As a new hygienist, I want to become more confident with diagnosing periodontal disease. What would you do if a patient presented with 4mm's with BOP posteriorly, with one or two 5mm's per quad? In school, we learned that 4mm's with BOP are unhealthy, but some insurances won't cover SRP unless there are more 5mm's.
Additionally, when would you consider that a perio maintenance patient needs another SRP treatment? Again, knowing that 4mm's with BOP show active disease process, would you first encourage better home care then re-probe the next visit? Since the patient has already exhibited bone loss, I wasn't sure if you would wait to treat until there were 5mm pockets or be more proactive and treat when there are 3-4 4mm's pockets with BOP per quad.
Also, if you have any recommendations on where to find perio protocols, I would appreciate the advice. Thank you.
Thanks for your questions - I truly applaud your desire to learn more about assessing and treating periodontal conditions. First, I'd like to point you to the best resource available for any questions related to periodontics: the website of the American Academy of Periodontology at http://www.perio.org. If you click on the tab that reads "Publications" and then "Clinical and Scientific Papers" you will find a wealth of evidence-based information. However, know that the best way to treat conditions once you discover them is to keep in mind that there is no set "cookbook" approach as each patient and each site must be treated individually.
One of the biggest risk factors for developing periodontal conditions is if the individual has a past history of periodontitis. In the examples you give, it sounds as if one of the patients has exhibited bone loss. This individual should be on a frequent recare schedule (at least every 3 months) to ensure his/her condition remains in check. I can't sufficiently answer what you mean by "wait to treat." So many variables enter into the decision, such as the patient's overall health, age, smoking status and more. My suggestion would be to read the AAP resources, specifically "Parameter on Periodontal Maintenance" and "Comprehensive Periodontal Therapy." These should give you good background information.
Regarding the other patient with 4-5 mm probing depths, bleeding and no bone loss, stress to the patient that he/she has early signs of disease and that you need to work together to make sure the disease process is reversed. Diligent oral hygiene is key in such cases. The patient needs to know that he or she controls the direction his or her oral heal is headed. If the patient returns and has performed diligent oral hygiene yet bleeding persists, then you need to determine if there are other conditions (perhaps systemic) that are causing the inflammation & bleeding.
Periodontics is challenging but can also be very rewarding. Unlike treating other oral conditions, there is a lot of "gray" in perio. If you use the available research and your best clinical judgment to treat your patients, you will know you have done your best.