Presentation on theme: "Connecticut Dental Health Partnership (CTDHP) Orthodontic Seminar"— Presentation transcript:
1 Connecticut Dental Health Partnership (CTDHP) Orthodontic Seminar June 20, 2012
2 Welcome! Agenda Time Topic 6:00 - 6:30 Meet and Greet 6:30 - 7:00 Dinner7:00 - 7:45 Presentation Introduction- Objectives- Salzmann scoring presentation- Case submission procedures7:45 - 8:00 Question and Answer
3 Objectives Introduce CTDHP staff Develop a common understanding of the Salzmann scoring processClarify submission processAnswer general questions
4 Cases That Do Not Qualify Fill out form with appropriate informationIn Comments section write “patient does not qualify please deny”Mail in with other Pre-authorization requestsDo not take x-rays or models for cases where they are not needed to diagnose
5 Objectives: Salzmann Scoring Process 5,210 orthodontic cases submitted CY 2011Denied cases are an administrative burden to the practitioner and CTDHPSalzmann Score% of TotalPractitioner ScoreCTDHP Score% VarianceAverage27.323.615.6%Average Approved Cases70.0%28.526.47.9%Average Denied Cases30.0%24.517.143.2%
6 Salzmann ScoringDefinition: Handicapping malocclusion and handicapping dentofacial deformity are conditions that constitute a hazard to the maintenance of oral health and interfere with the well-being of the child by adversely affecting dentofacial esthetics, mandibular function, or speech. Materials courtesy of the American Association of Orthodontists Library, 1974
7 Salzmann Scoring E. Intra-Arch Deviations: Missing teeth: scored by actual count of teeth; remaining roots are scored as missingCrowded teeth: insufficient space for alignment without moving other teeth in the arch. Crowded refers to tooth irregularities that interrupt the continuity of the dental arch when the space is insufficient for alignment. A tooth scored as crowded is not concomitantly scored as rotatedRotated anterior teeth: insufficient space for alignment of teeth so malaligned as to interrupt the continuity of the arc of the dental arch
8 Salzmann Scoring E. Intra-arch Deviations: Max & Mand Anteriors Maximum # of Maxillary or Mandibular Anterior teeth scored is 4 eachMaximum score for line one is 8 and for line three is 4 respectivelyA tooth cannot be rotated and crowdedCount spaces not teeth8
9 Salzmann Scoring E.Intra-Arch Deviations: Max & Mand Posteriors Missing tooth must be congenitally missing not just missing from arch. Remaining roots are scored as missingCrowding: insufficient space for alignment without moving other teeth in the arch. Crowded refers to tooth irregularities that interrupt the continuity of the dental arch when the space is insufficient for alignment. A tooth scored as crowded is not concomitantly scored as rotated. A maximum of 2 teeth per side per arch can be countedRotation: Crown rotated buccally or lingually > 45°Spacing must be evident on both sides of the tooth. A maximum of 2 teeth per side per arch
10 Salzmann Scoring Max & Mand Posteriors: Rotated posterior teeth: buccal or lingual surface wholly or partially faces proximal surface of adjacent teethOpen spacing: crest of interdental papilla is visible. Score each papilla in incisor section; score posterior teeth when both adjacent crests of the interproximal papillae are visibleClosed spacing: space is insufficient for complete eruption of a tooth. Cannot have closed spacing and crowding for the same teeth
12 Salzmann Scoring Intra-arch Deviations: (A) Method of placing casts for intra-arch assessment(B) Crowded anterior and posterior teeth
13 Salzmann Scoring F. Inter-Arch Deviations: 1. Anterior Segment Overjet: labioaxial inclination of maxillary incisor teeth with mandibular incisors occluding on or over palatal mucosaFor an incisor to be scored as excess overjet, any portion of the maxillary incisal edge must be at least 3mm ahead of the opposing lower incisorOverbite: maxillary incisors occlude on or opposite labiogingival mucosa or mandibular incisors occlude DIRECTLY on palatal mucosa
14 Salzmann Scoring F. Inter-Arch Deviations: 1. Anteror Segment Overbite is scored teeth 7, 8, 9, 10 in a ClassII Div 2 occlusion when these teeth touch lower labial gingiva.Overjet and overbite: score both when mandibular incisors occlude directly on the palatal mucosa and maxillary incisors are in overjetOpenbite: the vertical separation between teeth in opposing dental arches when the rest of the teeth are in terminal occlusion. Edge-to-edge occlusion is not scored as openbite or crossbite.
