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Thursday Troubleshooter: COVID-19 and determining FMDs

Jan. 28, 2021
This dental hygienist has a few questions about when to do a full mouth debridement. COVID-19 has delayed patient treatment, and she isn't 100% sure about her recommendation. What should she do?
This column is here to guide dental professionals with advice from the experts . . . because they’ve been there. Remember, you are not alone! Send your questions to [email protected]. Those who reach out will remain anonymous if their questions are used on DentistryIQ.

QUESTION: How do you determine a full mouth debridement (FMD)? I feel like with COVID-19, our office is seeing patients overdue for a prophy, and they have moderate supra calculus. Would you recommend FMD and then bringing them back in four weeks to assess what type of cleaning they need? Can we do an FMD without current x-rays?

Great question, and one I always start with, “Use your professional judgment.” I know, that sounds like a total cop-out! There’s no right or wrong answer here, but you have to use your critical thinking skills to assess the patient, the time you have for the appointment, and your office policies. I’m famous for getting myself in over my head when I should have just done a debridement, and then I run behind because I took on too much. So, it’s great that you are thinking this way.

Here’s what the American Dental Association has to say about debridement (D4355): “The need for this procedure arises when it is not possible to adequately access tooth surfaces or periodontal areas because of excessive plaque and calculus. These deposits prevent a thorough evaluation of the patient’s teeth and supporting gingival structures. Upon completion of the procedure, the patient would be expected to display generalized moderate to severe gingival inflammation, bleeding, and edematous gingival tissue. Healing must occur in order to perform an accurate evaluation and diagnosis, which is why a comprehensive evaluation cannot be performed at the same appointment.”

When you find yourself in this situation and you start thinking debridement, it’s time to communicate with the patient so that the person understands exactly what’s going to (and not going to) happen at the appointment. There’s nothing worse than an irate patient who “just wanted my teeth cleaned.” This is when the intraoral camera is your friend. When a patient can see what you’re talking about, they are usually more open to shifting their expectations and owning their condition. 

Once you decide on debridement, you need to do just that. Insurance expert and owner of Odyssey Management, Teresa Duncan, says that if you’re doing a debridement you should not bill insurance for a comprehensive evaluation. The debridement is meant to enable an evaluation. That will happen when you bring the person back in two to four weeks, depending on your clinical opinion.

As far as radiographs go, I’m back to saying use that professional judgment. Insurance is not a barrier here. You can perform a debridement without current radiographs, or you can bill radiographs with a debridement. What you need to consider is, will the radiographs be more diagnostic after the debridement and healing, or is it mainly soft calculus and plaque that won’t be in your way?

Hygienists often have to make these decisions so fast that we don’t have a lot of time to mull something over or have a long consult with the dentist. This would make a great topic for an office meeting, or at least a one-on-one discussion with the dentist. Determining how your office wants to handle these situations ahead of time will give you the confidence to make the right decision and then communicate that with the patient. 

To read previous Troubleshooters, visit DentistryIQ and search “Thursday Troubleshooter.” And remember! If you’re having problems in your dental practice, send your question and concerns to Troubleshooter for an expert to address. You’ll be helping others who are experiencing similar issues. Send inquiries to [email protected].