OCHWA Periodontal Treatment Protocol

Quick-reference summary of the OCHWA/UWA DMD phased periodontal treatment workflow (Steps 0–4). Summarized from OCHWA DMD PERIO Treatment Protocl.

Charting and Examination

• Record the periodontal chart in Titanium using the Titanium Perio tab (includes plaque index and marginal bleeding).
• Use the Periodontics eForm for recording.
• Comprehensive history, radiography, extra-oral, intra-oral, and periodontal examination culminate in diagnosis.
• Item 221 – Clinical periodontal analysis and recording is the charting code.

Probing order of preference

1. Complete probing of all sites without anaesthesia.
2. If discomfort, use topical anaesthesia (Xylonor 10% spray and/or gel), then complete probing.
3. If discomfort persists, local anaesthetic injection as a last resort. Aim to complete probing in a single session.

Step 0 – Emergency Care Phase

• Address acute conditions causing pain and/or infection: acute periodontal abscess, necrotising periodontal disease, irreversible pulpitis.
• Item codes: 013 oral examination limited; 213 treatment of acute periodontal infection (per appointment); 419 extirpation of pulp / root canal debridement; 311/324 etc. extraction of teeth associated with acute pain/infection.

Step 1 – Systemic / Risk-Factor Phase

• Guide behavioural change by motivating the patient.
• Risk factor control: tobacco smoking cessation (Ask, Advice, Help model); diabetes control interventions.
• Supragingival biofilm removal only: establish oral hygiene practices (reinforced at all stages), professional mechanical plaque removal, control of plaque-retentive factors.
• Item codes: 111 removal of plaque or stain; 113 recontouring/polishing pre-existing restoration (per tooth); 114 removal of calculus (first appointment); 115 removal of calculus (subsequent appointment); 131 dietary analysis and advice; 141 oral hygiene instructions; 142 tobacco counselling; 311/324 etc. extraction of asymptomatic hopeless teeth.

Do not combine 111 with 114/115

Item 111 is included in the procedures described by items 114 and 115, so these codes should not be used together.

Step 2A – Cause-Related (Non-Surgical) Therapy Phase

• All periodontal patients receive non-surgical instrumentation to reduce/eliminate subgingival biofilm and calculus.
• May use hand or powered instruments, alone or in combination; quadrant-wise or full-mouth delivery.
• Chlorhexidine mouthrinse may be considered for limited time periods as an adjunct.
• Gross caries control and initiation of endodontic procedures.
• Peri-implant disease management requires referral to the Periodontal department.
• Item codes: 222 periodontal debridement (per tooth); 250 active non-surgical periodontal therapy (per quadrant — at least 3 teeth in quadrant with CAL ≥ 3 mm or PD ≥ 4 mm).

Step 2B – Re-Evaluation

• Re-evaluate the patient after 8 weeks.
• If endpoints are met, therapy is successful: enrol in supportive periodontal care and proceed with restorative/prosthetic therapy.
• Endpoints: no pockets ≥ 5 mm with BOP; no pockets ≥ 6 mm; full-mouth bleeding score ≤ 20%.
• Item codes: 221 clinical periodontal analysis and recording; 022 intraoral radiograph (per exposure); any applicable codes from Step 1.
• Endpoints not achieved → Step 3. Endpoints achieved → Step 4.

Step 3 – Corrective / Surgical Phase

• Residual pockets 4–5 mm: repeat non-surgical instrumentation (note 4 mm is not the same as 5 mm).
• Residual pockets ≥ 6 mm: indicated for surgical therapy — refer to the Periodontal department.
• Localised residual pockets (<30% sites) may be re-instrumented by DMD.
• Generalised residual pockets (>30% sites) must be referred to the Periodontal department.
• If the cause of persistent deep pockets is unclear, refer for specialist evaluation rather than re-instrumenting or deferring to next year’s students.
• Peri-implant disease management requires referral to the Periodontal department.
• Item codes: 222 periodontal debridement (per tooth); 250 active non-surgical periodontal therapy (per quadrant); 019 referral.

Step 4 – Supportive Periodontal Care (SPC)

• SPC intervals between 3 and 12 months, patient-dependent based on the perio risk assessment tool.
• Professional mechanical plaque removal.
• Repeated individually tailored oral hygiene instructions.
• Item codes: any applicable codes from Step 1.

Step → Procedure → Item Code Map

Step	Key procedures	Item codes
Charting	Clinical periodontal analysis (Titanium Perio tab / Periodontics eForm)	221
0 – Emergency	Acute abscess/NPD/pulpitis management, extirpation, extraction	013, 213, 419, 311/324
1 – Systemic	Plaque/calculus removal, OHI, smoking & diabetes control, dietary advice	111, 113, 114, 115, 131, 141, 142, 311/324
2A – Cause-related	Non-surgical subgingival instrumentation (debridement)	222, 250
2B – Re-evaluation	Re-chart at 8 weeks, radiographs, endpoint check	221, 022 + Step 1 codes
3 – Corrective	Re-instrumentation, surgical referral for ≥6 mm / generalised	222, 250, 019
4 – SPC	Maintenance, PMPR, tailored OHI at 3–12 month intervals	Step 1 codes

Source

Summarized from OCHWA DMD PERIO Treatment Protocl (UWA Dental School; discipline lead Dr Pradeep Koppolu).