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Treating the Gingivitis Patient

By: Debbie Seidel-Bittke, RDH, BS

September 17, 2019


What is the true definition gingivitis?

How do we treat a patient with gingivitis?

This blog will share insight for dental professionals who are treating the gingivitis patient. 

The ADA now provides dental professionals with not only a clearly defined description of gingivitis, but we have a CDT code for billing purposes.

Soon we will have a FREE Training about treating the gingivitis patient. Please check our website and grab a FREE RESOURCE to be one of the first when this new training is released. Check back frequently for this new FREE RESOURCE.


Gingivitis Treatment ADA Definition:

 “Scaling in presence of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”

For many years’ hygienists have been treating gingivitis with a prophy 1 and a prophy 2 appointment and worse may be that we did our very best to “Clean” everything we could and wish (maybe wave a magic wand) that everything looks better in six months.

This is no longer our standard of care.


Hygienists are not janitors and we don’t “Clean teeth!”

Today’s world of dentistry is total health. Our message should be that optimal oral health will contribute to a healthy body and that means living a longer life.

Gingivitis is not a preventive service, but it is considered therapeutic.

In 2017 the ADA gave us a CDT code: 4346.


How to Classify a Gingivitis Patient?

Here are some of the facts you need to know if you are classifying and treating your patient for gingivitis:

  • No radiographic bone

  • 30 % or more areas of inflammation.
    • Moderate to severe inflammation
  • Full mouth comprehensive periodontal screening (CPE) is necessary
  • Intra-oral photographs will be helpful
    • For submitting (use a narrative) insurance for reimbursement
    • Use these to “show” your patient what you see in their mouth
      • The clinicians: Hygienist and Doctor are patient advocates
  • Complete an exam
    • Periodic exam or Comprehensive exam
  • Schedule your patient for a 2-4-week re-evaluation.
    • Complete the (CPE) and know if your patient is now healthy
    • If your patient is now healthy, do complete a prophylaxis
    • If your patient is not healthy; no improvement, schedule to re-evaluation after more treatment for gingivitis and refer patient to see their primary care physician for a blood panel.
      • Make sure other system conditions are not contributing to the gingivitis.
  • Full mouth procedure (not billed in quadrants like 4341/2).
  • Available to start billing January 2017 (It may take a few months for insurance to recognize payment).
  • Generalized=30% of the mouth must have generalized moderate OR severe gingivitis. Not based on the amount of calculus.





















What if you think insurance doesn’t pay?

Since the new CDT code for gingivitis came about more insurance companies are reimbursing for this service.

We always want to do what is in the best interest of our patients NOT what their insurance will pay for.

Always treat your patient for the condition that is present. If you know and see your patient has gingivitis, you will treat for gingivitis.

Insurance is a benefit and a benefit does not mean everything is FREE.

Does your patients’ employer have a vacation benefit? Yes? Does that include airfare, hotel and food when on their vacation?

Same situation exists for their dental insurance benefit. Not every situation (service) is covered.

What will you say to a patient who comes in every six months but today they have gingivitis?


Step 1: Explain to your patient what you will be completing at today’s appointment.

  • “Mr. Jones, today I will be reviewing your health and updating your medications, etc. We will take cavity detecting x-rays and doctor will be here shortly to examine your teeth and gums. I will be checking for any abnormalities of your lip, tongue, cheek floor of your mouth and throat. Next, I will use a ruler and take some measurements which tell us if you have healthy gums. I will call out some numbers (Explain about an assistant writing the numbers or your technology you call out the numbers to be recorded) and one to three are numbers which mean your gums are healthy. If you hear me say bleeding or a number of four this means you have inflammation in your gums. If you hear me call out a five or higher and bleeding, this means you have infection of your gums. If anything, I call out is not healthy, you and I will create a plan and we will treat the inflammation and infection, so your gums are healthy in the future. Please listen closely when I am calling out these numbers because when we are finished I will ask you what is the highest and what is the lowest number I called out. What questions do you have for me before we get started?”













Using this type of verbiage with your patient will bring them into activate participation and most likely, you will never have to ask what numbers they heard because when patients are listening and when they hear the numbers that are not good, they WILL be the one to tell YOU, “That did not sound good!”

This is what works very well to get “Buy-in” from your patients. This is how you can most easily tell your patients what is happening in their mouth. You won’t have to tell your patients what is happening in their mouth, they will tell you!

What do you say to a patient who says, “How could this happen when I always come in here every six months?”

Let your patient know that just like they may have the flu occasionally or a cold or sore throat, their mouth sometimes has inflammation and infection. Let your patient know that if they are feeling run-down, if they are under a lot of stress or immunocompromised, etc., this will affect the health of their gums.

Let your patients know that today’s world of dentistry includes optimal oral health which most likely means a healthy body and longer life.

This is a great opportunity to talk with your patients about the mouth-body connection.

The dental practices we work with who talk to their patients about the mouth-body connection and those offices who represent a wellness or complete health dental practice, are the most successful offices we work with!

Resource: https://jada.ada.org/article/S0002-8177(14)61881-X/abstract

More information: http://dentalcodeology.com/ and https://www.practicebooster.com/

ABOUT DEBBIE SEDIEL-BITTKE, RDH, BS

Debbie Seidel-Bittke, RDH, BS is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.

Please check out the FREE RESOURCES. Grab a FREE RESOURCE here today because when you do, you will be one of the first to know about our FREE Training RE: Treating the Gingivitis Patient.