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Gross debridement vs SRP?

I recently saw a new patient at my office. It had been 2 years since his last prophy. Before that he had gone every 6 months. So, in 45 minutes I completed an FMX and gross debridement with an exam. As I was going around, there was heavy bleeding, deepest pocket depth of 4 mm, moderate supra calculus lower anteriors with moderate sub tartar posteriors. I advised the patient to return for the 2nd prophy and he agreed. Quite honestly, I don’t know if I did the right thing. I still don’t know when to do SRP VS GROSS DEBRIDEMENTS. In my office we rarely do SRPS, mostly FMD’s and fine scaling after. He left and I just sat in my unit feeling defeated after I worked so hard to help him. I felt like after I decided I was going to do a FMD then prophy, I was second guessing my decision. I feel like this is something I should just know what to decide instantly, but it’s so hard. I need some advice.. and perhaps some comfort!



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I’m proud of you for reaching out to help with your treatment recommendations! Before reading my answer, I want you to know that I’m just trying to clarify, not make you feel like you were wrong or anything along those lines. Here it goes…
 
Full mouth debridements should only be done if a patient has so much debris, plaque, etc. that a doctor cannot do a proper exam. In practice, I rarely do FMDs because I personally feel they are an antiquated procedure that’s often overused and misused. FMD does not replace SRP, which is what it sounds like your office is having you do. Its much better to go straight to SRP and give the patient the treatment that they need right off the bat, all while coding correctly. By doing FMDs the patient may feel their teeth are clean and not return for definitive treatment. The tissue can also tighten and heal around calculus that wasn’t removed which can lead to a perio abscess.
 
Referencing the patient you saw, whether he needed SRPs or not depends on active infection including attachment loss. Was their active boneloss or did he have active gingivitis? If their was no indication radiographically or otherwise, of attachment loss (periodontitis), going from your description, he might be best treated with the gingivitis code, D4346. Again, this is just what I gathered from your description, its hard to definitively say without seeing the patient myself, clinically.
 
Here is a link that explains SRP vs FMD:
 
http://www.mckenziemgmt.com/managementtips/print/gallienne/PrintGallienneArticle416.html
 
Here’s a link to a study that shows FMD isn’t a “justified initial treatment approach:”
 
https://www.ncbi.nlm.nih.gov/pubmed/15998268
 
Here are links that may help too:
 
https://www.ncbi.nlm.nih.gov/pubmed/15998268
 
http://www.drotterholt.com/pseudopockets.html
 
Again, it’s awesome you are trying to figure this out! I really hope this helps!

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