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One hour full mouth SRP

I might soon be working for an office that requires its hygienists to perform one hour/full mouth SRP’s. I’m already stressed out and I don’t even know if I have the job yet. How many injections would that even be, and which types/landmarks would you suggest? Help.



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2 Answers

If you are already stressed out at the amount of time you are given (or lack thereof) for appointments, it may not be a job you want to accept. Personally, I don’t feel like 1 hour for full mouth SRP is enough time. Offices that are patient-focused tend to give 1 hour per quad so you able to treat the patient thoroughly. Not having an appropriate amount of time for appointments is not only a disservice to the patient but its hard on the clinician, both physically and mentally. Burn out is a big possibility with keeping a schedule like this, as is musculoskeletal injury.
 
As far as injection landmarks, they would be the same as if you were doing 1 quad.
ASA/IO: height of mucobuccal fold directly over first molar. Feel for infraorbital notch below eye pupil, move down to foramen.
PSA: height of mucobuccal fold above the maxillary 2nd premolar, 45 degrees out and down from occlusal plain. Other landmarks: maxillary tuberosity, zygomatic process of maxilla.
MSA: height of mucobuccal fold above the maxillary 2nd premolar.
IA: insert at mucous membrane on medial side of mandibular ramus, height of where pterygomandibular raphe goes vertical. Insertion: half way to coronoid notch, then half of that back (1/4 out from raphe), barrel of syringe over contralateral premolars.
long buccal: mucous membrane distal and buccal to the most distal molar in arch, syringe parallel to occlusal plane.
 
UR: ASA/IO (2/3-3/4 carp), MSA (1/2-2/3 carp), PSA (3/4-1 carp)
UL: ASA/IO (2/3-3/4 carp), MSA (1/2-2/3 carp), PSA (3/4-1 carp)
LR: IA, long buccal (1 carp)
LL: IA, long buccal (1 carp)
 
If a patient isn’t profoundly anesthetized and an injection must be redone or additional infiltrations need to be done, there’s added anesthetic.
 
Some hygienists like to do all 4 quads at once, however you need to question if you are comfortable giving that much anesthetic and if the patient can even handle having their entire mouth anesthetized. On a side note, its normally not recommended to anesthetize the entire mandible at one time because of self-mutilation risk. Being numb also makes patients feel “swollen” and a patient can panic if they feel like they cannot breath or swallow. Not that we treat according to insurance, but some insurance won’t cover a full mouth in one sitting. To get around this, some offices submit the claim over several days, which is fraud. You definitely don’t want to be a part of that!
 
Lastly, when hygienists accept being treated like a money-maker robot and accept working under these conditions it perpetuates the cycle of hygienists being treated poorly and isn’t good for the hygiene field as a whole. Not to mention it perpetuates a cycle of poor patient care. Its best to stick with offices where patient care is the main focus, not just the bottom line (money).

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I agree with Kara, find an office that cares about patients and their well-being and you won’t be put into a situation where you have only limited time for a variety of skills that need to be performed. I worked at an office like this and it was miserable, and when I found my forever office, you’re valued as a professional and not as an employee.

I don’t believe 1 hour for a full mouth SRP is adequate for you to do your job well and for the patient’s well-being. Good luck on your job search

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