deep cleaning of teeth/gums for early periodonitis

[Pipanella]

[QUOTE][i]Originally posted by KAZMAN [/i]
[B]


OH MY I bet they have been coding it wrong..

I assumed it was 2 cleanings a year... I just had my follow up and I got the rejection letter in the mail today..
If you don't mind I would like that code to see if they filed right.... [/B][/QUOTE]

D4910 Periodontal maintenance procedures (following active therapy)-for people with gum problems-it is a cleaning every 3 months instead of every 6 months.


This should be the one, Kazman. Please note that it can only be used if you have had periodontal treatment from a periodontist in the past.

Have them check on it! If it was coded wrong (D1110), they can refile it. Just make sure that they put in the claim notes that you had periodontal treatment and the date of that treatment. That will help avoid any delay in the processing of the claim.

[Mouse7088]

[QUOTE][i]Originally posted by standersen [/i]
[B]bethie - Please Oh Please don't "shop around" for less expensive medical/dental care!! You are wise deciding to go with the specialist! Sounds to me like you are getting a bargain, I just forked out $850 for my first crown - OUCH (literally)!!!

[/B][/QUOTE]

WOW...for a crown???!!?? My youngest (5 yro) just had one done last week. I paid $119.50, but the total was $135. It was on one of his molars. He had the shot for numbing and did quite...he did have some crocodile tears when they were about finished evening out his tooth, I think he got sick of hearing the noise and I knonw he didn't like the "tent" thing they put in his mouth. Every time he breathed thru his mouth it "sucked" in and it didn't feel like he could breathe "easily". He did really well tho and didn't cause the procedure to take any longer.

[Pipanella]

Mouse~ That was most likely a steel crown, which is what is put on 'baby' molars. A permanent crown will not be done on a baby tooth, nor will one be done on a permanent tooth until about age 15-16. That's due to the pulp of a permanent tooth being quite large until that time, as well as the tooth continuing to erupt until then (ever so slightly, you wouldn't notice it UNLESS you had a crown put on too early).

BIG difference between a crown on a baby tooth and a permanent one! Difference in the preparation of the tooth for the crown, and difference in the crown itself.

Our office charges $610 for the crown, unless the tooth it's being put on has to be 'built up,' then it's more. Not sure how much more, but maybe around $125? I don't have our fees here at home.

[Mouse7088]

HOLY COW, that's a HUGE $ difference for adult and childrens crowns!!! YIPES!!! I still had the deductible to meet and then ins. only covers like 70% and I THOUGHT that ($119.50) was bad...good gosh, I feel lucky!

[Pipanella]

Yes, steel crowns are a LOT less!!!!!!!

[standersen]

Yea - mine is solid 24k gold! Just kidding, it's porcelain - I think, and yes it was $850!!! 8o

[Pipanella]

[QUOTE][i]Originally posted by standersen [/i]
[B]Yea - mine is solid 24k gold! Just kidding, it's porcelain - I think, and yes it was $850!!! 8o [/B][/QUOTE]

That IS a lot. But everything costs more out west, doesn't it? So I've heard, or maybe that's just California. Your crown is just porcelain covered. Rest assured there is precious metal under that!

[bethie_alane]

[QUOTE][i]Originally posted by KAZMAN [/i]
[B]Its not to bad.. I had it done himmm.. with in the last few years...

I would suggest the following:
FLOSS Daily
Use lysterine (sp) daily
Get a SonicCare Electronic Toothbrush... Pricey but I think worth it..

I took a toothbrush to work so I could brush it work too..

The dentist did the deep scaling in 4 quads for me too..
wasn't to bad.. I think the Wisdom teeth being pulled was worse... Recovery wise.. [/B][/QUOTE]

actually i have been told to not use listerine indefinantly since it has alcohol and can dry out your mouth. my periodontist told me to use salt water since it causes an "osmosis" effect in your mouth causing the fluids and probably microscopic gunk under your gums to flow out to make the water less salty..... make sense??? works for me!!!!!

