FOUR PHASES OF MANAGED DENTAL CARE

Edited by Ted DeCorte, M.A.

As labor and management become more involved in managed care, many employee groups are starting to recognize the importance of an appropriate sequential order of treatment. This is nothing new. Traditional indemnity plans have always forced dentists to phase in treatment based on the Plan’s annual maximum, waiting periods, or "covered" benefits. A managed care plan with NO annual maximum and no waiting period is no different. A dentist phases in dental care according to the patient’s needs, but only after the patient has achieved a genuine level of dental-health maintenance. Dentists must deliver care that will enhance each patient’s ability to participate in his or her own dental-health maintenance. A phased course of treatment may be a 12-month or may be a 24- to 36-month process from start to finish depending on the patient's own willingness to work with the doctor to insure a long term solution to their own dental wellbeing. Some patients may never achieve a level of oral health beyond the initial dental phases.

The following Phases of Managed Dental Care are treatment guidelines only, and may not reflect the individual patient’s "covered" dental plan benefits.

What the Four Phases of Dental Treatment Will Accomplish:

• Allow for a triage of patient needs• Initiate the saving of as many teeth as possible.

• The final phases begin when the patient’s demand for restorative dentistry tapers off

• Each phase is practiced only when the patient can demonstrate meticulous home care.

I. Phase One: A patient’s emergency needs should be treated first. Emergency needs can be treated with medication, antibiotics, pulp removal, routine extractions, or whatever is necessary to reduce or eliminate pain. Only necessary radiographs should be taken in this initial stage of Phase One, and only routine extractions should be performed. More difficult extractions necessary to reduce the patient’s pain and/or infection may be performed by the GP or an oral surgeon. Once the patient’s emergency needs have been met, the patient will be asked to return for more definitive care. NOTE: Instead of an "emergency" root canal, relief of pain or emergency pulp extirpation is appropriately billed as emergency palliative treatment (9110).

• Emergency relief of pain (09110), emergency care, routine extractions (07110/7120)

• Complete diagnosis, x-rays, and models as needed• Prophylaxis (01110/01120), including fluoride treatment• Home care instructions (01330) demonstrated and evaluated• Initial periodontal therapy (04341)• Periodontal maintenance (04910)

A patient’s eligibility for other than diagnostic, emergency, and preventive treatments is based on the patient reaching an accountable, disease-free level of maintenance. Not attaining and maintaining a satisfactory level of dental health, because of the patient’s neglect or refusal to cooperate, reduces the successful outcome, and thus the availability of the next phases of treatment.

I. Phase Two: The patient is out of pain and has "graduated" from the hygiene department. Eligibility for this phase of treatment depends entirely on the patient having reached an accountable, disease-free level of maintenance. Phase Two includes all of Phase One, plus:

• Periodontal, osseous, and mucogingival surgery, per tooth, as prerequisite for restorative care

• Restorative dentistry-amalgams/resins• Necessary Endodontics• Complicated, non-emergency extractions (07210/07241)• Relines and repairs to existing dentures and removable

partialsII. Phase Three: The dentist holds the patient responsible for

everything in Phases One and Two. The patient understands the value of dental wellness and helps maintain his or her oral health. Phase Three includes all of Phases One and Two, plus:

• Space maintainers for children; preventive orthodontics• Single crowns, inlays, and onlays• New full dentures• Periodontal, osseous, and mucogingival surgery, per

quadrantIII. Phase Four: The final phase of treatment begins when the

patient’s need for restorative dentistry taper off and the patient has successfully completed Phases One, Two, and Three. A patient must demonstrate meticulous home care to proceed to this level. A patient who switches from dentist to dentist and who does not "support" the dental care received through behavioral parameters , will rarely reach the Phase Four treatment level. Phase Four includes all of Phases One, Two, and Three, plus:

• New partial dentures• New fixed bridges (fixed partial dentures)• Orthodontic care (pediatric, adolescent, or adult)

"A prime requirement of good treatment planning is to do the minimum required to achieve optimum oral health. Any dentist who makes mouths healthy and keeps them that way is practicing complete dentistry."