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Perio issues Dr. and patient

Please help, I have a patient that have sever perio 7-10 mm with puss present on more than half of his mouth, horizontal bone loss, furca involvement on max molars, radiographic sub calc. He had RP/S in our office in 2010, 2012 (not by me) pt had NOT improved, if anything has deteriorated. I stressed to DR that we can NOT do another perio maintenance he needs to see perio asap. I was looking ahead in my schedule and I saw him for a perio maintenance and a note that we can NOT RP/S again until later in 2014 in the fall. What to do?? Do I perform the perio maintenance knowing that it is doing nothing, start RP/S or refuse to see him and send him to perio ???? The patient is young in his 30’s.



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Author Note:
Maybe I did not make myself clear, I did inform the patient, I explained etiology of perio used a flip chart, showed him his x-rays and the puss present upon probing. At this point is were I stressed seeing a perio ref. THE DOCTOR went in after me and completely disregarded everything I said to the patient, and does not think it is as bad as I'm making it out to be. I found this out when I saw him back on my sch and I looked @ his notes.

13 Answers

I work in a perio office and when we have patients that don’t want RP/S because of insurance or finances. We just make sure to educate the patient about what is going on and we continue to do the maintenance with the patient understanding we aren’t helping the issues causing their periodontal problems.

I would suggest you talk to your doctor and still do the maintenance so you can educate the patient about their conditions and refer to a perio office. It sounds like this patient might need surgery.

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My dentist would say “do the best you can” and document everything you do and say. I think the patient needs to at least know a referral is an option and if they decline then just do the best you can.

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That’s such a sticky situation because you want to do the best treatment for the pt but you must follow your dentist protocol. I would tell the dentist that when the patient comes in for perio maintenance that I am telling this pt he need a periodontist. This is hard but its your hygiene license as well. Hopefully your dentist understands.

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I see alot of answers saying clear it with the Dr and follow his protocol…are hygienists not taught to treatment plan anymore?…If this was my patient I would explain the situation and status from what we have been hoping to improve the last couple times…stress its absolutely not working and a perio referral is completely necessary is saving teeth long term is their choice…the patient would be informed, and told about the referral before the Dr even enters the room…He’s not treating the perio, I am…so the follow up and need is mine….He/She follows it up with a “yes absolutely” and if the patient ultimately declines then treatment plan is altered…most however want to hear what is said at a perio consult…

Not informing the patient and waiting for the Dr is not how I was taught…I completely chart, evaluate, and treatment plan all patients prior to his courtesy visit when I’m done…I absolutely would tell a 30 year old with severe pockets to get his butt to a periodontist if he wants his own teeth in old age…

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Debbie have you ever suggested that the pt see a periodontist only to have the Dr. Go against you recommendation. Happens all the time and the Dr. Will say we are not sled to diagnose of refer. ..

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Sounds like supervised neglect from the dentist. We are trained to spot/educate/treat perio. If you take that away then what do we have. Remember we are all licensed individuals we need to not take that for granted and it sounds like your doctor is. I would still stand by what I find. Refer the pt again and discuss that a “cleaning” is getting him nowhere. Good luck 🙂

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I would talk to the doctor about how you feel. If he wants the patient to be seen, request the doctor see him.

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I would see him for the next “perio maintenance” appt & rec to the Dr that the pt be referred out to the Periodontist. If pt refuses, document & have him sign the record. Unfortunately, we can’t force a pt to follow-up with the specialist, but if we don’t tell them it is needed, we are not doing our job!! Good luck!

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I feel it is about standard of care. From what you said, this pt needs to have more aggressive therapy. I would express my feelings to your boss with clinical justifications. If he does not respond to this, chart, chart, chart…

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Explain your findings to the doctor. This patient cannot be treated up to the standard of care in a general office. Your doctor should agree with you on this and refer to the periodontist or perhaps another option is to schedule for extractions and full dentures. Explain the situation to your patient and stand firm. Myself, I wouldn’t even attempt to do any treatment with this patient except for patient education. There have been a few patients over the years we’ve referred out to perio, they never go, but they schedule a hygiene apt 2 years later and expect a prophy. I refer out again. If I know I cannot treat a patient with the utmost of care, I tell them so. I am glad my doctor let’s me have “control” over my patients hygiene care.

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I would explain your findings to the DR first and suggest either refer to periodontist or see patient every 3 months…I have patients that refuse to see a periodontist b/c of $$ so I SC/rp and have them back every 3 months for maintenance.

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If patient refuses to go to Perio, give him a prescription for PerioStat. Be sure you have explained the consequences of not treating the disease more aggressively. Document patient’s refusal for treatment in chart.

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Spot on DebbieG!! It’s our duty as hygienists to educate our patients! Not informing the patient is definitely below the standard if care. Encourage the patient to go for a perio consult , then once he receives all the info he can make a decision weather to persue perio therapy or not. If they refuse a referral … Document, document, document.

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