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SRP dilemmas

I’ve been a hygienist for almost 5 years now, and sometimes when I do SRP, I still feel like I’m missing a few calculus here and there esp the hard to reach areas. I’m not sure if this becomes better with time and experience, but any tips on how to improve? Also, my last job in another state, I was able to use local anesthetic do to SRP (which i felt more comfortable since the patient is all numbed up), and I feel that I do a more thorough job. My current office on the East coast only lets me use Oraquix, which I feel that it doesn’t really a do good job numbing up patients. Therefore, I feel like I’m not as thorough with the SRP since I don’t want to hurt the patients if i go deeper into the pockets. What’s your take on this?



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10 Answers

I agree about the use of local. It is very difficult to get to the base of the pocket and into furcations without having the patient numb. Would the dentist you work with consider doing anesthetic for you with the patients that have deep pockets?
As far as improving, I think it is trial and error. If you feel a piece of calculus, try to remove it, if you still feel it, come at it from a different angle. Another way might be to use your ultrasonic tip and “chip at it” from the edge of the deposit. Sometimes the chemical attachment of the calculus is so strong, it helps to undermine it from the border or edge of it.
Files work well on the mesial and distal surfaces, but make sure to keep it adapted to the surface so you don’t damage the cementum. Hope some of this helps. 🙂

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Oraqix works great for me unless the patient has “zings” from recession etc… I really rely on the ultrspasonic scaler using the triple bend first. Then hand scale with gracey curets and on occasion using files. Then at the end use the left and right inserts to triple check furcations and those deeper pockets. All the research now tells us that we are detoxifying and removing biofilm and calculus from those pockets and we do not need to make the cementum glassy smooth anymore.

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I agree on using local anesthetic. I feel like I can do a better srp than using oraqix. Just have to try asking your doctor adm the local. There are times where I do use oraqix if it’s just 1-3 teeth. I’m a hygienist for 9 years and there is time where I miss calculus too. You probably already know that everyone’s calculus are all different. Some are easier to remove and some are cemented like a rock! Especially on smokers! I usually start out with a beaver tail to get the heavy calculus and go back with right left or straight cavitron tips. I love using universals and Sickles on srps. I hope this helps and yes, you get better overtime.

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I am just a student and I can’t imagine only using oraqix for SRP. I wouldn’t be able to be thorough and the patient would not be happy. I would talk to your doctor about that. For the deeper pockets try the mini gracys. They work well for me along with the files.

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It depends on the tolerance of the patient…the anesthetic is for them not you, your technique should not change either way…We use mostly oraqix and for the average it works great…we also occasionally add N2O to that as most jumpy people are nervous not in pain…we do also use local if its indicated as we get going…We do however refer severe cases to the Periodontist and those are also the people that tend to be the most sensitive…Some general offices dont refer out enough…some give all perio referrals…we just adapt the best we can to whats presented….

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In the office I work at, we use local but only have a piezo and I can hardly adapt the tip to any mesial surface. Any tips on how to improve?

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Local is the obvious 1 st choice. I have much better luck with tac-gel vs oraqix.

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I agree with above, sometimes I’ll use oraqix if it’s 1-3 teeth or slightly shallower pockets in one area, but most of the time it’s better to just get them numb. I’d rather get them numb right off the bat than possibly notice later that they’re not very numb and have to go back and do it anyway! I would definitely ask your Dr about someone numbing up SRP pts.

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Great answers. I would like to add to please be kind to yourself and realize that you do not have x-ray vision nor can your scalers reach a 7 mm pocket with calculus borders that have been burnished by those before you. Do the best you can. We are highly trained skilled professionals but we are not super human. Don’t beat yourself up. The patient won’t die if you miss some calculus. I’ve been practicing for 20 years and haven’t killed a patient yet. They’re more likely to do that to themselves, i.e. not brush and floss.

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What I do is take 2BWX one on each side after S&RP at n/c to double check myself and go back obviously if u see something, of course small areas won’t show up, but helps. And my Dr has allowed me to have them back in 2wks for a n/c perio check and with shrinking u can get stuff missed. That will help if your Dr will allow that extra time! Hope I have helped!

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