A single new CDT code* has the potential to significantly move the needle on the AAOSH mission is to improve inter-disciplinary healthcare and collaboration, for the health of people everywhere. There have been significant gaps in the CDT codes contributing to a delay in therapeutic care of early periodontal disease and recognition of its medical relevance.
Think of it as CAMBRA for Perio
Caries Management by Risk Assessment (CAMBRA) is the up-to-date caries philosophy being taught in dental schools. Risk assessment methodology treating early disease before cavitation AND reducing the risk for caries infection can and should be applied for early periodontal inflammation.
Where does periodontal disease start? Many professionals say 4mm pockets or other disease-based visual quantifications. Yet the answer is periodontal disease can also begin with non-visible health factors. That’s because periodontal disease risk factors are systemic as well as oral. Just as with CAMBRA, these risk factors are not age-based.
Cat in the Gutter*
Many AASOH members and friends have heard of The Bale Doneen Method™. They coined the term Cat in The Gutter and use a cartoon to illustrate the danger lurking for patients who are unaware that they have damaging inflammation in the wall of their arteries. The CAT is ready to jump out and cause an event.
High blood pressure (HBP) is a red flag risk factor for cardiovascular disease. High blood pressure in children can also develop for the same reasons it does in adults including being overweight, eating a poor diet and not exercising.
We know HBP risk can be reduced with treatment. Waiting to recognize and treat HBP until there is a heart attack makes little sense. Lumping HBP in the same category with health makes no sense. Yet that that is exactly what the codes have created for dentistry with gingivitis infections.
How many truly healthy patients do we see? If we are honest, the number is low. Most patients present with some level of active disease. Using preventive procedures intended to prevent or reduce the likelihood of disease does not make sense when disease is already present. We know codes should never not dictate treatment yet the gap in the codes has contributed to this reality.
Metrics of Change
Our diagnostic methods, codes and treatment methods show dentistry’s belief in age-based health and disease. Children have not traditionally undergone periodontal evaluation. Preventive codes D1110 and D1120 are age-based. The underlying thought is children can be treated using preventive care due to the reversibility of gingivitis. Oral-systemic research and oral medicine shows this thinking as flawed. When considering biofilm pathogenicity, it is NOT age-based. The inflammatory risk/red flag is also not age-based.
The new code D4346 - Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation, provides us with the opportunity to treat inflammation therapeutically and reduce this red flag oral risk factor. Of equal importance is the metric this code provides.
As healthcare shifts from a fee-for-service model to a value-based care model, dental codes become the metrics for change. Measurement and evaluation of inflammation levels, systemic conditions, medications, recession, attachment loss, restorative and occlusal factors, behavior modification needs, and family health history are part of this process of care.
A shift in focus on the treatment is needed to allow patients periodontium to heal as our goal. These changes can move the needle of measurable success and improve the overall health of people everywhere.