DH125 Exam 1

CDT (Current Dental Terminology)

Codes on dental procedures and nomenclature that are used by dentists and dental insurers to identify and document services

How are CDT codes categorized?

Types of service: diagnostic, preventive, restorative, endodontics, periodontics, etc

Who reviews and updates CDT codes?

American Dental Association

Why are CDT codes important?

1. Standardization and consistency

2. Accurate billing and claims processing

3. HIPPA compliance

4. Data analysis and research

Code Maintenance Committee (CMC)

Subject matter experts chaired by a ADA member along one of five of their members who sit on the CMC along with reps from each of the nine specialties (meet yearly)

D0120

Periodic Oral Evaluation - established patient

An evaluation performed on a patient of record to determine any changes in the patient's dental and medical health status since a previous comprehensive or periodic evaluation

D0140

Limited Oral Evaluation - problem focused

An evaluation limited to a specific oral health problemor complaint

D0150

Comprehensive Oral Evaluation - new or established patient

Used by a general dentist and/or a specialist when evaluating a patient comprehensively. This applies to new patients; established patients who have had significant change in health conditions or other unusual circumstances, by report, or established patients who have been absent from active treatment for three or more years

D0180

Comprehensive Periodontal Evaluation -new or established patient

This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes

D1110

Prophylaxis - adult

removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors

D1120

Prophylaxis - child

removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors (UNDER 14 YEARS)

D4341

Scaling/Root Planing- four or more teeth per quadrant

involves the instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces

D4342

Scaling/Root Planing: one to three teeth per quadrant

D4355

Full mouth debridement

gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation

D4381

Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth (FDA approved)

D4910

Periodontal maintenance

This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements

D1208

Topical application of fluoride - adult

D1206

Topical fluoride varnish; therapeutic for moderate to high caries risk patients

D9910

Application of desensitizing medicament

D1330

Oral hygiene Instructions

D9230

Analgesia: Nitrous Oxide Delivery

D4346

Scaling in the presence of generalized moderate or severe gingival inflammation. FM after oral evaluation

What is considered the "gingivitis code?"

D4346 (no bone loss present)

FMX

D0210

D0220

Intra-oral First PA

D0274

4 bitewings

D0230

Intraoral- each additional PA

CDT Strategies

1. Maximize hygienist's schedule

2. Offer high value adjunctive services

3. Elevate periodontal care

4. Train hygienists in case presentation

5. Evaluate fees and PPO participation

6. Implement efficiency tools

7. Conduct regular hygiene department analysis

8. Enhance patient experience

9. Leverage hygiene for overall practice growth

10. Recognize hygienist's role in the office

What is the purpose of a SOAP note?

To organize progress notes entered by each health care provider contributing to the solution of the patient's problem

S: Subjective

Includes all the pertinent information that is presented to you by the patient or responsible person (may change at subsequent appointments)

What is included in the "S" category?

ANY patient complaint

Medical Alerts

Lifestyle

Emotions and/or attitudes

Patient's response to previous or current treatment

Information relevant to the patient's case or present condition

Premedication

Pain scale

O: Objective

Identify all of the objective findings at this particular appointment

What is included in the "O" category?

Medical History findings

All medications patient is taking if not listed under "S"

Vital signs

ntra/extra oral examination findings

Indices scores

Range of pocket readings

Any significant findings or pathologies

Findings that are of any concern

Results of appropriate consults

A: Assessment

Represents the dental hygiene diagnosis based on the data you have collected

What is included in the "A" category?

ASA classification

AAP classification

Amount (light, moderate, heavy) of calculus, plaque & stain

Statement regarding discussion of the DH Diagnosis and treatment plan

Statement that the patient agrees to the treatment "INFORMED CONSENT"

P: Procedures

Progress notes or services provided including all procedures performed on this patient at this appointment time

What information is included in the "P" category?

Quadrant or teeth scale

Type and amount of anesthesia/if used /or indicate "No anesthesia"

Nitrous oxide sedation

Post op vitals (if nitrous was used)

Indicate if patient tolerated it well.

FM polished or selective polish #'s 22-26.

Topical Fluoride treatment

Oral Hygiene Instruction given

Post-operative Instructions given

Photographic documentation (if any)

Always end with "Patient tolerated procedure well and left in good condition"

NV

Next visit

RTC

Return to clinic

What should your LAST statement always be?

The procedures and notes above were performed by dental hygiene student ___________CCDH under the supervision of Professor ___________ RDH

Post Operative Instructions

guidelines for caring of the mouth after dental treatment for optimal healing and decrease in pain

Anesthesia post-op

Avoid eating in the area-use opposite side of mout

Eat soft foods

Nothing hot or spicy

Wait to eat before anesthesia wears off

Post op for pain

take the medication you would normally take for a headache

NO aspirin

Rinsing instructions

Every 2 hours or as needed: after eating; after tooth brushing; before retiring

Rinse mouthful by mouthful, forcing solution between the teeth

For hemorrhagic situations avoid forceful rinsing

Hypertonic Sodium Chloride Solution

salt water - 1/2 tsp./4oz warm water

What is the contraindication for Hypertonic Sodium Chloride Solution and Sodium bicarbonate solution?

