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Do you do SRP on 4 mm pockets?

Was wondering if you do SRP on 4mm. Some of the doctors I work with want me to do them and I don’t feel comfortable doing that. And some doctors want the deep cleaning if there is just a tiny piece of calculus on the X-rays. Would love opinions on this? I would usually do a debridement then see if they need a deep scale after a few weeks.



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6 Answers

This is tough because there isn’t a black and white answer. If the patient has generalized 4 mm pockets with attachment loss (recession, bone loss, etc.) and was too tender for you to do a thorough scaling, then SRPs may be indicated as anesthetizing would be necessary. I think you should use your best clinical judgement (as you have been!) and do what you think is best for each individual patient and what you are comfortable with. It’s hard and frustrating when dentists want you to do something and all of your education tells you it’s really not the best treatment option. So again, do what YOU believe is the best treatment as you have been and in my opinion I think you have been doing the right thing! I hope this helps!

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I only do SRP’s on patients with 5mm pockets or higher. According to my office manager, who also does our billing, she says insurance will pay for 4mm or higher. I thinks its a little overkill if there is no moderate to heavy radiographic sub calculus. If I detect heavy sub cal, its generalized, and its radiographic I will recommend SRP treatment. If non of the above is detected I will explain to the pt if they do not improve their homecare and regular routine hygiene visits, I would recommend SRP tx in the future.

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It will vary from patient to patient. If they have 4 mm pockets with no bone loss and little to no sub calculus than the patient has gingivitis and not perio. In this case we usually do an 1110 prophy but that code is supposed to be a prevntative code on healthy patients but gingivitis means they already are in an unhealthy state. But does that mean SRP or a debridement is necessary? Usually not. So what do you do? I think we need a gingivitis treatment code. I only do SRP when the patient clearly has active perio because that is what SRP is for. That means bone loss, 5 mm plus probe depths, inflammation, BOP and sub calculus. If a patient has some but not all the criteria make a judgement call. Tell your doctor your criteria for recommending SRP and if he doesn’t agree and refuses to listen to the perio professional in the office then either do it the way he wants or consider finding an office that has similar view points as you do.

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No, I do not bill out for SRP on anything less than 5 mm pockets. If a patient has localized 5 mm pockets and they are stable no SRP. If pockets are increasing we may do localized SRP. Any patients with pockets over 6 mm are referred to periodontist for evaluation and treatment. I feel many offices over charge patients for SRP when it is not necessary by doing this they are no longer a regular prophy then become periodontal maintenance which is often not paid by insurance companies. I think there is a lot of abuse by offices trying to up their hygiene production at the patients expense.

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It depends on the patient honestly, I will do srp with generalized 4mm, bleeding and radiographic calculus. Also the root of the inflammation is important. Is the pt on a ton of meds, a mouth breather? Sometimes srp but other times I will do a 4 month recare instead depending on X-rays and med hx.

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Depends on the patient. If there are multiple 4 mm pockets with heavy calc and bleeding then yes. If there is not much sub calc then I do not. Sometimes I will perform a regular prophy first and explain to the patient that if we are unable to remove the calc during the prophy that they will need to come back for a more thorough cleaning aka SRP.

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