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Residual Calculus

Yesterday I was given the opportunity to watch our periodontist in action. I work in general practice but we also have a specialist that comes in every once in a while. The patient was a periomaintenance patient and his chief complaint was bleeding and exudate when flossing #11. The periodontist anesthetize done patient and determined that there was a large piece of residual calculus on the facial. The pocket was 7 mm, however, during PM appointments and Annual PC, this area was only reading a 2-3 mm PD. Of course I was astonished because myself and two other hygienists had seen this patient since SRP. It was definitely an eye opening experience. My question is to seasoned hygienists, what is the best way to detect something like this? The patient did not Present with deep pockets during annual readings, great oral hygiene habits, no bleeding on probing or inflammation in the surrounding areas. What are somethings I should be looking for to prevent this from happening?

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I’m not a periodontist and don’t mean to question one, but I wonder how one could determine it was “residual” calculus and not a change in homecare, occlusion, fractured root/crown, etc. that led to the pocketing, hence plaque impaction and calculus formation? I say this because if multiple different hygienists who have been seeing this patient have always measured a 2-3 mm pocket, I just don’t see all of you being wrong and “missing it.” Especially if it was large as the periodontist stated. Further, has the patient been undergoing stress (clinching), changed meds, or had any other lifestyle changes? If the patient never presented with bleeding, pocketing, exudate, or inflammation it just seems this is a new symptom due to another factor besides “residual calculus.” For instance, I once had a patient who was diligent in her 3 month appointments (alternating perio office and general office), excellent homecare, compliant with nightguard, however presented with one 9 mm pocket – this change happened within 3 months. Severe bruxism had led to a fractured root and there wasn’t a darn thing that a hygienist really could have done to prevent it. I’m just glad I found it before it abscessed. As hygienists, we just can’t prevent everything. As long as you are using your critical thinking and assessing probe depths, tissue, bleeding, bone loss, taking the appropriate radiographs, assessing and educating on homecare, and all of the tools we learned in our education, I just can’t think of much more you can do. That is unless your office wants to invest in an endoscope. Again, I really don’t like second guessing another professional, but there has got to be more to this than multiple hygienists leaving residual calculus.

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