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Conflict Srp

I have a pt who has been coming regularly on a 6 mo checkup for a few yrs. At last visit she complained her gums were bleeding when she brushed at home. After examining her gum tissue it was inflamed and red gen and even more so in anteriors. She has bleeding gen also much more than I have ever seen on her. She is on a new medicine but the dr doesn’t think it is medicine induced. She has 2-3mm pockets gen with a large amount of recession 2-6 mm throughout and therefore some boneless. Heavy calc is always present with her. My dr sugg full mouth srp. I agree with him that she needs gym therapy to get her healthy again. The other Hygienist at our office states ” how could you possibly do that and you can’t do that on someone who has 2-3mm pockets only” my Dr says you can esp with her recession. I agree with him. I always use USS on her. The other Hygienist asked ” so what are you going to do differently than you have usually done for her” please share your thoughts on this and any advice.



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3 Answers

I would really look into the new medicine this patient is taking and see if it poses a bleeding risk or xerostomia risk. I say this because if nothing has changed with her homecare, you have to look at the factors (lifestyle, meds, homecare products, etc.) that have changed. Not that we treatment plan according to insurance, but with pockets of only 2-3mm, I doubt insurance would even cover the treatment of SRPs. Maybe they would take into account of CAL, but I’m not sure. I guess my question is, is this patient’s gingiva inflamed or does she have active bone loss (lamina dura present?)? Of course all of this is hard to say without seeing the patient myself, but from the sounds of it, my thoughts are more aligned with the other hygienist.

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I can see where you are coming from because with the recession like that there has been boneless. I would also struggle with Sc/ RP because you don’t have the pockets but we know it’s not healthy because of the bleeding. Personally I would think too your not really doing anything different.
I would love to hear more people’s thought on this. I believe her diagnosis as type 3 perio which technically means you would( or someone previously) have sc/rp and she would be on perio maint. That is my school side. My real life side would probably shorten her frequency to 3 months , look into the meds. I don’t truely know the correct answer. But I do have issues with Sc/Rp when you aren’t doing it. ( does the fact that the roots are already exposed count as root planning?)

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maybe the patient is grinding…try a night guard
heavy calc? with heavy bleeding but no 4mm pockets…sounds fishy
i wouuld do a fm debridement, peridex rinses at home, 3 month recare

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