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What determines the need for SRP?

I’m a recent grad and I’m having a hard time determining treatment for SRP. Besides the obvious sub calc, bone loss, inflammation, and 5+mm I’m good to recommend a SRP. But I’ve seen a couple of people for tx of SRP who visually look fine, hardly bleeding, oral hygiene good, 5mm pocketing and bone loss but they have had SRP in the past. My question is what determines the need for SRP? Is it the bone loss?

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1 Answer

When treatment planning SRP, it doesn’t really matter if they’ve had SRP treatment in the past, it matters how they present today and what treatment would best suit them right now. There are many factors that determine the need for SRP. Some of these criteria include probing depths, bleeding on probing, clinical attachment level, the degree of furcation involvement, the extent of recession, tooth mobility, and plaque score. The question to ask yourself is if there’s active infection. If so, is it gingivitis (inflammation, bleeding, etc. without clinical attachment loss) or periodontitis, causing tissue and bone destruction.
Just because a patient “looks okay” upon visual inspection doesn’t mean they don’t need non-surgical periodontal treatment/SRP. As mentioned before there are many factors to consider that you can’t see just by visual inspection. Further, bleeding is a sign of infection even if it’s mild. Patients who use tobacco tend to look fine clinically and present with not much bleeding, however, they have may have active infection. This is because nicotine is a vasoconstrictor which keeps bleeding to a minimum and hides inflammation. This is where a patient’s health history can be of great importance.
Here’s a good article that walks through the diagnosis of periodontal treatment:
Also, don’t hesitate to pull out your hygiene books from school, if you still have them, to do a review on treatment planning, etc.

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