Periodontal disease, scaling and root planing: Clinical guidelines, outcomes and documentation essentials

Periodontal disease is a prevalent yet often underestimated condition in dentistry. It results from the colonization of subgingival areas by pathogenic microorganisms such as Spirochetes, Actinobacillus actinomycetemcomitans and various Bacteroides species. These bacteria evade host defenses, stimulate inflammation and initiate tissue destruction. The accumulation and calcification of plaque biofilm leads to calculus formation and disease progression.

Clinical diagnosis

Inflammation of gingival tissues is often the first sign, assessed through various indices. Bleeding on probing (BOP) is a critical marker, with a BOP index of 25% or greater indicating active disease. Increased periodontal pocket depths with attachment loss are key indicators that periodontal structures have been compromised or lost.

Scaling and Root Planing (SRP)

SRP reduces gingival inflammation, decreases pocket depths and improves tissue reattachment. While transient postoperative sensitivity and gingival recession can occur, these are manageable and outweighed by long-term benefits.

Studies show significant infection control with mechanical subgingival instrumentation and effective plaque control. Patients in a structured maintenance program with sustained oral hygiene show stability in attachment levels, while those lacking continued, regular recall appointments and adequate home care show significant recurrence.

Claims documentation

Submit comprehensive periodontal charting, including probing depths, bleeding scores and evidence of attachment loss. Radiographic documentation, such as a full-mouth series is critical. In cases where radiographic signs are subtle, submit a narrative to contextualize the clinical presentation and patient-specific risk factors, including relevant systemic conditions/medical history, prior periodontal therapy dates or intraoral photographs.

Being aware of insurance documentation requirements can streamline claims processing and avoid unnecessary delays or denials. For more information, please reference the following claim review guidelines:

• Commercial plans: National Standardized Dental Claim Review Guidelines
• Medicare Advantage plans: National Standardized Dental Claim Review Guidelines

The American Academy of Periodontology provides updated research, clinical protocols and patient resources.

References

Lang NP, et al. Periodontology 2000, 1996.

Badersten A, Nilveus R, Egelberg J. J Clin Periodontol, 1984.

Axelsson P, Lindhe J. Periodontology, 1981.

UnitedHealthcare Dental Utilization Review Guidelines.

Pepelassi EA, Diamanti-Kipioti A. J Clin Periodontol, 1997.