Selecting Appropriate

Treatment Plans
Respond with Clicker

 Areyou need to plan a treatment plan is

the periodontal charting.
 True or False?
Respond with Clicker

 Doyou think a prophy would be the best

treatment plan for this patient?
 Yes or No?
Performance Objective

 Using the radiograph and periodontal

descriptions, dental hygiene students will be able
to determine the appropriate treatment plan to
100% accuracy.
Four Main Treatments we use

 Prophylaxis – 1110
 Periodontal Maintenance – 4910
 SRP 1-3 teeth – 4342
 SRP 4+ teeth - 4341
Prophylaxis - 1110

 Prophylaxis means preventative

 Done when the periodontium is healthy or has gingivitis
 NO past periodontal treatment or therapies
 Bone loss MAY be present (from recession or age)
 If there is no current periodontal issues or past periodontal
treatment, can still code as prophy on reduced periodontium
Periodontal Maintenance - 4910

 Periodontal Maintenance is done for those who HAVE HAD

periodontal treatments
 Has had SRP treatment
 Periodontal surgery treatments
 “ONCE a 4910, ALWAYS a 4910”
 Can never go back to prophy, but can have SRP treatment as
necessary
SRP 1-3 Teeth - 4342

 Scaling and Root Planing LOCALIZED 1-3 teeth

 Done when only 1-3 teeth in a quad are affected with
active periodontal disease and need treatment
 Write the code – SRP - 4342 – and indicate which quad
and teeth will be treated (if you are working in
multiple quads, must write all of them): SRP 4342 UR
#2-3, SRP UL #14-15
SRP 4+ Teeth - 4341

 Scaling and Root Planing on 4+ teeth in a quad

 Done when more than 4 teeth in a quad are affected
with active periodontal disease and need treatment
 Write the code – SRP 4341 – and indicate which quad (if
you are doing multiple quads, must write all of them:
SRP 4341 UR, SRP 4341 LR
How to get Treatment Plan

 Can only get treatment plan by using ALL your information you gather
about your patient
 This means you MUST use your radiograph assessment AND your
periodontal assessment
 Radiographs tell you bone levels and radiographic calculus
 Must has bone loss on radiographs to plan periodontal disease therapies
 Periodontal charting tells you probing depths, CALevels, bleeding,
calculus, recession, mobility and furcations
Concept Map

 Lets create a concept map on the process of

treatment planning
 Go to: cmap.ihmc.us
 Or use Microsoft Office (PowerPoint or Word), or pen
and paper to create your concept map
 Concept Map Write accurate
periodontal
Determine if Accurately Recognize description Select
there is bone write patient does considering higher appropriate
loss on healthy not have CAL due to treatment
No
radiographs radiograph periodontal inflammation or plan
description disease recession (Prophy)
Know healthy/mild/moderate
Yes
and severe ranges for Know healthy/mild/moderate
radiographic bone levels and sever ranges for
periodontal disease Determine if Select
Determine patient has Yes appropriate
Write if probing passed treatment
Determine Write appropriate
radiograph depths are Yes periodontal plan (4910)
severity of healthy
description healthy treatment?
bone loss periodontal
description No
considering higher Select appropriate
No treatment plan (Prophy
CAL due to
Know recession with reduced
healthy/mild/moderate and Determine periodontium)
Write
severe ranges for periodontal localized or appropriate Determine need for active
disease generalized periodontal perio therapy or continue
description with maintenance or
referral
Know 30% or more is
generalized, less than
30% is localized
Lets Practice!
46 year old male, new patient, no history of periodontal disease

Measurements are 1-2mm’s from CEJ to crest of bone

Periodontal Charting
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with generalized healthy

radiographic bone levels as evidenced by 1-2mm’s from CEJ to crest of
bone
 Periodontal Description: Patient presents with generalized healthy
periodontium as evidenced by 1-3mmCALevel, and 4-5mm’s CALevel
on #3, 5, 15, 18-21, 28 and 30 due to recession.
 Treatment Plan: Adult Prophy 1110
Case Studies
Treatment Plan Case
Study #1
34 year old Female, history of periodontal disease since teens.

