Personally, I wouldn’t necessarily “offer” a prophy. Instead, I would explain the the reason for perio treatment, the difference between a prophy and SRP, the benefits, the risks and prognosis if the patient does not undergo treatment, then let the patient decide for themselves. If they decline treatment the patient should sign an informed refusal form and you should chart like crazy what you explained to them.
I read a great response on a thread about patients refusing perio treatment, one hygienist said, “From time to time I will see a patient who just flatly refuses perio treatment and adamantly wants the free cleaning. So I say, “What do you expect that to do for you?” Usually they respond with something stupid like, “I will have clean teeth.” So then I say, “So if it’s important to you to have clean teeth, is it also important for the entire tooth to be cleaned? Because if I perform your free cleaning we will be cleaning only the portion above the gumline. So is it ok to leave the part under the gum dirty? And is it ok to leave the infection there too?” Sometimes I will give another analogy: “Let’s say you have a cut on your arm and it’s now infected below the skin level. Do you want me to wash the surface with soap or do you want to treat the infection? If you want the infection treated why are your gums different? Is it because it doesn’t hurt or you can’t see it?” “Do you ever smell people with bad breath that make you take two steps back? Do you understand that these people can’t smell it? Do you want that?” (http://www.dentaltown.com/images/Dentaltown/magimages/0913/DTSep13p34.pdf)
This article gives a good example of a refusal form:
This is always tough and very frustrating! Educate the best you can and let the patient make their choice from there.