[bethie_alane]

[QUOTE][i]Originally posted by Sandal16 [/i]
[B]I had this done about 6 months ago, without novacaine! (My choice). It was uncomfortable, but not painful. It took 2 visits and they did 1/2 of my mouth each time. I seem to accumulate tartar very quickly, but I'm too much of a chicken to go for frequent cleanings! I know I'll regret it in the future. They always tell me that flossing is more important than brushing, but I've never been able to floss in my whole life! It gives me the creeps. Strange, I know. :( [/B][/QUOTE]

dang you are brave! i used novacaine! they must have given 1/2 my mouth 10 - 20 shots! didn't feel a thing!

my mouth feels great now. even the whole mouth hasn't bleed since i have been flossing and brushing about 3-5x a day now (i have to everytime after i eat now: rinse with salt water, floss, brush)

i was completely awake and the terrible noise of scraping under your gums is like nails on a chalkboard! i kept making these faces and the periodontist's assistant kept asking me if i was in pain and i'm like no, it's the noise!

[bethie_alane]

[QUOTE][i]Originally posted by Pipanella [/i]
[B]How did I, a dental hygienist, miss this thread????

Bethie, it sounds to me like you are in the early stages, and that the dentist/hygienist that suggested perio treatment caught it in time. They really sound like they are on the ball with things, so just do what is recommended.

Kazman is right on with his recommendations, too. And you have to do it faithfully. Periodontal disease is episodic, meaning that it can be not as bad, then get bad again. What this means is, you can go for one of your checkups and things look great, then two weeks later, you might have a flare-up. But it you are really really consistent with your home care, you'll do fine.

When you are done with treatment, they will probably keep you on a 3-4 month recall schedule for your cleanings. Make sure they code these out as 'after perio treatment' cleanings and not the regular ones. (I can't recall the ADA code right now....) That way, you'll have more coverage from your insurance company. The periodontist will do that if you go to them for awhile following your treatment, but eventually, you will return to your regular dentist for maintenance, so make sure they code it right. They might also have you alternate between the periodontist and your dentist once your treatment is over.

You really ARE super young for this. I would guess that you may have inherited the tendency for gum disease. Has either of your parents had a problem with it? Also, diabetics are prone to gum disease. They also know now that smoking doesn't just aggravate periodontal disease, it actually plays a part in causing it. In any case, you will have to stay on top of this for the rest of your life. It's a lot easier to prevent gum disease than it is to make it go away once you've got it.

I would be more than happy to answer any other questions you might have! Believe me, getting treatment now is the best thing you can do for yourself. [/B][/QUOTE]


awesome that i am getting official advise!

don't know why i have this problem. my perio said that sometimes braces can cause it (i had braces for most of highschool) because it contributes to bone loss and it is extremely difficult to floss with braces and plus when your a kid you really don't care about flossing (i am sooo learning my lesson now!)

both my folks have all their real teeth, my dad has diabetes but it's cuz he's overweight.....

anyway, my gums and mouth have improved soooo much since my treatment on june 28th, next 1/2 is being done the day before my b-day, how fun....

although my mom say cornily that it is the best b-day present i could give myself, the gift of keeping my teeth!

[Pipanella]

bethie~ I'm so glad things are going well for you! I'm glad you are taking this seriously, because sometimes people don't.

As for the Listerine thing, you wouldn't have to use it every time you brush. At night, after you brush and floss before you go to bed would be enough. There is also a prescription rinse, Peridex, that is often prescribed in conjunction with perio treatment. And there is an over-the-counter rinse, Peroxyl, that can be good to use, too (it has peroxide in it). So, you have many things available to you, if you need them. Mouthwashes like Scope are next to useless therapeutically and can actually irritate mouth sores.

Did anyone ever tell you that it's best to floss BEFORE you brush? That's to remove the plaque between your teeth, so that the fluoride in the toothpaste can get right to the tooth surfaces in between, where decay is known to start. (I know this thread has nothing to do with decay, but I just thought I'd throw that tidbit of information in!)

