To Perform Full Mouth Gross Debridement (D04355) or Not...

A patient presents with moderate to heavy supra/subgingival calculus along with bleeding upon probing (BOP). Upon initial probing you find the subgingival calculus is creating an in-accurate depth.

Do you 1) Perform Full Mouth/Gross Debridement and treatment plan(TX) for future Scaling and Root Planing (SRP)? 2) Keep the periodontal record, have the DDS perform an exam, then TX plan for SRP and re-probe after TX?

The dilemma of a Full Mouth/Gross Debridement is that once some of the supra/subgingival calculus is removed the gingiva starts to heal and the tissue shrink around the cervical margin, creating the access to the rest of the subgingival calculus difficult. Even if this patient is given local anesthesia the instrumental access creates a longer SRP appointment and more of a chance for fatigue and improper ergonomics for the clinician. So when do you find it appropriate to perform a Gross Debridement?

CDT Code 04355 Full Mouth Debridement: is used to enable comprehensive periodontal evaluation and diagnosis of the removal of subgingival and/or supragingival plaque and calculus that obstructs the ability to perform an oral evaluation. This is a preliminary procedure and does not preclude the need for other procedures. (ADHA.org)

So "technically" if the calculus present is not allowing a accurate probe measurement (Comprehensive Periodontal Evaluation) a Full Mouth/Gross Debridement can be performed. As well as if supra/subgingival plaque, just plaque, is impeding an oral evaluation by the DDS, code 04355 can be used initially.

So we come to the conclusion that it is legal to use 04355 when with gross amounts of plaque and/or calculus present. It is up to the clinician and DDS to determine which code is proper to use and for the most part this code should be used as standard procedure on all similar patients in your office.

Using Code D0180 and evaluating the need for SRP...

Using CDT Code (D0180) Comprehensive Periodontal Evaluation – New/Established Patient:

A healthy mouth can be effectively determined by having a complete evaluation of the periodontal health. This consists of charting recorded for: pocket depths, bone level, bleeding, suppuration, furcation involvement, recession, mobility, clinical attachment loss (CAL) and overall health of the periodontium.

If probe depths, bone loss or CAL are 5mm or more the next step includes an assessment into whether scaling and root planing (SRP) is needed. This assessment needs to take into account the radiographic bone level, presence of calculus/bleeding and the CAL. If it is deemed the measurement is not a pseudo-pocket, the need for SRP is treatment planned and Periodontal Disease and etiology along with expected goals/outcomes must be discussed with the patient.

Along with non-surgical therapy (SRP) the possible addition of adjunctive local medicament's (Arestin, Peridex) should be evaluated for their assistance. The effectiveness of these additions should be based on scientific evidence-based research as well as your own anecdotal clinical findings of success.

I have found that trying to add Arestin to treat pockets that have measured 7-8mm or more even after effective SRP, has had a minimal effect on the pocket shrinkage. However I found overwhelming success with the addition of Arestin after effective SRP in pockets that measured 4mm-6mm.

So take the time to treat patients with quality care and provide them with the best and most effective products on the market. Happy Scaling!