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Tough pockets

When I work hard scaling out pockets and do all I can do to heal a patients mouth I get frustrated when it doesn’t work. I have only been a hygienist for a few years but I still take it to heart when it doesn’t work the way is like. I blame myself. I have even suggested referral to periodontist a in these cases but my boss often want to wait it out. This makes me uncomfortable. What do all of you do with cases like this? I tend to avoid pocketing greater than 6mm to ensure patients get the best care. I refer out for these.



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8 Answers

Its hard not to take it to heart when pockets don’t heal the way we expect or hope for. And I think you are right to refer for pockets deeper than 6 mm. That is what the periodontist specializes in and if they are qualified to help the patient in ways beyond our means in a general practice office then its the right thing to do. The fact that you care enough to even ask this question tells me you are a great hygienist who cares about the outcome of her care and not just there ti collect a paycheck. Just remember sometimes we do all we can but there are so many factors in getting a positive healing response to care and some we can’t control. Genetics, systemic diseases (maybe even unknown by the patient), home care, stress, and thorough scaling my the hygienist are only a few of the factors that contribute to the end result. You can’t put all that blame on yourself. Just continue to work on the skills you are in control of that help the patients and you can leave work knowing you did your best.

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I agree with Hoosier, there are many factors that contribute. Along with your thoroughness in treatment, make sure the OHI you give is understood. I always demo and send them home with freebies to help with compliance. Often, I can be found on the dental aisle of local stores, I do this to make sure that what I am suggesting they use, they can find.
If there are any medical issues that might complicate healing, I always stress the connection and the importance of their diligence at home.
I always discuss the importance of a healthy diet and how adding just a few fruits and vegetables into their daily routine can help tremendously because of the antioxidants gained.
It does feel frustrating when things don’t go as planned, but know that we are only really in control of what happens in office.

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Absolutely refer for the patient that doesn’t get a good result…I prep the patient for the referral before he even comes in to say hello….if he by chance poo poo’s my referral then its on him…BUT I will always follow up with that patient suggesting the consult….added knowledge early on from a specialist only adds to their desire to save their teeth…I am sure to stress that a consult is not an obligation….most follow thru….but I will say 99% of the people I refer, he backs me up….after all, its us doing the probing, evaluating, and the treating…

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I think the amount of time I spend on homecare is good and I always do demos. One of the issues I run into most is compliance. I have had a couple of patients have full mouth SRP every two years and they just won’t do the work at home. It frustrates me but I can’t force them.

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Most of the issues are due to the patients home care. We can clean to the base of each and every pocket once a month, but if they aren’t controlling the plaque and biofilm at home it will not be as effective. I often teach my patients Dry Brushing (without toothpaste) until their teeth taste and feel clean. I tell them it can take as long as 5-20 minutes, but it works. I had a patient with 5-6mm with isolated 7mm on #2 DB and DL. Now since using dry brushing with the mouthwatchers toothbrush his 7mm is 5mm and he has 3-4mm elsewhere and no bleeding. Low plaque and biofilm now.

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You are doing the right thing in wanting to refer. You cannot take it personally, although that’s what most of us hygienists do. I agree with Hoosier, it can be patient compliance or systemic. Make sure you’ve covered all these areas.

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I had a gentleman come in the other week for his first perio maint after SRP. His pockets were about the same as when I started on him. I told the dentist I didn’t think he would benefit from a maint because he needed to see periodontist. When I advised the pt we were referring him out, he said he really didn’t do his home are could we do his SRP again and he would do better. I told him to talk to the specialist bout it

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I just had a pt new to our office that came in with a ridiculously high blood pressure, and bleeding generalized 5s and 6s. Very little buildup, supra or sub. He had has a deep cleaning twice in the past. He obviously hadn’t been good on keeping recalls (it had been about a year since his last cleaning), and the homecare wasn’t terrible but could’ve been better. I felt wishy washy about doing SRP again bc I am not sure that it will help due to the lack of calc (although I’m sure there is plaque) and the fact that his health isn’t completely under control. But I know that that is what I am able to do to try to help him, and if that doesn’t work, we will talk the referral talk. (And have him talk to his Dr.)

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