Dentaltown July 2017 - 49

Debridement if new patient and refer to perio for SRP. I'm done trying to persuade people
and insurances it needs to be done. I let them know they have perio and give them a referral. ■

Bro Jackson
Member Since: 09/03/13
Post: 9 of 29

5/20/2017

Just in the presentation, that's all. ...
"I am seeing gum and bone loss in several areas that has progressed over time-this means
that you can lose your teeth if this is not treated. Is that something you would be interested in
preventing?" (Of course you will get a yes.)
"We want to make sure we can offer you the most appropriate treatment that will ensure
your gums and bone stay healthy and are maintainable in the future. We will start with an initial
cleaning and re-evaluate in a month. For any areas that do not completely heal, we do have
additional treatment that can help problem areas-this treatment will prevent you from having
more gum and bone loss in the near future so that you can keep your teeth as long as possible." ■

GoOutside
Member Since: 05/24/11
Post: 10 of 29

5/20/2017

Once I ended the same-day PX-exam issue, patients did much better at accepting any kind
of perio treatment that I felt was necessary.
Schedule the patient for X-rays, exam and treatment plan. This allows you to skip the problems that come with trying to change what the patient thought they were going to have done at
that first appointment. ■

austindoc2
Member Since: 05/15/03
Post: 11 of 29

5/20/2017

harry747

If pockets are deeper than 6mm, do you refer directly to periodontist? ■
5/20/2017

At gross debride appointment, if hygienist says there's lots of sub-g calc then we go to SRP
immediately. If not too much, then re-eval in six weeks.
For over 6mm, it depends on how generalized it is. These are some of the toughest clinical
judgments I make. Gut feeling certainly comes into play, like how much compliance do I expect
to get from the patient. In my location we see patients from many different cultures, and some
are not amenable to accepting American dentistry. ■

Member Since: 07/01/14
Post: 12 of 29

Tom Mitchell
Member Since: 02/16/04
Posts: 14 and 15 of 29

5/21/2017

IMO, there's a vast difference between 4mm and 6mm pockets and you can't treat them the
same. I have lots of young patients who come in with generalized 4mm pockets with no bone
loss. You can do a gingival scaling cleaning on them, they come back in after a few months of
flossing and they look great. On the other side, there are patients that come in with generalized
5-6mm pockets who need scaling ASAP, and even after scaling them they come back after 6-8
weeks with little to no improvement. Then you need a new treatment avenue (possibly more
time, LANAP, perio referral). So it's really a case-to-case basis. I don't think you can treat all
perio patients the same-look at occlusal factors, existing restorative work, etc. It's a tailored
treatment plan to each individual patient.
Oh, and I don't get the gross debridement thing. Just get in there and scale. I've never seen a
gross debridement patient come back who didn't need scaling. ■

RockyMtnDDS
Member Since: 05/06/08
Post: 16 of 29

5/27/2017

Gross debridement has nothing to do with treating disease, and everything with getting
supragingival calculus off that prevents the examination. ■

drjhross
Member Since: 11/26/04
Post: 17 of 29

5/27/2017

dentaltown.com \\ JULY 2017

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