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Periodontal Patient

So I am a new dental hygienist for about 4 months now. I see a lot of patients for peridontal maintenance. My concern, with some more involved perio patients that I’m running into is during periodontal probing there isn’t a huge difference from the previous charting, but their pocket depths are ranging from 4-7 mm, OH is poor/fair and it seems the disease is still active. They have been on this maintenance for awhile, couple years or so. Should SRP be re-recommended depending on when it was done previously ?

Also would this type of patient always be on periodontal maintenance recall due to the depth of the pockets, since a prophylaxis is coronal?

Do you believe 4 mm pockets should have SRP done to them ?

Lastly, if after the SRP is re-done, and there still is no sign of a postive outcome. What would you reccomend to the patient ?

Thank you !!

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1 Answer

If a perio maintenance patient, or any patient, presents with active disease, 4-7 mm pockets, along with clinical attachment loss, non-surgical periodontal therapy/SRP is warranted. Remember that there are more factors to consider than just pocket depths. Be careful not to base your treatment recommendations on what insurance covers. You want to treat the patient based on their periodontal condition, not on what the insurance covers. Make sure you explain to the patient what periodontal disease is, what is causing it, what could happen if treatment isn’t given, and homecare options that can help them. Here is a link from the ADHA explaining periodontal treatment protocol: http://jdh.adha.org/content/82/suppl_2/16.full.pdf
After definitive periodontal treatment, a patient is put on perio maintenance. According to the ADA, how long a patient stays on perio maint. is up to the clinical judgment of the dentist. The ADA specifically states, “This is a matter of clinical judgment by the treating dentist. Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. However, if the treating dentist determines that a patient’s oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate.” So if a perio maint. patient has been periodontally stable for a few years, according to the ADA, they can be put back to prophy status.
To clarify, when performing a prophy, you want to scale subgingivally to the base of the sulcus. Bacteria form both supra and subgingivally, with the most virulent bacteria being subgingival. For a prophy to be therapeutic, all biofilm and calculus must be removed. Here is a Position Paper on prophylaxis from the ADHA: https://drive.google.com/file/d/0BxZ3GkplnH16UV91Sm5NN28wYVE/view
If perio treatment has been completed and the patient’s periodontal condition isn’t improving, its time to refer them to a periodontist. It may not be improving due to lack of motivation and lack of homecare, systemic conditions, among other factors.
Here is one last link that may be helpful to you: http://www.drotterholt.com/pseudopockets.html

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