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The Event Has Ended, But the Learning Hasn't!


V Kim Kutsch, DMD
Kathryn Gilliam, BA, RDH, FAAOSH
Machell Hudson, RDH
Susan Maples, DDS, MSBA
Kandra Sellers, RDH, BA
Christine Taxin
Douglas G Thompson, DDS
Douglas A Young DDS, EdD, MS, MBA
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“Well-timed and 
full of valuable information”

-2020 Attendee

“This was amazing new up-to-date information, and 
the educator was extremely knowledgeable.”

-2020 Attendee

“VERY good at getting the important info out in 
an uncomplicated way. Lots of good info in a short amount of time. Great presenters!! Thank you!!”

-2020 Attendee

“The passion of the speaker came through very clearly. This is something that should be added to the dental hygiene curriculum to help students learn to identify victims.”

-2020 Attendee

“I appreciate how Kathryn condensed so much information 
in only one hour, truly remarkable!”

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Executive Dream Team

Laura Moriarity
Brenda Lopez RDH
Jenny Wolfenbarger
Shareef Mahdavi
Tom Viola, RHp, CCP

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Medical Protocols for Periodontal Therapy - Kathryn Gilliam, BA, RDH, FAAOSH 

Q: How is the bacterial DNA testing coded, and how well do dental insurance plans cover this, in general, or 
does it need to be medically cross-coded? Not to say that we should only treat based on insurance, but that’s 
the first thing our patients want to know before they agree to anything. 
A: Studies have shown that infectious agents, such as the highly pathogenic bacteria, Porphyromonas 
gingivalis, can promote mitochondrial dysfunction by inducing mitochondrial fragmentation, reactive oxygen 
species, collapse of MMP (matrix metallo proprianase) and reduced ATP function. 
Q: Do you have any information on Periodontal disease and Parkinson's disease? Links to one another? Or 
impact on Perio Health? 
A: Parkinson's disease is a neurodegenerative disease. Periodontal disease has been found to increase risk of 
Parkinson's disease because gram-negative periodontal bacteria with endotoxin LPS break down the blood 
brain barrier. Inflammatory cytokines (Il-1, IL-6, TNF-a) released by the bacteria lead to the production of nitric 
oxide and reactive oxygen species, the result of which is the destruction of dopaminergic neurons. This seems 
to be an important contributor to the development and progression of Parkinson's disease. 
Q: How do we test to see what bacteria is in the patient’s mouth? Is this something we swab and send to a 
A: There are a few different methods for testing the bacteria in the mouth. An oral saline solution can be 
swished and gargled and sent to a lab in a test tube, which is the method OralDNA Lab uses. Paper points can 
be inserted in to the periodontal pockets and dragged across the circumvallate papilla and the buccal mucosa 
to collect a sample and sent to the lab in a tube, as well, which the method used by MicrobeLinkDx. These are 
the two labs we use in my practice, my favorite being the paper point method. 
Q: We use carefree, probiotics, essential oils, cholloidal sive laser, microscope, and blood work we also use the 
DNA test and only when I say do all this and then the communication breaks down and the verbiage or script 
has to be made a critical part of the hygienists role as well as the support of the entire staff NOT just the 
dentist and then it is lost ... and they walk out, as well as the Not being compliant
A: It sounds like you're doing a lot of things right. The breakdown is happening with communication skills. This 
type of training is a big part of the coaching that I do when I go in office with dental teams. Everyone on the 
team must be well-versed in these different techniques and why they are recommended, as well as in the 
science of the oral - systemic connections. I would recommend coaching and training to enable your entire 
team to function cohesively and allow patients to choose the best treatment that you offer. If the hygienists 
and other team members can't communicate effectively, the patients lose and the practice loses. I wish you 
great success and if I can be of service, please reach out to me: 
Q: list blood test for inflammation 
A: There are many blood tests you can use to look at inflammation. Some of the more common ones used in 
integrative dental practices are: 
1. C-Reactive Protein 
2. Myeloperoxidase (MPO) 
3. Lipoprotein Associated Phospholipase A2 (LpPLAC2) 
Q: How do we code for bacterial DNA testing and does insurance cover these? Or medical cross coding 
A: I don't know if dental insurance will cover the cost of bacterial DNA testing - there may be some plans that do. In my practice the patients pay upfront and submit for reimbursement. I have no idea if they receive the reimbursement. Medical insurance will cover these costs. Please refer to Kandra Sellers for details about implementing medical billing in your dental practice. Resources - TIPS Medical Billing There are many codes you can use. There's a very detailed guide by OralDNA Labs.

Diagnostic Codes in Dental and Medical Billing - 
Christine Taxin 
Q: In Nebraska we are recognized by Medicaid to bill but no other insurance recognizes us as a provider. Why is that?
A: I cannot answer that question since Hygiene without providers is still new. However, one hygienist I have worked with still works with a provider and can bill under him, even in her office.
I would highly recommend that you contact the insurance commission and get a list of the laws for your state.