Measurements are 1-2mm’s from CEJ to crest of bone OTHER than the
following: #2,3, 8, 14, 15, 30 and 31 are 3-4mm’s from CEJ to crest of bone
Periodontal Charting
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with generalized healthy

radiographic bone levels as evidenced by 1-2mm’s from CEJ to crest of bone,
and localized vertical bone loss as evidenced by 1-2mm’s bone loss associated
with teeth #2,3,8,14,15, 30 and 31.
 Periodontal Description: Patient presents with generalized healthy
periodontium as evidenced by 1-3mmCALevel, localized mild chronic
periodontitis on #3, 7-8, 14-15, 29-31 as evidenced by 3-5mm’s CALevel and
6mm’s CALevel on #30 due to recession, and localized moderate chronic
periodontitis on #2 as evidenced by 6mm’s CALevel.
 Treatment Plan: SRP 4341 – UR, SRP 4342 UL #14-15, SRP 4342 LR #29-31,
Tissue Re-eval
Treatment Plan Case
Study #2
15 year old female, no hx of periodontal treatment. Bone level measurements:
#2-5, 10-11, 13-15, 18-20, 28-29, 31 are 3-4mm’s from CEJ to crest of bone.
#6, 12, 21, 27 and 30 are 5-6mm’s from CEJ to crest of bone.
#7-9, 22-26 are 7-10mm’s from CEJ to crest of bone
Periodontal charting – NOTICE: For this periodontal charting, the CAL is
calculated under Attachment Loss (as loss, not level)
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with generalized mild horizontal

bone loss as evidenced by 1-2mm’s bone loss, localized moderate vertical
bone loss on #6, 12, 21, 27 and 30 as evidenced by 3-4mm’s bone loss, and
localized severe vertical bone loss on #7-9 and 22-26 as evidenced by 5-8mm’s
bone loss.
 Periodontal Description: Patient presents with generalized moderate
aggressive periodontal disease as evidenced by 3-7mm’s CALevel, and
localized severe aggressive periodontal disease on #7-9, 23-25 as evidenced
by 8-12mm’s CALevel.
 Treatment Plan: REFER to Periodontist
Treatment Plan Case
Study #3
24 year old male, new patient, no hx of periodontal treatment
Measurements: All bone level measurements are 1-2mm’s from CEJ to crest of
bone
Periodontal Charting
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with

generalized healthy bone levels as evidenced by 1-2mm’s
from CEJ to crest of bone.
 Periodontal Description: Patient presents with
generalized healthy periodontium as evidenced by 1-3mm
CALevel and 4mm’s CALevel on #3 due to recession.
 Treatment Plan: Adult Prophy -1110
Treatment Plan Case
Study #4
54 year old male, new patient, has not been to the dentist in over 20
years
Measurements are 3-4mm’s from CEJ to crest of bone on #5-6, 20-28, 32
and 5-6mm’s from CEJ to crest of bone on #1-3, 7-16, 29,30
Periodontal Charting
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with generalized moderate

horizontal bone loss as evidenced by 1-4mm’s bone loss
 *Both the mild and moderate level of bone loss represent
approximately 50% of mouth, therefore we write the higher level of
bone loss in description.
 Periodontal Description: Patient presents with generalized moderate
chronic periodontitis as evidenced by 2-7mm’s CALevel and localized
severe chronic periodontitis as evidenced by 8mm’s CALevel on #14-
16.
 Treatment Plan: SRP 4341 UR, SRP 4341 LR, SRP 4341 UL, SRP 4341
LL, Tissue Re-eval
Treatment Plan Case
Study #5
61 year old male, hx of SRP treatment and periodontal surgery – on 3month
recares
Measurements are 1-2mm’s from CEJ to crest of bone, #23 and 25-26 are 3-
4mm’s from CEJ to crest of bone, #24 is 5-6mm’s from CEJ to crest of bone
Periodontal Charting
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with generalized healthy

radiographic bone levels as evidenced by 1-2mm’s from CEJ to crest of
bone, localized mild radiographic bone loss as evidenced by 1-2mm’s
loss on #23, 25-26, and localized moderate bone loss as evidenced by
3-4mm’s loss on #24
 Periodontal Description: Patient presents with generalized healthy
periodontium as evidenced by 1-3mm’s CALevels, and 4mm’s CALevels
on #11-14, 18-20, 28-31 due to inflammation, and 2-7mm’s CALevels
on #23-26 due to past bone loss and recession
 Treatment Plan: Periodontal Maintenance - 4910
Treatment Plan Case
Study #6
32 year old female, new patient, no hx of periodontal treatments
Measurements are 1-2mm’s from CEJ to crest of bone
Periodontal Charting
Radiograph and Periodontal Descriptions

 Radiograph Description: Patient presents with generalized healthy

radiographic bone levels as evidenced by 1-2mm’s from CEJ to crest of
bone
 Periodontal Description: Patient presents with generalized healthy
periodontium as evidenced by 1-3mm’s CALevels, and 3-4mm’s
CALevels on #11-15, 18-19, 21-23, 30-31 due to inflammation, and 2-
4mm’s CALevel on #23-26 due to recession.
 Treatment Plan: Adult Prophy - 1110
The End
Any Questions?