The Dilemma of Full Mouth Debridement

Perio Profits

Over the years definitions of codes change, and the way we utilize them in dentistry also changes. One of these codes that is always up for spirited debate is the 4355, Full Mouth Debridement. 

The definition has changed in recent years, which has changed my utilization of this code. It used to be defined as,

“ 04355–Full mouth debridement to enable comprehensive periodontal evaluation and diagnosis. The removal of subgingival and/or supragingival plaque and calculus that obstructs the ability to perform an oral evaluation. This is a preliminary procedure and does not preclude the need for other procedures.”

Now it is defined as,

“Full Mouth Debridement to enable comprehensive evaluation and diagnosis. The removal of Subgingival and or supragingival plaque and calculus. The procedure does not preclude the need for additional procedures”

The new definitions suggest that this procedure is no longer used just to remove obstructive deposits, but can be utilized to aid us in providing assessments regarding patient health.

In some circumstances I find it necessary to remove the supragingival deposits to aid in comprehensive evaluation of current health.

Are we dealing with localized inflammation and infection from the deposits, or has the disease advanced beyond a localized issue?

The Full mouth debridement helps us determine this very thing. The debridment is performed, the removal of the deposits and the patient returns for a comprehensive evaluation about their periodontal health. 

In a position paper from the ADHA on periodontal coding, they stated the following about Full Mouth Debridment,

“In the presence of Periodontal Disease, Periodontal Debridement is indicated. These procedures can be the definitive treatment for gingivitis or early periodontal disease, or can be a pre-surgical treatment when the disease is more advanced.”  

This is exactly how we recommend this procedure is used. As the definitive treatment for gingivitis, to enable a comprehensive evaluation…did the inflammation resolve? Or is more in depth scaling required?

We often will also utilize 4355 as a pre-cursor to Periodontal Scaling and Root planing when utilizing Full Mouth Disinfection. 

Experts teach a variety of ways to use, or not use 4355.

In my opinion, science has proven there is an Oral Systemic Link and real risks exist to systemic health with the presence of inflammation in the mouth.

It is vital that we are making a comprehensive assessment regarding each patients health, and taking every preventive measure available to us to facilitate healing.

This is why I continue to utilize 4355 as a component of comprehensive diagnosis when appropriate. 

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