Caries ... the new specialty for the general dentist

By Christine Taxin

With new technology for diagnosing and treating dental caries, we have a new set of codes and treatments for everyday use in our practices. Educating our patients that dental caries is a transmittable and contagious disease puts our treatment recommendations in a new light.

Having our assistants and hygienists understand the role they play in patient education is imperative to the success of this type of program. By looking at the patient’s history, they can determine the patient’s risk for dental caries. Doing a risk assessment is the only way we can treat our patients with caries infections properly. Using the assessment as a guide, we can then put patients into a program similar to perio programs and treat dental caries as a disease on a long-term basis. This is doing much more than just drilling out decay and plugging up the hole.

The following new code that is used as of January 2011 explains to the insurance company the type of patient you are treating. In order to bill for this treatment, you must understand what moderate or high risk is.

D1352 Preventive resin restoration in a moderate to high caries risk patient – permanent tooth. Conservative restoration of an active cavitated lesion in carious fissures or pits.

These next codes also require training. They focus on CAMBRA (CAries Management By Risk Assessment) and involve regeneration of tooth structure.

If a tree is diseased, we would use medication to kill the disease and help the tree grow back to full health. Why not our teeth? Using a regenerative treatment can help patients save their teeth and avoid root canals.

D3351 Apexification/Recalcification/Pulpal regeneration – Initial visit. Apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc. Includes opening tooth, preparation of canal spaces, first placement of medication, and necessary radiographs. This procedure may include first phase of complete root canal therapy. Only on permanent teeth.

D3352 Apexification /Recalcification /Pulpal regeneration – Interim medication. Apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.

D3354 Pulpal regeneration. Completion of regenerative treatment in an immature permanent tooth with a necrotic pulp. Does not include final restoration. Includes removal of intracanal medication and procedures necessary to regenerate continued root development, and necessary radiographs. This procedure includes placement of a seal at the coronal portion of the root canal system. Conventional root canal treatment is not performed.

Have you thought about using these codes in the last two years? How have you used them, and is the entire team trained to understand the use of them?

Since teaching at New York University College of Dentistry, I have a new perspective on why coding is so important – and not just for the biller or front desk team member. If the doctors and team members understand what they are billing and why, they will develop a different set of skills to communicate with patients.

Also, the type of treatment, instruments, and products are important decisions. Are you going to use a risk assessment form, a product to remineralize, and a caries prevention product for your patients? Will you be doing a saliva DNA test in your office to better understand your patients’ total health, enabling you to provide better treatment?

A few things to think about: When you start the new year and set your goals, ask yourself: What will I be adding to my practice, and how will I train my team? Treating as an “oral physician” can help your patients see that visiting your office is more important than any other visit they make for their health. Your office can and should become the place patients receive the treatment they need and learn how they can stay healthy.

By just adding this one small step to your practice, you can add more production, keep your recall appointments booked, and help patients understand why their appointment is not about money, but about their overall health.

Contact me at [email protected] to update your programs with caries risk assessments and increase your office production today.