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Does every 5 mm require srp?

I work at an office where one of the hygienists will treatment plan every 5 mm as srp. Occasionally the srp will be scheduled in my chair, so I see them. I have found that many times I will re-probe and get a 4 mm. There is no bleeding or calc. Just a 4 or 4.5 mm pocket. Does this require srp? I am a newer hygienist so maybe I am missing something?



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2 Answers

It’s always a tricky situation when you don’t agree with a treatment plan by another hygienist. Using your clinical judgement, do you feel these patients have active periodontitis? Just because you are a “newer” hygienist, doesn’t mean you don’t know what active perio presents as! I would definitely be concerned if this is happening on a regular basis. A 4mm pocket could be pseudopocketing from bruxism (clinching) not necessarily perio, for instance. Do these patients have active bone loss (lamina dura not seen on crestal bone) or any sign of disease besides just a 4 mm pocket? You said there was no bleeding, which tends to be the first sign of infection. So, I question what’s going on here too. It might be a good idea to sit down with the doctor and the other hygienist and actually talk out what the office’s perio protocol is. You don’t want to say that you need a meeting because you don’t agree with the other hygienist, make it come across that you want everyone to be on the same page so the patients get the best treatment possible. However, if this continues after a meeting, I would go to the doctor privately and explain your concern of over-treatment. My point is, not to throw the other hygienist under the bus if she just needs a refresher (I’m trying to give her/him the benefit of the doubt here). Again, you are a highly trained professional and if you feel something isn’t right, it probably isn’t and you aren’t just “missing something!” Good luck!

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I would use my own judgement. You may have less clinical experience but you are just as qualified to make decisions. I’ve had a similar thing happen. I did not do SRP, did Ad Px, documented why and explained to the patient that once I ‘got in there’ it wasn’t as bad as previously thought. I did not want to ‘throw’ the other hygienist under the bus either. I told her sometimes it’s hard to determine until you’re actually ‘in there’.

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