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Periodontal Maintenance

When I was in school and a patient presented with one or two quadrants of localized periodontal disease, we treated those areas and then continued the patient as a prophylaxis. I have colleagues who keep patients on a prophy only if they had one quadrant of localized scaling and root planing What is the protocol for assigning a patient to periodontal maintenance?

Periodontitis is a bacterially driven, inflammatory disease that can affect one or more teeth, and one or more sites around a tooth. Diagnosis is based on careful history taking, as well as documentation of clinical attachment levels, to differentiate it from pocketing within the soft tissue space only (gingival inflammation or enlargement or both). A patient with periodontitis is a patient who has a disease that is irreversible, can be controlled, but not necessarily cured, and can demonstrate bursts of activity (or disease progression) at different sites at each visit. The goals of therapy are to eliminate/reduce pockets to physiological levels through nonsurgical and surgical means, remove local etiological factors, eliminate local plaque retentive factors, and reduce/eliminate factors that contribute to disease severity (smoking, vaping, hyperglycemia, etc).1,2

The goals of maintenance therapy are to maintain the dentition in a disease-free state. Since the disease exhibits a random model of progression and can recur, a patient who has experienced periodontitis in the past is at higher risk for recurrent disease, and requires close recare, monitoring, and preventive care. This, by definition, is periodontal maintenance. The interventions required to maintain the dentition in a state of health require removal of the bacterial plaque and calculus from supragingival and subgingival regions, and polishing the teeth. Therefore, while scaling is part of the larger umbrella of periodontal maintenance therapy, it is not the only procedure that the patient might need for control of disease.1,2ˇ


References

  1. American Dental Association. D4910 Coding for Periodontal Maintenance. Available at: ada.org/en/resources/practice/dental-insurance/d4910-coding-for-periodontal-maintenance. Accessed September 26, 2023.
  2. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018;(89 Suppl):S159-S172.

From Dimensions in Dental Hygiene. October 2023; 21(9):46

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