{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
{5000 - 24999} RedRed
{25000+} BlackBlack

Please confirm that you would like to report this for an admin to review.


New hygienist probes and finds deeper pockets than other RDH. SRP?

A patient has been coming in for years for Prophy’s 6 MRC, his probe readings have been 1-3mm with localized BOP. You come in as a new Hygienist and do a Full Mouth Probe and your readings are different. you are probing 1-3mm with Localized 4-5mm BOP. Do you recommend SRP in those localized areas?



Confirm that you would like to Remove Email Alerts for your question. You cant undo this and you will not be able to re-subscribe.


13 Answers

I would recommend localized non-surgical periodontal therapy/SRP in those areas if there is active bone loss on his radiographs or any clinical attachment loss change. You treat what you are presented with at the time because it’s a fine line of if the hygienist wasn’t as thorough with scaling or probing or if it truly is a lapse in homecare on the patient’s part. It could even be a change in the patient’s health history increasing risk factors for perio.
 
If there’s no clinical attachment loss (including active boneloss) and leaning toward gingivitis, non-surgical periodontal therapy isn’t warranted. There, you would want to educate heavily on home care, demonstrating proper brushing and flossing technique (or proxy brushes or water flosser – whatever is best for the particular patient). I would link the need for homecare to the periodontal disease process, to really make the patient understand how homecare (if that’s the issue) makes a difference. Then at the next appointment, reassess the patient’s periodontal condition and go from there.
 
You don’t have to do a debridement before non-surgical periodontal therapy. A debridement is for a patient that has too much plaque/calculus/material alba that the doctor cannot do a proper exam. It is scaling above the gumline. Debridements get tricky because to a patient, it “looks” like their teeth are clean, but subgingivally (where it really matters) they are not. I only do debridements when absolutely necessary because if the tissue closes up around any calculus it can cause a perio abscess. Whether you need to do a debridement is based on need and clinical judgement.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


Is there sub calc, change in med Hz, change in home care? These are just some of the things to consider. 🙂

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


Yes! There is a reason why you probe more than just at a comp exam! Periodontal status can change over time and that’s how you should explain it to the patient, even if you think the previous RDH didn’t probe correctly.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


Thanks. From insurance stand point, can you go from a Prophy to Localized SRP (4342)? Or would you have to go into a debridement first?

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


Yes. I would recommend LSRP and explain changes in probing depths, disease, systemic link etc. I would not recommend debridement & there’s no need for one first unless you feel it’s needed

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


From insurance standpoint you can go from prophy to LSRP…just be sure to have documented probing depths.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


After 4342 you will charge out 4910 not 1110 for 3-4-6 month continue care interval.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


Thanks ladies! I understand that educating the patient IS VERY IMPORTANT.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


You’ll need to consider more than just probing depths to make the diagnosis. CAL and X-rays are imperative to make a decision. Gingivitis can also have 4 & 5mm pockets, so clinical attachment loss and X-rays need to be considered before making a decision.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


I hate when my boss recommends debridement on a new patient when they clearly need quad scaling. He says, and reasonably so, it’s so he can get proper probe depths etc. But I find it extremely hard to get patients to consent to sc/rp after debridement cause they just can’t seem to understand thrusters different things so I never recommend debridement if I can help it. Also I find our other hygienist never records pocket depths she says she probes but I see no proof of it but even my measurements can vary 1/2 mm or more in a six month period. Operator error is always an issue

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


I would agree with Sue. I would consider other factors before making a decision.
If I did recommend SRP, I would explain to the patient that this is why we routinely check the pockets, because changes can occur that quickly. If you are questioning your measurements I would explain that you found considerably deeper pockets and think a SRP may be necessary to the Dr (before he goes in for exam) and ask if he minded spot checking a few pockets.
I too had a Dr that liked to perform FMD before SRP. I explained to patients right away we would just be removing enough calculus to get accurate readings and some calculus would still be underneath the gum line. If at their next visit (a week or so later) pockets were greater then 4mm we would have to do a SRP to remove the calculus that remained.
I always use the analogy that the tarter is like a splinter in your finger. As long as it remains under the tissue there can be no healing and the infection will remain and get worse until it is removed. Even if the splinter is no longer visible to the eye.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


This is a very difficult situation and I have been there…today! I tend to take a conservative approach and use the opportunity to educate the patient about periodontal disease and how it can be episodic. I go heavy on the home care instructions and demonstrate the correct way to floss and recommend any other extra home care products that will help them out. This gives them a chance to own it and to let them know that if the pocket depths and bleeding doesn’t improve at their next recare appointment then it’s time to talk about periodontal therapy. It sets up a good foundation for success if periodontal treatment is needed and prevents the other hygienist from looking neglectful. If the problem becomes consistent with other patients then it might be time for all the hygienist to calibrate their periodontal probing technique. We did this in our office, where one patient volunteered and we all probed the same quadrant. We also had a local periodontist come to our office to discuss periodontal disease and the correct way to probe. It’s a matter of getting on the same page.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


That’s a great idea! To calibrate periodontal evaluation.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


You must be Logged In to Answer this Question

Already a Member, Log In
Not a member yet? Sign Up