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ADA Gingivitis Reporting Guide: Implementing D4346

ADA Gingivitis Reporting Guide: Implementing D4346

The profession started the year with the news that gingivitis was now being added to the Code on Dental Procedures and Nomenclature (CDT Code). D4346 is defined as: scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. The removal 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.1 This code should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.  While this code is a welcome addition, dental professionals are quick to acknowledge that codes are specific to insurance and considered a documentation tool with which to classify diagnosis, treatment planning and document the treatment of gingivitis.

ADA: A Guide to Reporting D4346:

To assist professionals in their use and understanding of the new code the American Dental Association (ADA) released “A Guide to Reporting D4346”, described as a resource guide from the ADA developed to educate dentists and others in the dental community on the newly approved scaling code for CDT 2017 that went into effect Jan 1, 2017. This guide delineates when to use D4346 compared to using codes for debridement, prophylaxis and scaling and root planing. Up until the release of this code treatment of patients with gingivitis were being documented as a ‘prophylaxis’ even through the required time and clinical intervention was beyond that of a ‘prophy’. Considered therapeutic vs. preventive, D4346 refers to full-mouth gingivitis with instrumentation occurring after assessment/diagnosis. The absence of periodontal involvement without respect to age, D4346 represents a major patient population. This code cannot be used in conjunction with prophylaxis or scaling and root planing.


D4355: Polish First!

In addition to D4346 clinicians can now utilize a code that will assist with oral evaluation. D4355 is performed before the subsequent comprehensive evaluation simply to remove gross deposits from the tooth surface. Implementing a full mouth debridement for the purpose of completing an assessment and evaluation will be essential in generating an accurate diagnosis and developing an appropriate treatment plan. Polishing the teeth is an excellent first step when utilizing D4355 as it will remove surface plaque, biofilm and stain prior to instrumentation. The rationale for pre-instrumentation polishing is to improve visibility and reduce gross biofilm deposits, which is a key aspect of D4355.
In these cases utilizing a prophy paste that minimizes spatter and is easy to rinse will be appreciated by patient and clinician alike. Keystone Industries’ Gelato® Prophy Paste has been named the Top Prophy Paste in the Hygiene category of The Dental Advisor’s 2017 Product Awards, an award Keystone has now won five times consecutively. Specifically, Gelato® was recognized for its splatter-free and easy rinse formulation.
In clinical research conducted on Gelato®, 35 consultants used the product over 2,500 times and came to an overall 91-percent clinical rating. Among the consultants, 63-percent said they would switch to Gelato Prophy Paste, and 80-percent said they would recommend it to dental professionals.


Maximizing Treatment and Exceeding Expectations:

Maximizing treatment by implementing the new gingivitis code will go a long way in establishing the realities related to the frequency and prevalence of gingivitis. Enhancing clinical experiences by using Gelato Prophy Paste will be appreciated by your patients with formulas for every patient type to assure maximum results with minimal enamel loss. Exceed your patient’s expectations with flavors for every taste and convenient infection control compliant unit dose cups. Download the ADA Guide to Reporting D4346 to accurately implement the new gingivitis code and have access to a resource that details other oral hygiene assessment/treatment codes. Once implemented, consider the option to maximize both the clinician and patient experience with Gelato®! Here at Keystone we are looking forward to keeping you up to date on the latest technologies, research and protocols that impact your practice!


About Keystone Industries

Since 1908, Keystone Industries has maintained a strong reputation of producing innovative high-tech dental products in the operatory, laboratory and preventive realms. Keystone is committed to the goal of total customer satisfaction. Their dedication is driven by the need to provide customers with the finest quality materials while developing products that meet and surpass customer expectations. These expectations have continued to excel as the company has moved forward with expansions around the globe. Learn more about Keystone Industries.



For more information on Gelato Prophy Paste or any of Keystone’s many products, contact Keystone Industries toll-free at 800-333-3131 or online at


Kristy Menage Bernie, RDH, MS, RYT

Kristy Menage Bernie, RDH, MS, RYT, is the Director of Educational Designs, an oral healthcare industry consulting company based in San Ramon, CA. She celebrated her 30th year in the profession by completing a Master’s of Science degree with honors in 2015 from the University of California, San Francisco, where she is also an Assistant Clinical Professor. Kristy is an international speaker on a variety of topics as well as a facilitator of workshops for educators in dentistry. She has been quoted in Esquire Magazine, Women’s Health Magazine, interviewed by ESPN Radio and featured on the cover of RDH Magazine. Kristy has been featured on major dental and dental hygiene conventions and is known for facilitating interactive, fast-paced sessions based on the latest technologies and research. She can be reached at



[1] Coding done right. ADA News, Dec. 1, 2016 [Internet] [cited 1 August, 2017].

[1] A guide to reporting D4346. American Dental Association [Internet] [cited 1 August, 2017].

[1] Clinical evaluations: Gelato prophy paste (2017 product award) Dental Advisor [Internet] [cited 1 August, 2017].

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