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How to access deep perio pockets

My doctor is wanting me to scale patients with loc. 9-12m pockets. The patients have already been told it would be best to be seen by a periodontists, and I have not hidden my discontent with the idea of treating them in our office due to risks of unresolved pockets and perio abscesses. So I now have a couple of questions… Of course I’m documenting documenting everything about that pts refuse to see perio and that I have explained that due to the severity of their perio disease there is little chance that I will be able to reach the base of the pockets. Is there a law or scope of practice concern here (I practice in WA)? Also what does a perio hygienist do that a general hygienist doesn’t do? How the heck can I reach that deep of a pocket? my cavitron tip measures 9mm before it curves, are there any specialty instruments that I can look at?

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1 Answer

A perio hygienist would treat as a hygienist at a general practice would, however, the periodontist would do flap surgery after treatment to access the pockets for thorough removal of calculus. Hygiene instruments are only effective up to 6 mm, and if you use an endoscope, that’s even questionable. Your doctor could be setting both of you up for neglect or malpractice by having you treat these patients. Because of that, I’m glad you are documenting. If a patient loses a tooth or an area becomes abscessed, I’m not sure how your doctor is going to explain that you weren’t able to treat the area(s) properly which is why they lost a tooth or got an abscess. The conversation alone could implicate neglect. Whether there’s a law or scope of practice concern, you’d have to read your state’s practice act or call the board for clarification. I’m sorry you are being forced to do this. I certainly wouldn’t be comfortable with it either!

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