Hypertension

Sodium bicarbonate solution

Baking soda- 1/2 tsp./8oz warm water

Hydrogen peroxide

used when salt water is contraindicated: equalparts of water and peroxide

What is the contraindication for hydrogen peroxide?

prolong use may cause blackhairy tongue

What is in most commercial products?

alcohol, water, flavoring, etc.

Oxygenating Agents (Hydrogen peroxide,Sodium perborate, Urea peroxide)

Effective for debridement

Has limited antimicrobial effectiveness

Home remedy: equal parts water and 3% Hydrogen peroxide

What is negative about chlorhexidine rinse?

Creates a stain that is difficult to remove

Chlorahexadine instructions

One capful undiluted

Hold in mouth for one minute and expectorate

Use before scaling and after scaling in office

Home use: by prescription only: follow directions on bottle- usually 2 x daily

Sharps injury protocol

1. Report immediately

2. Clean wound: express blood, clean with soap and water, flush mucous membranes

3. Facility will blood test patient

4. faculty will counsel you

5. Obtain baseline data for HBsAG, anti HIV, and HCV

5. faculty will complete forms

6. faculty will notify school

7. student takes forms to school within 24 hours

8. retest blood test at 6 weeks, 12 weeks, and 6 months

ADVANTAGES FOR HAND SCALING

1. Greater control

2. Increased tactile sensitivity

3. Area specific designs for adaptability/access

ADVANTAGES FOR POWER SCALING

1. Less tissue distension

2. Healing benefits of lavage and irrigation

3. Reduced operator fatigue

Primary goal of periodontal debridement

Removal of bacterial plaque and by-products

Secondary goal of periodontal debridement

calculus removal

Periodontal debridement

Mechanical removal of tooth deposits

Considerations for power scaling

Less tactile sensitivity

Water control evacuation needed

Production of contaminated aerosol

Medical contraindications

Potential occupational hazard (noise/vibration)

What powers a sonic scaler?

Uses compressed air to produce vibrations

How many cycles per second is a sonic scaler?

3,000-8,000 cycles per second (Elliptical movement at tip)

What powers a piezoelectric scaler?

Electricity energized ceramic discs within the handpiece

How many cycles per second is a piezoelectric?

30,000 kHz (Linear tip movement)

What surfaces are active on a piezoelectric?

all surfaces, lateral most active

How is an electromagnetic scaler powered?

Electrical energy magnetically changes dimension of the metal stack to produce vibrations

How many cycles per second is an Magnetostrictive Ultrasonic scaler?

18,000 - 42,000 cycles per second - most used is25,000 or 30,000 cycles per second (elliptical movement)

What surfaces are active on an Magnetostrictive Ultrasonic scaler?

All surfaces active - Concave & Covex most active

How does automatic tuning work?

Insert tells the unit how to work

How does manual tuning work?

Unit tells the Insert how to work

Frequency

the number of cycles or excursions the insert tip moves back and forth per each second of operation

Cycle

one complete linear or elliptical stroke path

Kilohertz (kHz)

1,000 hertz or 1,000 cycles per second

Power control

Regulates stroke length =distance the tip travels aka Amplitude

frequency

Speed

amplitude

distance

Frequency (speed) + Amplitude (distance) =

strength

guardian wrench

covers tip and removes it on piezoelectric scalers

What is the active tip area affected by?

frequency

Higher frequency =

smaller active tip area

1mm loss = how much efficiency loss?

25%

2mm loss = how much efficiency loss?

50%

What is the average life of a tip?

360 uses, or 9-12 months

Why is water always needed?

to reduce the frictional heat for both magnetostrictive and piezoelectric units

What is water used for in magnetostrictive?

to cool the heatgenerated in the magnetostrictive handpiece

What is water used for in piezoelectric?

Water is only used to cool the tip, not thehandpiece

Aerosol Control

Use pre-procedural antiseptic rinse to reduce bacteriallevels by 92.1- 94.1%

Tips for patient comfort

Low power setting

Light pressure

Position the insert parallel to the tooth surface

DO NOT use the point of the insert

Keep the tip active Assess the water control

Ultrasonic technique

Grasp

Fulcrum/Finger rest

Insertion

Adaptation

Pressure

Activation

Always enter the pocket with the tip...

activated

How should you approach calculus?

from the coronal edge and work apically

Deplaquing

To detoxify and debride

Access every square millimeter of the root

Use a light touch with methodical strokes

"Color" in the root surfaces

Know root anatomy

Follow the root of the tooth

The _____ the power setting, the _____ and more ____ the stroke

higher, longer, powerful