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Short Commentary: SRP – More Than Simply Removing Calculus

SRP – More than Simply Removing Calculus

Hygienists provide more than instrumentation. You change lives with your concern, compassion, education and expertise. Townie “Jersey Devil” tells us about one experience she had that surprised her, and proved to her that dental hygiene care goes beyond simply removing calculus.

Two perio maintenance visits after the dentist performed scaling and root planing, I saw this 32-year-old male patient for the first time. The panoramic radiograph showed generalized calculus deposit and 4-6mm probing depths prior to treatment. Checking his medical history, he had high blood pressure and smokes.

As I seated him I asked what his home-care regime was and how he felt about his teeth. He told me “My mother and grandmother don’t have their teeth so I don’t expect I’ll keep my teeth either.” Besides having poor oral hygiene he was an overall sloppy mess and despite having had a shower, he smelled like a sour towel.

At this point, I knew I had my work cut out for me. I explained that even though he had the predeposition for periodontal disease, he didn’t have to lose his teeth. After further questions I found out that he had a Waterpik, but didn’t use it very often and he won’t floss, even with the many floss aids now available. His brushing was only OK.

Periodontal charting showed the pocketing was unchanged from six months ago. There was very little supragingival calclulus and some subgingival calclulus, with heavy bleeding in those sites. While I scaled his teeth I re-educated him on the importance of the perio systemic link, referring specifically to his high blood pressure and stressed the need for better daily oral hygiene. It was like talking to a wall. Despite all of my efforts, he was convinced that he had inherited bad gums and he was going to lose his teeth anyway. Some days it’s like beating your head against a wall. It’s so frustrating when you’re trying to help people who won’t even help themselves.

I completed the perio maintenance visit and scheduled a reevaluation appointment for 10 days later. If the pocketing and bleeding remained, we would decide between retreating with more scaling and root planing or referral to a periodontist. The patient was not at all receptive to the suggestion of referral to a periodontist. Since I hadn’t worked with the patient from the beginning, the dentist and I wanted to see if my explanation of why good oral hygiene is so important would make a difference. We decided the oral hygiene needed to be in place before we either retreated or referred him to a specialist.

Ten days later:

To my great surprise, he returned in 10 days looking and smelling better and his attitude was much more positive. We re-probed and his numbers were 3-4s instead of 5-7s and the bleeding was significantly reduced. His home care was much better and he even dusted off the Waterpik and uses it regularly now. He brushes the way I taught him and also now uses floss aids.

The dentist and I were both happy with the improvement and decided to maintain a three-month recall. He now understands his responsibility in the treatment involves effective daily oral hygiene.

Three months later:

He really has maintained everything. He even smelled better. And most important he understands that just because his mother and grandmother lost their teeth, he can keep his with the proper care. He has such a different attitude about himself and his teeth and is willing to do his part in the treatment. Hard to believe this is the same person I saw three months ago. This is why I go to work every day!
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