As for periodontal disease being caused by braces, that would be pretty unusual. Yes, for sure, kids usually don't brush as well as they need to when their braces are on, and I've seen some pretty angry-looking gums over the years! Once the gums have gotten swollen from poor oral hygiene with orthodontics, it's hard to get them back to normal, even after the braces are off. But these really aren't the norm, and it would be unusual even then to see actual bone loss from from this. In cases of adult orthodontics, though, it's another story. There definitely is a danger in experiencing bone loss there, unless home care is meticulous. The Sonicare toothbrush is a GREAT idea for anyone, but especially for those with braces.

I'll tell you what, bethie, I'll bet that your home care is wonderful from here on out! And I'll bet that you won't have any more problems after this. Just keep up the good work!

[b]Bethie Alane - STAR PATIENT OF THE WEEK!![/b]

[bethie_alane]

Pipanella-

Got treatment 1 week ago. Is it unusual that a couple of my teeth sorta hurt when I clamp my mouth tightly shut. I'm not sure if it's a tooth they deep cleaned or not but it is a tooth where i can get the floss almost half way up the tooth.......

any advise????? I don't see periodontist until 7/16 for other 1/2 of my mouth....

[Pipanella]

bethie~ Now don't gross out when I tell you this, but no, that's not unusual, and here's why. When you have what you had done, it's actually root planing, meaning they go under the gums and smooth out the rough root surface, removing bacteria, plaque, calculus (tartar, which is calcified plaque) and dead cells that have attached to your root surface, as well as just generally making the root smoother so that plaque and bacteria won't reattach as easily. When they do this, they also are removing diseased cells from your gums. It's a relatively tight fit down in there!

Teeth are merely suspended in their sockets by periodontal fibers. When you go down into the pockets surrounding the tooth, some of those fibers are cut. It can't be helped and is actually a good thing, in your case. This accounts for some of the sensitivity you will feel. They will reattach, hopefully more towards the crown of the tooth. This, along with the shrinkage of any swelling that you may have had due to the disease, will make the pocket more shallow, allowing you to clean down in it easier. Any pockets that are deeper than say, 4 mm, are very difficult for you to keep clean with brushing and flossing. And if you can't keep them clean, then bacteria will continue to do its thing and make the pockets even deeper. Not a good thing!

So, now that you've had your Periodontics 101 lesson for today :) , don't worry about any sensitivity like that. It's normal!

[MadClikr]

Sounds painfull to me. I can't have novacaine b/c anything in the caine family makes my family's hearts uh.. what's that fancy word.. uhm, fibulate or something, basically, they stop beating. Some rare allergic reaction that's passed down in my family every generation... I remember there was a dentist once that didn't believe my granddad when he told him this, he gave him the shot anyway and my granddad was legally dead for about three minutes while they revivied his heart. Almost gave the dentist a heart attack, but it serves him right for not bothering to listen to him. I guess I better start flossing with my braces... it's such a pain to do though... and I have "soft" teeth...

Hope all is going well with your mouth!! :D Smile!! :)

[Pipanella]

[QUOTE][i]Originally posted by MadClikr [/i]
[B]Sounds painfull to me. I can't have novacaine b/c anything in the caine family makes my family's hearts uh.. what's that fancy word.. uhm, fibulate or something, basically, they stop beating. Some rare allergic reaction that's passed down in my family every generation... I remember there was a dentist once that didn't believe my granddad when he told him this, he gave him the shot anyway and my granddad was legally dead for about three minutes while they revivied his heart. Almost gave the dentist a heart attack, but it serves him right for not bothering to listen to him. [/B][/QUOTE]

That dentist should have used anesthetic WITHOUT EPINEPHRINE!! The epinephrine is supposed to make the anesthetic faster acting, but in some people it causes their hearts to pound. Me included. Without epinephrine, it doesn't. That's why they make it both ways.