On the first appointment I have to decide how I will continue treatment. The questions I answer are:
1. How much calculus?
2.How old is the calculus?
3.Where is the gum infection..buccal, lingual, interproximal?
4. How fearful is the patient?
5.How much do they have to learn with their oral hygiene?
They will be put into one of three categories.
1. Less than 12 mos since last cleaning acceptable oral hygiene...adult prophy, oral hygiene 101
2.More than a year since last cleaning but not too long and poor oral hygiene..... two appointments two weeks apart.... gross debridement, oral hygiene 101...two weeks later adult prophy, review oral hygiene 101.
3.Lots of old calculus,poor oral hygiene, fearful, worse than the first two categories...
*First appt...gross debridement with Titan sonic cleaner of all teeth(getting outer layer of softer calculus off..refer to "Calculus and it's characteristics"), oral hygiene 101, give proper tools to do the job ie tooth brush, tooth picks, approximate perio readings for insurance etc.
*Second appt two weeks later...gross debridement with Titan of all teeth(getting outer layer of softened calculus off), review oral hygiene, paying attention to technique, do they have any questions, be sure to compliment on any progress they have made.
*Third appt two weeks later....finish gross debridement with Titan and hopefully start root planing, review oral hygiene problems and compliment patient on progress.
*Forth appt.... start or finish root planing, perio reading again because first ones approximated, review and compliment on oral hygiene progress.
The advantage of this process is: You don't get carpal tunnel from trying to get old tenacious calculus off on the first visit...You don't have to anesthetize the patient because you go as far as they can tolerate and stop....the next visit they will be more healed and will be able to continue farther and calculus has softened....They have homework to do and they aren't so sore that they can't practice what you are preaching......They will come back in 4 or 6 mos for recall because you treated them with respect and didn't hurt them....The appt. can be shorter because it doesn't take two hours to gross debride.....The patient describes the procedure like scratching an itch.
I put two weeks between the appointments because if they are missing places with their oral hygiene technique it will start to show up....sooner the healing will be a result of what you did. The other reason...I want enough time for the newly exposed calculus to soften.
I write in charts SRP UL, SRP LL, SRP UR, SRP LR...I have accomplished the same thing. The insurance company wants me to go from A to Z in each quadrant in four appointments. I go from A to H in the first appt G to M in the second appt N to S in the next appt and T to Z in the last appt. The end result with both is the same. Except it was easier on you and the patient.
1. How much calculus?
2.How old is the calculus?
3.Where is the gum infection..buccal, lingual, interproximal?
4. How fearful is the patient?
5.How much do they have to learn with their oral hygiene?
They will be put into one of three categories.
1. Less than 12 mos since last cleaning acceptable oral hygiene...adult prophy, oral hygiene 101
2.More than a year since last cleaning but not too long and poor oral hygiene..... two appointments two weeks apart.... gross debridement, oral hygiene 101...two weeks later adult prophy, review oral hygiene 101.
3.Lots of old calculus,poor oral hygiene, fearful, worse than the first two categories...
*First appt...gross debridement with Titan sonic cleaner of all teeth(getting outer layer of softer calculus off..refer to "Calculus and it's characteristics"), oral hygiene 101, give proper tools to do the job ie tooth brush, tooth picks, approximate perio readings for insurance etc.
*Second appt two weeks later...gross debridement with Titan of all teeth(getting outer layer of softened calculus off), review oral hygiene, paying attention to technique, do they have any questions, be sure to compliment on any progress they have made.
*Third appt two weeks later....finish gross debridement with Titan and hopefully start root planing, review oral hygiene problems and compliment patient on progress.
*Forth appt.... start or finish root planing, perio reading again because first ones approximated, review and compliment on oral hygiene progress.
The advantage of this process is: You don't get carpal tunnel from trying to get old tenacious calculus off on the first visit...You don't have to anesthetize the patient because you go as far as they can tolerate and stop....the next visit they will be more healed and will be able to continue farther and calculus has softened....They have homework to do and they aren't so sore that they can't practice what you are preaching......They will come back in 4 or 6 mos for recall because you treated them with respect and didn't hurt them....The appt. can be shorter because it doesn't take two hours to gross debride.....The patient describes the procedure like scratching an itch.
I put two weeks between the appointments because if they are missing places with their oral hygiene technique it will start to show up....sooner the healing will be a result of what you did. The other reason...I want enough time for the newly exposed calculus to soften.
I write in charts SRP UL, SRP LL, SRP UR, SRP LR...I have accomplished the same thing. The insurance company wants me to go from A to Z in each quadrant in four appointments. I go from A to H in the first appt G to M in the second appt N to S in the next appt and T to Z in the last appt. The end result with both is the same. Except it was easier on you and the patient.
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