Oral diagnosis



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Periodontal Procedures

  • The diabetic protocol has been previously outlined (see periodontal diagnosis)

  • Periodontal surgeries (apically re-positioned flap, osseous surgery, gingivectomies, etc.) should not be performed with adequate post-surgical flap coverage (PerioPack).

  • Scaling and root planing (ADA Codes 4341 and 4342) should not be coded unless anesthesia is given. If anesthesia is not given and subgingival scaling is performed, the correct ADA Code is 1110/1205 (adult prophylaxis with or without fluoride).

  • A gross (or general) debridement (ADA Code 4355) is to be used to prepare a patient for full periodontal services – it is not a replacement for such services. If this code is used, anesthesia may or may not be given, but at least one follow-up appointment involving scaling and root planing (see definition previously) must be performed.

  • Atridox or other chemotherapeutic agents may be used following periodontal treatment or to resolve a single periodontally-related problem (periodontal abscess).

  • All periodontally-treated patients should be set up on a recall system as determined by the dentist. The recall visit should include oral hygiene reinforcement and maintenance with a Piezon or hand instrumentation, depending on the patient’s condition.

  • The use of the miscellaneous periodontal code (ADA Code 4999) is not allowed in the Schurz Service Unit.



Removable Prosthodontics

  • The use of Valplast or Flexite partial dentures, or clinic-fabricated acrylic partial dentures, may be only of a provisional or temporary nature due to gingival stripping. If a patient elects to have this type of partial denture fabricated, he/she must be told that it is a temporary partial denture.

  • The denture or partial denture codes (ADA Codes 5100 series, 5200 series) may be coded only at the conclusion (delivery) of the procedure.

  • The use of the miscellaneous prosthodontic codes (ADA Codes 5899 and 5999) may not be used in the Schurz Service Unit.



Oral Surgery

  • Due to the geographic isolation of service unit clinics, third molar extractions, impacted or not, may be referred on a case-by-case basis through Contract Health Services in the Schurz Service Unit.

  • A surgical extraction (ADA Code Series 7200) involves the removal of alveolar bone with the use of a surgical handpiece to section teeth or remove bone. Removal of alveolar bone using elevators, Rongeurs, or other means does NOT constitute a surgical extraction.

  • The biopsy of clinically-observed lesions may be referred to an oral and maxillofacial surgeon, utilizing Contract Health Services in the Schurz Service Unit.

  • Oral surgery should not be performed unless a thorough medical history is obtained, the dentist or dental staff takes radiographs of the involved tooth (teeth), and the dentist has the capability to provide adequate post-surgical analgesics.



Orthodontics

  • Comprehensive orthodontics requiring estimated treatment plans in excess of nine months are not allowed in the Schurz Service Unit.

  • If a service unit dentist begins an orthodontic program, he/she must realize that he/she cannot transfer duty stations or relocate without first completing orthodontic treatment on all patients where orthodontics was initiated – failure to complete treatment may result in medical malpractice for that provider.

  • The minimum requirements to begin orthodontics on a patient – whether removable or brackets – are:

  • Panoramic radiograph (ADA Code 0330)

  • Diagnostic casts (ADA Code 8660)

  • Comprehensive dental examination and treatment plan (ADA Code 0150)

  • Orthodontic examination using IHS-approved forms (see attached) (ADA Code 0160)

  • Again, because orthodontics can consume many resources in the service unit dental facilities, each clinical dentist should make sure he/she wants to start an orthodontic program, that he/she has adequate training (a minimum of 30 hours of post-dental school training), and that the program customized for the service unit dental facility allows for equal access to all patients potentially requiring orthodontic care.

THE SCHURZ SERVICE UNIT CLINICAL GUIDELINES – STANDARDS OF CARE – IS A LIVING DOCUMENT THAT MAY CHANGE PERIODICALLY DUE TO CHANGES IN MISSION, PERSONNEL, OR INDIAN HEALTH SERVICE GUIDELINES. IF THIS DOCUMENT CONTAINS CONTRADICTORY INFORMATION TO OTHER PUBLISHED INFORMATION, THE ORDER OF PRECEDENCE IS:



  1. Indian Health Service Oral Health Program Guide

  2. Schurz Service Unit Clinical Guidelines – Standards of Care

  3. Schurz Service Unit Policy & Procedures Manual

  4. Other published information

Published: 29 September 2004

Amended: ________________ ________________ _________________ ______________

________________ ________________ _________________ ______________

(annual review required)
Note: For each amendment, the entire document must be reviewed and approved by the service unit dental chief, service unit clinical director, and the Area dental consultant/director.
The Schurz Service Unit Clinical Guidelines-Standards of Care have been reviewed and approved by:

__________________________________________________________ _____________________

Timothy L. Ricks, DMD, MPH SSU Dental Chief Date

__________________________________________________________ _____________________

Stephen Mlawsky, MD, SSU Clinical Director Date

__________________________________________________________ _____________________

Steven A. Tetrev, DDS, MPH, Phoenix Area Dental Consultant (Acting) Date

AMENDED: _________


The Schurz Service Unit Clinical Guidelines-Standards of Care have been reviewed and approved by:

__________________________________________________________ _____________________

Timothy L. Ricks, DMD, MPH SSU Dental Chief Date

__________________________________________________________ _____________________

Stephen Mlawsky, MD, SSU Clinical Director Date

__________________________________________________________ _____________________

Steven A. Tetrev, DDS, MPH, Phoenix Area Dental Consultant (Acting) Date

I acknowledge receipt of the Schurz Service Unit Clinical Guidelines – Standards of Care, and have reviewed the document:


__________________________________________________________ _____________________

Name: Marlon A. Brown, DDS, Chief, Fallon Dental Program Date

__________________________________________________________ _____________________

Name: Susan Wellman, DMD, Chief, Walker River Dental Program Date

__________________________________________________________ _____________________

Name: Barbara Rosse, Dental Assistant, Walker River Dental Program Date

__________________________________________________________ _____________________

Name: Pamela Spotted Wolf, Dental Assist, Pyramid Lake Date

__________________________________________________________ _____________________

Name: Connie Baine, RDH, Contract Dental Hygienist Date

__________________________________________________________ _____________________

Name: Stacie Swensen, RDH, Contract Dental Hygienist Date

__________________________________________________________ _____________________

Name: Mark Rosenberg, DDS, MPH, Contract Dentist Date

__________________________________________________________ _____________________

Name: Ivora Crutcher, Dental Assistant, Ft. McDermitt Date

__________________________________________________________ _____________________

Name: Date

__________________________________________________________ _____________________

Name: Date

__________________________________________________________ _____________________

Name: Date

__________________________________________________________ _____________________

Name: Date

__________________________________________________________ _____________________

Name: Date

__________________________________________________________ _____________________

Name: Date

__________________________________________________________ _____________________

Name: Date






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