This is what I did find: Nebraska 2007 Sec. 38-1130 Public Health Dental Hygienist: The Department of Health may authorize an unsupervised dental hygienist to provide services in a public health setting or a health care or related facility. Requirements: Dental hygienist must have 3,000 hours experience in at least 4 of last 5 years. Dental hygienist must also have professional liability insurance. Provider Services: Dental hygienist can perform prophylaxis for a healthy child, pulp vitality testing and preventive measures including fluorides and sealants.
Q: Christine, does the use of fluoride varnish include SDF 
(silver diamine fluoride)?  
A: I believe you are asking if the additional benefits pay for the Silver Diamine Fluoride. If I am incorrect just let me know exactly what you are asking. The answer is the following if it is about the additional benefits. What is the code for silver diamine fluoride?
The SDF Billing Code is CDT Code D1354: Interim caries arresting medication application – conservative treatment of an active non-symptomatic carious lesion by topical application of a caries arresting or inhibiting medicament and without mechanical removal of sound tooth structure
What is the dental code for fluoride varnish? D1206
D1206 refers to professionally applied fluoride varnish and D1208 is any topical application of fluoride including fluoride gels or fluoride foams (excluding fluoride varnish).

Q: Does the pediatric feeding disorder code apply to 
myofunctional therapy type procedures? Like CT scan and 
tongue thrust therapy
A: That is a loaded questions for me to answer with no understanding of the type of treatment you are performing.
A CBCT scan 1. Needs to be read by a radiologist in order to do treatment. If that is not done taking a cbct scan must have full documentation including the cervical, and sinus area. I have a free web program coming up so please join in.
Second when you are providing the treatment for the disorder you can use the code but must document exactly why you are doing, what is the possible outcome and what happens if they need more treatment.

Treating Caries Chemically: Minimally Invasive, Maximally Effective - Dr. Doug Young 

Q: Does the protocol apply to both children and adults?  
A: Same basic idea but modified to each child’s ability to follow instructions. For example, sometimes 
gorgeous brush on CTX for treatment rinse instead of having them swish and spit. Things like that. 
Q: what brand of GI cement does the speaker use to replace those fillings 
A: I use Fuji triage for sealants, Fuji 9 extra for aesthetic zone, and Equia Forte for strength in the posterior and 
where I want to mask the black of SDF.  
Fuji II LC is a resin modify glass ionomer which needs to be set with a curing light. 
Fuji IX Extra Is a high viscosity glass ionomer which is chemical set and it’s excellent for aesthetics because it is 
very translucent. And still quite strong., 
Fuji Triage is the law viscosity Glass Animals are used for sealants it comes in a pink white and pink  it can also 
be used for temporaries   
Q: About not using phosphoric acid on dentin before application of glass ionomer, does that apply to resin 
modified glass ionomers, too?
A: Yes 
Q: also, what is the protocol of placing GI on dentin?  
A: Follow the 10 steps listed in the course  
Q: Dr. Young, do GI restorations work on vital teeth with subgingival fractures?  
A: That of course depends upon the extent of the fracture. Always inform the patient and start with the least 
invasive option first which may include glass ionomer   
Q: Esthetically how do you handle the black staining that occurs after the SDF?  
A: Clean the perimeter margins using the 2 mm rule and selective carries removal then bond the glass ionomer 
as per manufacturer’s instructions using polyacrylic acid, rinse, blot dry, application of GIC As per the 10 steps 
outlined in the lecture. 
Q: Any tips for interproximal SDF placement? 
A: I like trying to contact with air and saturating the lingual occlusal and facial embrasures with STF. It will get 
sucked in by capillary action. Then coat with fluoride varnish. 
Q: Could you use for recurrent decay under a crown in nursing home type patient?   
A: Leaving the key under crown follows the same principles of selective carries removal clean the margins and 
properly sealed in a glass ionomer as per the 10 steps outlined in the lecture 

Putting out the Fire: The Hygienist Role in Inflammatory Disease  Machell Hudson, RDH 
Q: Where can we get the forms you shared? 
A: Caries Risk Assessment- Carifree 
AAP Staging and Grading-  
Stop Bang and Epworth- American Sleep Association 
Risk Factor Sheets (which also includes all the above)- Integrative Dental Coaching with Machell Hudson (all 
included in Patient Education Book)  

Wellness Coaching for Dental Caries - Dr. V Kim Kutsch
Q: When does low PH cause caries vs erosion?  
A: Both are interconnected. The critical pH for demineralization of enamel is pH of 5.5 and the frequency of the oral environment below that threshold would aide in erosion. Ex. If a patient drinks a 40oz refillable soda all day they may see more erosive reduction of enamel across all tooth surfaces. If the acid is mediated/produced from the biofilm, it causes dental caries, and this tends to be a slower process and focused on areas of the teeth affected by the biofilm. If the acid is either intrinsic (gastric) or extrinsic (food or liquid) then it causes erosion. The patterns of erosion tend to be spread across tooth surfaces based on the source and destroy mineral structure faster than it can remineralize.
Q: Could you please repeat the name of that genetic issue related to caries on lower anterior teeth?
A: The gene mutation is on the LYZL2 gene. It creates a Lysozyme mutation reducing the protective proteolytic enzyme produced by the submandibular glands which would normally bathe the lower anterior teeth.
Q: Is the diet soda better than the sugary one?  
A: Diet soda isn’t equipped with the sugars, but it’s pH is still well below the demineralization threshold of enamel. And the pH of the oral environment left behind will select for cariogenic bacteria, especially at a high intake frequency. So, a pH elevated product like CariFree Spray, Rinse, or Gum would help neutralize the acidic environment after drinking a soda.
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