Sometimes the clinical and radiographic examination is insufficient to determine the full nature of a dental or oral issue. There are many tests that can also be done some of which involve sending to a lab for the final results.
D0415: Collection of microorganisms for culture and sensitivity
Having discovered the many specific bacteria that cause both tooth decay and periodontal disease, it is sometimes necessary to take a sample of the dental plaque and send it to the lab to determine if a patient has unusually high levels of these pathogens. This test is indicated when traditional treatments do not seem to be working as planned.
D0418: Analysis of a saliva sample
The saliva has many important functions in the mouth. One of which is to provide a stable, acid-free environment. It is such an acidic environment that leads to tooth decay.
When decay occurs with unusual frequency or severity, testing the saliva for proper function can be an important part of the treatment process. Saliva is also becoming recognized as an important clinical tool to determine other systemic health of disease issues.
D0421: Genetic test of susceptibility to oral diseases
With the advent of DNA testing, we can now take a sample of oral tissue or bacterial plaque and submit it for genetic testing. The purpose of this test is to obtain a certified laboratory analysis to detect specific genetic variations associated with increased susceptibility for oral diseases such as severe periodontal disease. Again, this test may be indicated if traditional treatment does not seem effective or a patient has reported a significant family history of this destructive oral condition.
D0425: Caries susceptibility tests
Recently, tests have been made available to see if a person is susceptible to tooth decay, i.e. dental caries. One machine in particular is called a "Diagnodent" which passes a light source through the tooth to see if caries has already begun.
D0431: Oral Cancer screenings
Several new and simple ways of taking tissue sample are available to provide an adjunctive pre-diagnostic test to aid in the detection of mucosal abnormalities including malignant and premalignant lesions. Although not a true incisional biopsy, one example of such a test is called a "brush biopsy" where a brush is gently swept along a suspicious area of the mouth and some cells are retrieved and sent to the lab for further review.
D0460 Pulp Vitality Testing
The pulp is the vital, living tissue within the center of every tooth. If the pulp gets diseased, the health or vitality of the tissue becomes compromised. If the pulp has become non-vital (no longer alive) it must be removed before the dead tissue becomes necrotic and abscesses out of the root and into the bone.
One way of pulp vitality testing is to use heat and cold on the suspicious tooth and compare it to a known healthy tooth elsewhere in the mouth. Another, more accurate method uses an electronic device to measure the health of the pulp.
D0470: Diagnostic Casts
If you read the section on this website regarding "TMJ Facial Pain" you will know that analyzing the relationship of how the upper and lower teeth function against each other is very important. By taking impressions of the teeth we can create these diagnostic molds to help with this evaluation. In addition, if teeth are missing and require replacement, diagnosiic casts of the teeth can help design this prosthetic solution.
Diagnostic casts can be evaluated with or without a separate analysis that mounts the molds on a machine that simulates the workings of the jaw. (see code D9950: Occlusal Analysis.)
On occasion a test will require sending a sample to an accredited lab to determine the results. It is rare by when this happens you may see one of the dental codes below appear on a statement or insurance form:
D0490: Accession of exfoliative cytologic smears, microscopic examination, preparation and transmission of written report
This labwork is required if procedure D0431 is performed as an oral cancer screening.