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SRP missed calculus

So I am fairly new at an office. And I recently did a very hard srp. Patient hadn’t seen a dentist in 10 years. And had several 8/9mm pockets. I had a very hard time removing calculus In some of those pockets. I tried my best to remove it but I know I didn’t get it all. I feel awful and very upset because I know down the road when we take X-rays myself and others can see I missed it. Should I just slowly re treat the areas at the perio maint visits!? What does everyone else do when the pockets are very deep and hard to remove!? Thanks



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5 Answers

Pockets this deep might need a flap done with a possible graft, I would be considering referral to a periodontist.

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I am a student and this confuses me . If you have a patient with deep pocket readings and you refer them to a periodontist for flap surgery and they REFUSE yet continue to treat the for perio maintenance appts at your office couldn’t you get sued for supervised neglect? Please educate me on proper documentation of this as i dont want to make simple mistakes once i graduate?

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Probing depths 7-12mm is hard for anyone completing Non-Surgical Periodontal Therapy. A periodontist would not even perform non-surgical S/RP because they know they cannot access the base of a pocket that deep. It will require a flap surgery like Sue said. If pt refuses referral to periodontist then all you can do is try to remove the calculus at every perio maintenance appt.

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I agree with previous comments completely! Don’t beat yourself up over not removing all the calculus!! Be sure to document as much and as best as possible. Patients like these you can SRP at every appointment and still not get it all. With such deep probing depths, and probably super duper tenacious calculus, a referral after nspt is the best plan of action. Rest assured you have done everything you could do.

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Everyone here is spot on. Make sure your patient is educated regarding his/her perio; recommend referral; document if pt refuses referral.

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