What is the S/RP protocol?

[predentchick]

So a patient comes into the clinic and needs full scaling & RP. Do you do a general cleaning first and then break it into quads, or do you just go staight to the S/RP in quads and don't do a general cleaning first. Does this make sense??

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[grtuck]

So a patient comes into the clinic and needs full scaling & RP. Do you do a general cleaning first and then break it into quads, or do you just go staight to the S/RP in quads and don't do a general cleaning first. Does this make sense??

Never thought about it before, but I just start doing the Sc/Rp and incorporate the polishing (cleaning) into it.

 

[1-16-17-32]

In general I would go strait in and start S/RP in quadrents. But if it was a situation where the mouth is awfull and there is calculus everywhere and you dont really have an idea what you are up against, and because of all the calculus you cannot get probing depths and assess what is going on, then I would do a gross debridement, and follow that by individual quadrants of scaling.

 

[predentchick]

thanks! i HATE perio. HATE HATE HATE. Can I say that?

 

[DrJeff]

In general I would go strait in and start S/RP in quadrents. But if it was a situation where the mouth is awfull and there is calculus everywhere and you dont really have an idea what you are up against, and because of all the calculus you cannot get probing depths and assess what is going on, then I would do a gross debridement, and follow that by individual quadrants of scaling.

Thats esssentially how I do it in my office. When a new patient comes in, perio data is charted first, at which point one of my hygenists will come and get either me or my partner(when my hygenists come over they basically will tell my partner or I that new patient X is in the chair, it's been Y amout of time since their last cleaning, their perio charting shows Z, and they'll make a suggestion as to how they think the patient should be handled periodontally (i.e. cleaning only, scaling for sides or quadrants, gross scale and then proceed or if they think a referral to a periodontist (or oral surgeon) may be needed). Then either myself or my partner will examine their mouths and make reccomendations as to films that need to be taken and the type of perio treatment that is needed.

In general, if we're going to be scaling them, unless they are covered with obscene amounts of calculus (i.e. giant walls of calculus engulfing all the anteriors and/or calculus on the occlussal surfaces ) we'll reappoint them for scaling with anesthesia and just do the initial exam/data collection and films the first visit. Only if they have the equivalent of 10 pounds of calculus will we do the gross scale/perio debridement prior to the regular scaling/root planing. The most frustrating thing though with perio treatment isn't getting the patients to accept it, its coding it properly to get the insurance coverage that the patients expect, and then keeping the coding proper in the subsequent perio prophy/perio maintenance phases that scaling patients will be on after initial therapy is done

Oh yes and as I've posted before, I hate perio, so I really love my hygenists and they get compensated quite well in preventing me from have to "scrape schmutz!"

 

[predentchick]

Great post Jeff. Thanks.

 

[Mr. So-So]

I actually don't mind doing perio. With slimlines, sharp instruments, and an assistant capable of polishing/flossing/giving OHI, actual treatment doesnt take much time Dr time. Actually, being in process of building out a stratch build-out practice, having a hygienist reallly isn't a possibility in the short term anyways.

DrJeff, do you have any experience doing accelerated hygiene? (hygienist working out of 2 ops with an assistant)

 

[markyman]

question from someone who hasnt started doing perio yet:

what is entailed just a cleaning/hygiene vs srp vs gross debriment/scaling? whats the difference?
Also which of the above is perfomed during a Supportive Periodontal Treatment phase (recall)?

thanx

 

[12YearOldKid]

cleaning/prophy = scraping schmutz off teeth
gross debridement = scraping enough of the schmutz off teeth so that you can see what you are doing
scaling and root planing (srp) = scraping schmutz off teeth above and below the gumline

I apologize if that was too technical.

 

[DrJeff]

DrJeff, do you have any experience doing accelerated hygiene? (hygienist working out of 2 ops with an assistant)

My partner and I have talked this concept over with our hygiene team, and even though our hygenists realize that this would lead to an increase in their pay(they get an hourly salary which is evaluated quarterly based on production and if production is up, so is their pay), they weren't interested in it. And in a very competitive hygiene market like mine is, we don't want to "rock the boat" and find the practice short a hygienist. Or as we look at it from a business perspective a full hygiene team not wanting to do an "accelerated" hygiene schedule = lost POTENTIAL income for us. An unhappy hygienist leaving or practice and forcing us to have to cancel hygiene patients until we can find a new hygienist(it took us 6 months last time ) = lost ACTUAL income

I'm learning as my years of practice go on that one of the keys to keeping my mental sanity intact is a happy team at the office, and as such, anytime we contemplate making major/drastic changes to how the office operates as thr owners, my partner and I want to make sure that the entire team thinks that its a good idea that will benefit not only themselves, but the entire office.

 

[ItsGavinC]

I'm learning as my years of practice go on that one of the keys to keeping my mental sanity intact is a happy team at the office,

Errrh, what he meant to say was "lots of golf". Just keepin' it real.

 

[DrJeff]

Errrh, what he meant to say was "lots of golf". Just keepin' it real.

It's actually lots of golf from April through November and lots of skiing from November through April! That's how I keep my sanity!