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Scaling and root planing

What is everyone’s office policy on SRP? We have 5 hygienists and one who does it on any 5mm pocket even with out sub calc. I feel every case is for the individual and have seen results with flossing and a mouth rinse in conjunction with 3 to 4 mos recall. This hygienist pretty much trashed me to my boss and says our office isn’t doing it’s job as far as perio goes. I do a lot of SRP just not a few sites with bleeding. Any input?



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4 Answers

Your office should all be on one page. Maybe you need a consultant to come in and teach all five of you what is disease and what is not. Develop a protocol for everyone to go by and stick to it. Previsor is a good site to input information and get a disease prognosis since not all of you agree with each others diagnosis. IMO I think if a pt has one site or 50 sites of bone loss and 4-5-6mm pockets etc then it is periodontal disease. Whether it’s localized or generalized it is treated different than a healthy adult prophy. Yes, some pt can be placed on 3-4 recalls and floss and reduce pocketing, but really the chances of a totally compliant pt is slim to none. If you are cleaning below the gum line 4-5-6mm with bone loss it is perio disease. Adult prophy is healthy above the gum line cleaning. Once I got it out of my head that I will hurt their feelings……they will improve with 3-4 month recalls…..they said they’d do better and floss and rinse……blah, blah, blah……it’s not our fault. Treat the patient correctly. Complete perio charting includes PD, AL, Furcations, mobility, bleeding etc…..added all together: Numbers Don’t Lie…..either the numbers say the pt is perio or healthy. Trust your numbers. Trust your education. Treat the pt correctly and the pt will trust you. Hope this helps.

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Also, pocketing is pocketing is pocketing……whether there is no sub gingival calculus, lt sub calc, mod sub calc, heavy sub calc…..there is a disease process going on and a host response to that bacteria, endotoxins, food debris, calculus etc…….all must be removed. Remember Sharpey’s Fibers? Those fibers are gone and will never come back and attach that gingiva/sulcus to the root/bone ever again. Long Junctional Epithelial Tissue is what we want to achieve so that tissue suction cups against the root to reduce the pocketing. That is why you must perio chart every single time after you’ve completed S/RP……you know the perio maintenance appt 4910 every 3-4 months. You want those numbers to improve yes!, but you also do not have the original Sharpey’s Fibers you now have LJE attachment that can be healthy at one point and unhealthy at another appt. you just don’t want those numbers to increase past where you originally started with at the first S/RP appt. Let’s say all numbers added with recession numbers were 6mm and below, but a year later a few sites have increased past 6mm then you consider referring to periodontist or using an anti microbial and check closely to monitor if the pt needs to be referred. Get your perio book out and review Sharpey’s Fibers and LJE and full perio charting. I still refer to my perio books and dental magazines and journals. I always learn new perio info, techniques, pt instructions etc from all that information. I read all the time to be informed of any and all new information on anything related to dental hygiene. Sorry…..a lot of info…..I only want to help our profession and hope I have given you some insight.

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Hygenius took the words right out of my mouth! Not much more to add, great answers Hygenius!

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Perio protocol
http://bit.ly/1p5cN0b

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