I intend to write a more scholarly article on this subject and get it published as an opinion piece in a peer-reviewed journal, and have been sitting on the idea for a long time now (years, I am sure). I just need to get it off my chest and get the ball rolling. Right here, right now.
As usual, we have done it to ourselves. We created the language that has resulted in dental benefits companies and our patients devaluing a critical health care service that we provide for all of our patients.
I am not completely versed in the coding for dental procedures and the descriptions of those codes. In Canada, when we provide basic oral hygiene care for our patients there is scaling, root planing and polish (formerly called rubber cup prophylaxis or prophy). I am ranting about the last term here.
Polish? Really? Are we shining teeth? Dental benefits companies will often have generous coverage amounts for scaling and root planing because they understand the benefit of the procedure, but the polish, or prophy, is often limited to just once per year. But if we see patients more than once per year (and many are seen three or more times per year for periodontal therapy), our patients will arrive in my office and say they don’t want a polish because it is not covered. Aaarrrgh!
We know that periodontal disease is a problem that involves bacteria, the biofilm they create and the host immune system’s ability, or lack of ability, to keep the system in balance. The resulting tissue destruction could lead to tooth loss and systemic health complications. The vast majority of adults have some form of periodontal disease. And with confirmed links to cardiovascular disease and diabetes (a growing problem in North America), we need to be ever vigilant in keeping our patients informed and healthy to the best of our abilities. We know this.
In treating our patients, subgingival scaling, root planing and surgical curretage (whether with cold steel or via laser therapy) removes the biofilm and their associated bacterial colonies from the sulcular region and from within the tissue that the bacteria have penetrated. But this subgingival invasion started supragingivally. And it is the polish procedure that removes the supragingival biofilm. Without this critical component of our treatment, our subgingival work will fail sooner. Without removing the biofilm above the gumline, the recolonization of the area below the gumline happens in hours or days, instead of weeks or months.
Our national dental associations have created procedures and codes with descriptions that use language that does not support how important this procedure is. We are not polishing teeth. We are not making them shiny. We are removing the supgragingival biofilm.
I propose that we start calling the procedure an SBR, or supragingival biofilm removal. Performing scaling, root planing and SBR, and would be easier to understand and support. All we have to do is convince our national dental associations to change the wording of our procedure codes to support this important facet of our health care treatments.
One day, I’ll write that more scholarly letter on this subject, now that I have it off my chest. I feel better now.
On another note, I had previously written about how busy I was and how out of balance my practice and my life have become, and I had announced my intention to sell my practice. Well, the valuation took longer than I imagined it would, and was finished about three months after I started the process. Within three weeks of my practice going on the market, I have had six interested colleagues and two firm offers. Now I need to sit down and evaluate which offer is best to meet my goals. I’ll post more in my next blog.
Thanks for reading. Now, back to my daily grind…
Larry Stanleigh, DDS