Im a new hygienist and I do most Scaling and root planing procedures in my office because I have local anesthesia certificate. I continually scale the root surface using slimline left and right tips plus other ultrasonic tips, then I use my hand instruments and irrigate with chlorhexidine post op. I also give them OHI such as flossing, stimudents,listerine and waterpik if necessary. When a patient returns for the 6 week re-eval and there is no tissue reduction and bleeding is apparent what is the next step? I don''t know what else I can do to reduce pocket depth and bleeding. Any advice you have for me would be great thanks. Im getting frustrated because I feel like I am letting the patient down.
Hi - Congratulations on being a new member of our profession! Your question is one that both new and experienced practitioners face, and there''s not a simple answer. One of the most obvious factors contributing to ongoing inflammation and unresolved probing depths is that there may be residual calculus left on the root surfaces. As a new clinician, it may be difficult for you to determine this, especially if you don''t work with a periodontal endoscope. Sometimes the calculus can be burnished on to the root surface, so detecting it can be a challenge. Another factor might be your approach: it''s recommended that you use the larger ultrasonic tips for removal of heavy deposit and then the Slimline tips afterward. While there are newer ultrasonic tips that can be used on higher power, the original Slimline-type tips were not meant for removal of heavy deposits. Be sure to read Anna Pattison''s "Tips on Technique" column in the upcoming April issue. She discusses thinner ultrasonic tips and the use of anesthesia in greater detail.
Of course, there may numerous other reasons why you are seeing continued inflammation after debridement procedures (such as systemic health issues.) It would be impossible to discuss all the possibilities in this response. So I suggest you try to determine if there indeed is residual deposit left on the root surfaces. Also, if your office works closely with a periodontist, and unresolved sites that you cannot control should be referred to the specialist for care.
I hope that helps!