15 Salzmann Scoring (B) Overbite-mandibular incisors on palatal mucosa. (A) Overjet- maxillary incisors labial, mandibular incisors over palatal mucosa.(B) Overbite-mandibular incisors on palatal mucosa.(C) Overjet and overbite maxillary incisors labial, mandibular incisors on palatal mucosa.
16 Salzmann Scoring Inter-arch Deviations: Incisors crossbite: maxillary incisors are lingual to mandibular incisors when posterior teeth are in terminal occlusion.Crossbite of posterior teeth: canines, premolars, and first molars are buccally or lingually placed out of the entire occlusal contact with their opposing teeth. Cusp tip is out of the fossa. End-on is NOT considered a crossbite3. Open Bite: Erupting teeth cannot be counted as an open bite. Tooth must be fully erupted.
17 Salzmann Scoring 1. Relate Man. To Max. Teeth F. Inter-Arch Deviation 2. Posterior Segments1. Relate Man. To Max. TeethA. Distal Category is for Class IIB. Mesial Category is for Class III2. Flush terminal plane not Class II or III3. Opposing cusp must be over the tip of the opposing cusp
23 Comments SectionNarrative only applies to clinical reasons to justify the case qualifying for treatmentAdditional photos, x-rays, etc. that support the narrative must be includedDo not send treatment plan, mechanics to be employed, etc. as these do not alter the scoring of the case
24 Salzmann Scoring: Example Casts Overhead ViewLeft Side ViewBases of models are not parallel, backs are not even
25 Salzmann Scoring: Example Casts Frontal ViewRight Side ViewBases of models are not parallel, backs are not trimmed
26 Salzmann Scoring: Example Casts Rear ViewBack needs to be trimmed to allow evaluation of overbite
27 Quality of RecordsX-rays must be printed on PHOTO paper not copy paperPanoramic radiograph must be relevant time-wise in relation to the modelsModels must be of diagnostic quality and trimmed in occlusion, W/O wax bite, to ABO guidelinesPoorly trimmed models and models with broken teeth will be returned ungraded!
28 Study Model PackagingThe ideal way to ship models is with each model first placed in a blue fluoride tray, then bubble wrapped and secured with a rubber bandDo NOT ship the models with wax bite attached between upper and lower models. Models become difficult to separate and teeth break
30 Returned Orthodontic Submission Form Member: __________________ ID#: ____________________Claim #: ___________________ Date: ___________________Dear Doctor,Your request for review of orthodontic services for your patient is incomplete as submitted or, in the opinion of the program’s dental consultant(s), does not appear to be consistent with the criteria of the Connecticut Medical Assistance Program. To allow proper processing of your request, we are returning your submission and supporting documentation for the following reasons:Client’s name as it appears on their gray CONNECT card is requiredClient’s Medicaid ID number as it appears on their gray CONNECT card is requiredDentist’s NPI, TIN and/or SSN identifiers are required on the accompanying claim formPanoramic radiograph for full X-Ray series is requiredProperly completed and scored Malocclusion Severity Assessment, including section “G” on Other Deviations (sample form enclosed) is requiredDiagnostic Casts (models) must be properly trimmedRadiographs and/or models must be of diagnostic qualityOtherPlease resubmit this request with the missing or corrected information and/or materials for further consideration.Interceptive treatment is not a Medicaid covered service: Patient has mixed dentition and no documentation from referring general dentists, behavioral health or mental health providers, or other severe deviations affecting the mouth and/or underlying structures are present as noted in section ‘G’Please discuss monitoring, future orthodontic therapy and alternative treatment options with your patient at this time