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Full Mouth Debridement before s/rp?

I had a patient yesterday that hadn’t had a cleaning in 12 years. He was very sensitive to probing and had generalized 4mm pockets. He was in his 20’s so bone loss was not advanced at this point. My doctor recommended FMD before the s/rp. I’m worried about my patient being too sensitive for that appointment and being unable to do much. I think I’ll be ok to use a topical anesthetic. Do most offices recommend a FMD before s/rp? Any tips to make a comfortable FMD appointment?



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4 Answers

We learned in school that an FMD is not the best thing to do prior to SRPs because the tissues can start to heal leading to bacteria trapped in the pocket and a possibility for a perio abscess. The only time I have done FMDs is when you can’t visibly see enough to take the perio measurements due to heavy supra plaque.

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I usually do FMD when it’s a gingivitis case. I call it an IPT (Initial Perio Therapy) and in 6-8 weeks re-eval probing and it pseudo pocketing improves then Fine Scale (Adult Prophy) dependent on OH if good 6 month recall. If bad go over OHI and decide if 3-4 month recall would be better until home care compliance is good. Reason I treat this way is the FMD (IPT) code if pt is gingivitis with just slight bone changes etc…. Then at the 6-8 week Fine Scale appt if pockets are still present and those areas have some bone loss then if needed you can do Selective S/RP or quad S/RP and insurance will not deny the S/RP. If you only do an Adult Prophy and at the re-eval appt they need further Perio treatment insurance will deny it. Adult Prophy is used with healthy adults above the gumline only.

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For new or returning patients who have not been to a dentist in quite some time and have heavy buildup, we do FMD with a return in 6 weeks for perio charting, comp exam and final prophy. Depending on charting, we either appoint for SRP or an appropriate recall. I had one recently that did FMD, 6 week final prophy and then 3 month recall. No resolution of pockets,some actually got worse, now doing SRP. He is young too (29).

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I agree with Shawnie. With the absence of bone loss, I would do a thorough prophecy with anesthetic in two appointments. The patient would be responsible for paying for one of the appt.s.
The patient would be comfortable and you could be thorough.

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