Periodontal disease—literally, disease “around the tooth” - affects the gums and the bone to which a tooth is attached. It is a bacterial infection that causes tooth loss and gum recession, and its main culprit is the bacterium, Streptococcus mutans, or S. mutans.
These tiny purple bacterium live in your mouth with upwards of 25,000 of other species of bacteria, some of which are helpful to maintaining a healthy mouth and others, like S. mutans, are the causes of decay.
For about thirty minutes after finishing a meal and your saliva production has slowed, the pH of your mouth sits at a level that allows S. mutans to thrive. The bacteria work quickly, and begin consuming the two things it loves most: the remaining starch and sugar molecules left behind from your food. Once S. mutans has finished consuming these starch and sugar molecules, the by-products of its *own* digestion process are a thin film of plaque that coats your teeth and provides a home for them, and lactic acid which erodes your tooth's enamel and can result in cavities.
Procedure D4342 represents the action taken to remove the buildup of plaque and its more hardened form, tartar, through periodontal scaling and root planing, or SRP. This procedure is similar to how teeth are cleaned during a typical adult prophylaxis and pediatric prophy, but the process takes place on the cementum of the tooth, which is the outer surface of the tooth's root, and below the gumline. This process is technically known as debridement, and is recommended if “early active” periodontis is witnessed in combination with tartar buildup, and a periodontal pocket (a widening of the gumline that has pulled away from the tooth), of 4 to 6 millimeters in detectable depth. This code also refers specifically to the number of teeth treated – in this case, anywhere from one to three (but no more than three), in a single quadrant of the mouth. These quadrants are simply referred to as: upper right, upper left, lower right and lower left.
The procedure first involves the application of an anesthetic to numb the affected areas, and an antiseptic to lessen the volume of live bacteria in the mouth. Next, using a sharp hand tool called a curette, your dentist will scrape off (or, “scale”) the hardened tartar deposits on the root of the tooth in an upward motion. An electric instrument called an ultrasonic scaler may also be used to break off the deposits from the tooth should the curette not prove as complete a solution. Any deposits left behind by the ultrasonic scaler can be scraped off by hand.
After this, your dentist will then smooth out, (or, “plane”) the root surfaces. Planing is a process very similar to what a woodworker would do when they take a long roughened edge of a board and make it smooth by using a “planer.” The same general technique is used here to make the cementum smooth once again, and more equipped to combat plaque buildup in the future.
Because it is effective in eliminating infection, scaling and root planing is often the only treatment needed for periodontal disease. However, in cases where the disease is more advanced or the gum pockets are too deep, your dentist may have to apply timed-release antibiotics to the affected areas, or resort to surgical treatment. In any case, your dentist will schedule reevaluation and prescribe regular maintenance visits for continued care.
To look up and find more cdt dental codes from the American Dental Association, please visit our complete Dental Procedure Code Library.