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How to decide prophy vs SRP?

If a patient presents with the following probings: 1-2 5mm’s w/BOP and 3-4 4mm’s w/BOP per quad, would you only SRP the 5mm sites? I’m a new hygienist and would like feedback from other hygienist what you would recommend in this situation.



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10 Answers

You need to do a complete Perio charting with PD, CAL, BOP, furcation involvement, mobility and suppuration. Those 1-4mm probing depths could have 1-?mm attachment loss and will show you exactly total attachment loss. If less than three teeth in a quad it’s selective s/rp and if more than 3 teeth in a quad it’s a full quad of s/rp. Once selective s/rp or full quad the patient is always a 4910 periodontal maintenance every continued care interval of 3-4 months.

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If there is minimal to no boneless I would do localized SRP of 5 mm pockets. However, if it is a chronic perio with mild to moderate boneless with BOP I would SRP all. You can also ck calculus at exam appt and if it’s easily removed decide on more localized. If more tenacious go for full quad. Hope that helps. Everyone is different.

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These patients are so hard to treatment plan! I still run into this problem, In addition to what Lrskda recommended I would consider when was their last cleaning, because if its been quite some time doing SRP may benefit them the most so you can clean everything well and giving them a good starting point again, in hopes they maintain good recall history. Then when I bring them back at 4mon PM if home care is good and calculus is minimal then you can consider them being a 6mon PM. This is what we do at my office.

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Thank you for asking this! I was actually thinking the same thing! In school I guess we were never really taught where to “draw the line” – basically ALL of our patients fit this need when in school.

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These patients are difficult to decide…sometimes by the time you decide you could have done the treatment :-). If it was a patient of record every 6 months perio was wnl. Then we do a perio chart (we do complete perio charting annually for healthy patients and 2x per year for perio involved patients) and the perio chart shows 5mm in 1 area with bleeding I would have to wonder if there was trauma etc…if it is a over due patient I would recommend site specific, New patient SRP. I like to know I did everything possible on a new patient then monitor success and maintain. If they are a smoker existing or new SRP always.

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X-rays, X-rays, X-rays. I find that carefully looking for radiographic calculus as well as changes in bone levels helps. I love using my 11/12 explorer and seeing if I can feel any sub gingival calculus as well. In my career I have had a couple of questionable cases but in the end I tend to choose full mouth over localized depending on medical and dental history.

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In the past I have gone with the full quad but explained to the patient that we will reassess as the treatment progresses. If you get to a tooth where there is little calculus and it is readily removed, remove those teeth from the SRP plan. Patients will never be upset when the treatment is less extensive than what they first thought it could have been. My patients have always appreciated that I am making decisions on their treatment based on evidence that I am finding and that the best treatment is being performed.

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I really appreciate your answers! I’m relieved to not be the only one who feels this presentation is tricky. Now, let’s change it up and say this is a perio maintenance patient. Would you go ahead and do quad scaling, including the 4mm’s with BOP, since they are more susceptible to disease progression?

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I would still choose based on the amount of calculus. I feel this way because we now know that the purpose of SRP is not to make the roots “glassy smooth”, just smooth and if there is limited calculus on a tooth, you really aren’t scaling and root planing. That isn’t to say that I wouldn’t be thorough on those teeth, just that I would be spending less time there, albeit I would definitely use the ultrasonic for the purpose of flushing those 4 mm pockets and doing some damage to the bacteria. I see patients all the time that have BOP with 4 mm, if there is radiographic bone loss and your probings have increased since the last visit and there is sub calc, SRP is probably the best, if there is little or no sub calc and numbers are stable, perio maintenance might be my call.

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This is going to help you

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