moderate-high caries risk individuals o Review the evidence-based review of topical fluorides and prescribing protocols.(2) • Patient specific recommendations determining patients recare interval based on individual risk.

Stacy McCauley, RDH, MS, is an Adjunct Assistant Professor at UNC Chapel Hill and brings 20 years of dental industry experience including clinician, corporate dental business, and most recently as a coach with Inspired Hygiene. She can be reached at [email protected]. To read articles in RDH eVillage FOCUS written by Stacy McCauley, click here. To read more about prophylaxis and dental hygiene, click here.