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What pockets are to deep to SRP in a general dentistry office and when should a patient be referred out?

My dentist frequently makes me do SRPs on patients with 7, 8 and even 9mm pockets. I just feel as if these pockets are too deep for me to be doing the patients any good. I feel they should be referred to a periodontist. Is it normal for hygienists to do this? When I show my concern about this my Dr. tells me he has 25 + years experience and I need to trust him. If I “scrub the heck out of these pockets” then they’ll be down to 2-3 mm in no time. This does not feel right to me, however I’m new to hygiene and would like a more experienced opinion. Can even the most experienced of hygienists adequately SRP areas this deep, let alone a newer hygienist?



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4 Answers

I don’t agree with your dentist, I agree with you. Once pockets become over 6 mm there’s only so much we can adequately reach with our instruments no matter how long you have been practicing. In my opinion, a patient with multiple pockets over 6 mm should be referred to a periodontist for flap surgery. Further, if calculus is left and the tissue heals around it, it can cause a perio abscess. A patient can sue your doctor (and even name you in the suit) for not providing proper treatment or referral. It sounds to me like your dentist is either uneducated (even if he has been practicing 25+ years) or is trying to line his pockets by keeping the patients in his practice only. He is putting his license at risk and possibly yours too. It is important to work in an office that shares your standard of care, and unfortunately it sounds like you and your doctor are not on the same page.

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If you refuse to do what the doctor has asked, it could be seen an insubordination. In which the doctor can fire you. Before refusing to do what he treatment planned (SRP), I would have a meeting with your doctor. I would tell him that you are troubled that you two are not on the same page regarding periodontal diagnosis. Give examples of why not referring out can go bad – like the examples I gave in the first post. You may want to be prepared with specific examples of patients in which this occurred. State that you are concerned for him and the patients regarding upholding standard of care. Also add that you are looking out for both of your licenses, as undertreating can threaten both of your licenses and you are trying to be proactive to avoid this. With that said, I have worked with a doctor like this and no matter how many times we had a chat about my concerns, nothing changed. He was set in his ways. I moved on from that office and it was the best thing I ever did. If you do decide to stay at this office, make sure you chart that the doctor recommended such and such treatment instead of a referral to cover your back. Also, if you stay, you might want to invest in malpractice insurance of your own.

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Okay, thank you. I had a feeling this was completely off, but wanted to make sure I was not missing something. I definitely think you are right about wanting to keep the patient in his office to make all the money he possibly can. This particular patient has had endo problems in these areas and my doctor is telling me to wait for it to heal and then do SRP. It’s sad because I’m so grateful to have a job. But he’s making it impossible to live with these ridiculous requests. Am I allowed to refuse to do an SRP?

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I I’ve been practicing for 20 plus years in my opinion srp 6mm’s then what doesnt heal refer out. At least you may have prevented a full mouth treatment with perio dds and may only need isolated treatment and possibly saved your patient some money.

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