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4-6 Week Finescale/Perio re-eval

So, in school we were taught that any time you do SRP it is followed by a 4-6 week re-evaluation to assess for healing and determine frequence of perio maint recall. I work at a very busy practice. We stay consistently booked up solid 6 months in advance with very few “holes” in our schedule sooner than 6 months out. Many times I will see a prophy patient and it has been over a year since their last visit and when I ask their answer is always, “I had to cancel one appt and this was the first available appt.” Scheduling SRP & Finecales are troublesome…Especially when you take into account some pts are only available on 2:00 on a Tuesday or some other strict schedule. Sometimes I will schedule a pt for SRP, but the finescale ends up being 3 months from that finescale date which turns out to be a 3mrc perio maint visit instead of a finescale.

Can someone please explain to me WHY the 4-6 week re-evaluation is SO important? What is the harm in doing SRP and then having the first perio maint visit 3 months from then? As a perio pt, every appt is a re-evaluation of their perio condition and generally we like to see the majoity of perio maint every 3 months due to the shift from gram positive to gram negative bacteria. Do other hygienists have this issue? Is not being able to get pts back for finescale in 4-6 weeks okay? Is it mainly important for new patients who need SRP to have the finescale…since with an established perio maint pt being seen every 3 months that needs LOC SRP will have been seen 3 months prior to the SRP?

I hope I am making sense here. I know it’s about giving the pt the “best possible care,” but since scheduling is so hectic, pts are already unhappy about costly SRP, Arestin, having to have 2 seperate appts for their cleaning and now I’m asking them to come back in a month or so and then get seen twice as frequently as they used to.

Just looking for a little insight from seasoned hygienists.



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The 4-6 reevaluation after non-surgical periodontal therapy/SRP is an important part of the dental hygiene process of care (assessment, dental hygiene diagnosis, planning, implementation, evaluation, and documentation) for a few reasons. The reevaluation, “tissue check,” or what some call an interim appointment, is needed to check up on patients’ homecare and give additional OHI depending on how they are doing; remove biofilm or any residual calculus (ultrasonic and handscale); perio chart to evaluate healing or any inflammation, bleeding, etc.; determine if a periodontal referral is necessary or additional treatment modalities are needed, polish, and determine perio maintenance recall schedule.
 
It is also important to reevaluate at the 4-6 week mark because if you wait 3 months until the patient’s first perio maintenance and the patient didn’t respond well to treatment (for whatever reason), additional tissue destruction can occur that could have been prevented. Periodontal pathogens can recolonize in 9-11 weeks; so for the patient that may have recolonization at 9 weeks, waiting 3 months could lead to avoidable tissue destruction and progression of disease.
 
It sounds like your office may need another hygienist or another day of hygiene added to their schedule. Just because an office is “busy,” shouldn’t mean patients should have to have parts of their care “skipped” because the office can’t fit them in (in this case, the reevaluation). In my experience, I’ve always worked in offices that could accommodate patients for their needed treatment.
 
Additional resources:
 
A nice explanation of reevaluation:
http://www.dimensionsofdentalhygiene.com/print.aspx?id=1392
 
Dental Hygiene Process of Care Explanation:
https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf

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