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Slight-mod bone loss with recession, gen 1-3mm pocketing needs SRP?

I work for a company and they have recently changed their perio policy. They are saying if a pt has any bone loss and recession, even when pocketing is gen 1-3mm, SRP is needed. So pt’s who have been coming in and have recession and with bone loss but pocketing is 1-3mm will now need SRP, because it is below is cej. I understand they have bone loss but there is no pocket to scale. Any thoughts on what the right thing to do for the patient are greatly appreciated!



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3 Answers

This is not good, I’m sorry you are having to deal with this! Cookie-cutter treatment protocols, especially this one, are definitely not in the best interest of the patient. This doesn’t even make sense; according to this, every time the patient comes in they will be treatment planned for SRPs.
 
Doing the “right” thing would be to not abide by their new perio policy and treat patients based on individual need. However, that could get you into trouble with your employer. It might be worth having a meeting with who ever decided this and explain your concerns. Such as, performing SRPs without active infection can be seen as over-treating. Patients can sue the office/doctor(s) and they can be disciplined/fined by the board. Not to mention its not in the best interest of the patient. However, it sounds like money is the office’s first interest, not patient care, so they may not care about this (sadly).
 
Overall, you need to work for an office that shares your patient care standard. If this policy stands, it seems that you and this office aren’t on the same page. You have to sleep at night knowing you did right by your patients. Plus, you don’t want to put your own license at risk because of an office’s shady policies.
 
This is definitely a tough one! I encourage you to go with your gut!

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I will be looking for a new job, but while I’m searching I still need to have an income. I don’t want to get in trouble with the dentist and do a prophy when the pt has slight or mod bone loss with recession and 1-3mm pocketing. I understand they have bone loss and attachment loss, I’m just not on board with tx planning SRP. They are saying anything below the cej is scaling and the ADA says nothing about pocketing, only bone loss. any thoughts on how I can approach this while I’m job searching?

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Like I mentioned before, you need to talk to who ever made this decision explaining the problem with over-treating, disciplinary action and fines by the state board, and possible insurance fraud.
 
In reality, the doctor knows what a healthy pocket depth is and what isn’t. This is a “make more money” issue. However, there are several articles and CEs that state what healthy pocket depths are and what’s not. If you have any books from hygiene school, they would clearly state this information and you can show that to the doctor. Here is just one link from the Journal of Dental Hygiene on treatment planning: http://jdh.adha.org/content/82/suppl_2/16.full.pdf
Further, insurance carriers aren’t going to cover periodontal treatment on someone with healthy pocket depths. The dentist will discover this quite quickly when insurance stops paying for these.
 
Here is an article that talks about what will happen to the doctor if just one patient complains to the board (including disciplinary action becoming public record, not only to patients but insurance carriers):
http://www.rdhmag.com/articles/print/volume-30/issue-11/columns/fabricating-periodontal-problems.html
I would show the doctor this too.
 
After having a chat with the doctor, and in the meantime if the doctor doesn’t change their ways, I wouldn’t recommend over-treating patients. It’s your license on the line too. Thoroughly chart your findings: periodontally stable, pocket depths in the health range of 1-3 mm, no bleeding upon probing, gingiva healthy: pink, no inflammation, firm, recommend such and such recall interval, things like this. If the doctor wants to treatment plan SRPs over what you have charted, then the doctor needs to perform the treatment. You must protect your license! I realize this is an extremely tough spot to be in, but this is why you must talk to your doctor about it.
 
I hope this helps and wish you the best of luck!

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