Name of the Procedure:

Common name: Periodontal Maintenance
Technical term: Periodontal Prophylaxis
HCPCS Code: D4910

Summary

Periodontal maintenance is a dental procedure performed to clean the teeth and gums thoroughly to prevent periodontal diseases. It is crucial for patients who have had previous treatment for periodontal disease, ensuring the condition is under control and the gums remain healthy.

Purpose

The primary objective of periodontal maintenance is to prevent the recurrence of periodontal diseases such as gingivitis or periodontitis. The procedure removes plaque, tartar, and bacteria that can cause infection and inflammation, thereby maintaining oral hygiene and health.

Indications

• A history of periodontal disease
• Symptoms like swollen or bleeding gums
• Deep periodontal pockets detected during dental examination
• Post-periodontal surgery patients
• Patients with dental implants

Preparation

• Avoid eating 1-2 hours before the appointment
• Disclose medical history, especially any medications
• No specific fasting or extensive preparation required for most patients

Procedure Description

1. Medical History Review: The dental hygienist reviews the patient's medical and dental history.
2. Examination and Cleaning:
   • Use of a mouth mirror to examine the patient's mouth for signs of oral health issues.
   • Scaling: Removal of plaque and tartar buildup from teeth surfaces and below the gumline using specialized tools such as ultrasonic scalers.
   • Root Planing: Smoothing the root surfaces to discourage further tartar buildup and bacterial growth.
3. Polishing: Teeth are polished to remove any remaining plaque and stains.
4. Fluoride Treatment: Application of fluoride to strengthen the enamel and prevent decay.

Duration

The procedure typically takes about 45 minutes to 1 hour.

Setting

• Dentist's office
• Outpatient dental clinic

Personnel

• Dental Hygienist
• Dentist (oversight and examination)

Risks and Complications

• Mild discomfort or sensitivity, particularly for those with deep pockets or exposed roots
• Risk of infection, though very low
• Temporary bleeding of gums
• Minor gum recession due to intensive cleaning

Benefits

• Prevention of periodontal disease recurrence
• Improved oral hygiene and health
• Decreased risk of tooth loss
• Better breath and overall oral aesthetics

Recovery

• Post-procedure, patients may experience mild gum sensitivity or tenderness.
• Instructions include avoiding hard or chewy foods for a few hours.
• Mild pain relievers can be taken if necessary.
• Follow-up appointments every 3 to 4 months as recommended by the dentist.

Alternatives

• Routine dental cleanings for patients without a history of periodontal disease
• More invasive procedures like root debridement or periodontal surgery for severe cases
• Pros: Routine cleanings are less intensive and invasive.
• Cons: Routine cleanings might not be sufficient for those with a history of periodontal disease.

Patient Experience

• During the procedure, patients might feel mild pressure or vibrations, especially during scaling.
• Local anesthesia is generally not required, although numbing gel might be used for sensitive areas.
• After the procedure, some sensitivity and tenderness in the gums can be expected, which typically resolves within a few days.

Pain management strategies include over-the-counter pain relievers and specialized toothpaste for sensitivity. Regular periodontal maintenance is key to sustaining oral health for patients with a history of periodontal disease.