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Perio Abscess Post SRP Tx

I recently performed half mouth SRP’s on a patient. His pocket depths were 4-8mm. Pt presented with generalized moderate radiographic calculus.
A week after tx, he was back in the office for an emergency exam. Turns out, he developed an abscess on the distal of #18 where there was a 7mm pocket from both the buccal & lingual.
Of course, being the over-analytical worry-wart that I am, I couldn’t help but ask what was wrong with my patient. When I asked my boss at the end of the day, she pulled up the PAX that was taken that day and showed me that there was a piece of residual calculus. She explained that the tissue healed around it and formed an abscess.
Okay. Totally embarrassing slash mortifying. 🙁 feeling really defeated and horrible that I caused a patient so much pain. Im worried this patient will never want to see me again. 🙁 has anyone ever experienced this before?



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3 Answers

Thank you Kara! I really appreciate the advice. It sure is wild what one can encounter in this wonderfully complex world of Dental Hygiene. Again, thank you for your inspiring words!

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Don’t feel defeated; once pockets become over 6 mm there’s only so much we can adequately reach with our instruments. In my opinion, this patient should have been referred to a periodontist for flap surgery. While you may feel horrible remember that you did not give this patient periodontitis; you were trying to help them. I’ve never had this happen personally because my doctor refers when necessary. This may be a conversation you need to have with your doctor. Again, don’t feel bad, even though that is so much easier said than done! Try to take this as a learning experience. And maybe it will show your doctor the need to refer out, in turn providing better patient care in the future.

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Kara,
Why is it that in some cases hygienists or dentists will leave calculus behind and the patient never develops an abscess? Also, at all 3 of the offices I work at, neither one of the dentists refer out if a patient has pockets 7mm and deeper until SRP tx is completed and little or no improvement is found. Is this wrong? Should I address this issue? Thank you!

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