Today was Janette's first day as a dental hygienist. Who is Janette you ask your computer screen....well she is the newest member of the Cedar Dental Center's team. She graduated from Dixie State College in May and has successfully procured a job at my office about 1 day before I knew Candice was moving down (but do not worry about Candice-she beat out 4 DSC girls for a job at a really good office here in Cedar! Way to go girl!). Back to Janette; since today was her first day it reminded me of July 6, 2006 which was my first day. It has been a great year. I cannot believe how fast it has gone. I have had so much fun at work that it does not seem like I have spent any time there at all. I have had backaches, finger cramps, wrist throbs, neck tweaks, shoulder twinges and my share of bad breath....from my patients not me.... but it has been a great 365 days.
Even though I have graduated and passed all the board exams I learned more this year that I ever thought possible. Luckily I have had some great mentors and friends who have helped give me advice through this blog and over the phone. Thank you to all you ladies who have helped me. So here is yet another question I have been trying to deal with. I had a patient who had 11 mm of recession on the palatal of 15. Pretty much that whole palatal root was exposed. The pocketing was 9mm on distal and mesial with 4mm on straight palate. There was not any mobility-HUGE roots. Anyway the root surface was covered in this soft substance. It did not look like calculus or feel like calc but I did my best to remove it anyway. I fear that I was removing cementum. This brings up the quandary of when are we removing cementum-which the PDL needs to reattach to the tooth- and when are we removing calc? I know we have all seen the aggressively scaled root surfaces and know that we can and do cause damage. So when do you leave that roughness on a root surface and when do you scrape that root smooth? In school I was taught to remove EVERYTHING, to get the roughness off and to have perfectly smooth teeth before getting a scale check but in perio class we were taught that Scaling and Root Planning was a procedure that could be too aggressive and going out of popularity.
Today I clean teeth to the best of my ability--which is SO much better that when I was in school! I try to get every deposit off of each tooth and I try not to be too aggressive on those fragile root surfaces. I hope I am doing an ethical and professional job.
6 comments:
I don't really have any advice for this one, but I will tell you that I was blown away by the 11 mm of recession and 4 mm pocket depth....you weren't kidding when you said HUGE roots!!!!
I love your blog for this purpose; we all need to rebound quandaries like this. When I am not certain about a rough area I have to trust the surrounding tissue. It will not lie, if there is an irritant causing infection it bleeds and has that "darker" appearance. I have a few “maintained” patients with root exposures similar to this; however the 9mm pocket does not indicate health. Regardless of the amount of recession, in order to maintain any area, the pocket needs to be within that WNL limit. The patient would not be able to adequately debrid or clean a 9mm pocket, regardless of the compliance level. My opinion is that you have to do an analysis of what this tooth has to offer. Is it impossible to close a 9mm pocket with SRP and arestin? No. Is it difficult? Yes. Is it worth it based on this tooth’s guarded prognosis??? There’s the dilemma. Based on the patients history you have to decide, with so much recession and root exposure, surgical pocket depth reduction may be a futile effort. My bottom line… 9mm is not health. Efficient debridment of the root structure with gracey’s is necessary in conjunction with 3 mrc. Follow the hints the tissue is giving you. If it is gushing blood then a deposit is most likely present, if it is not, it is probably spec calc present on root anatomy. 9mm is an important key to this quandary. I love the approach of “trying not to be too aggressive on those fragile root surfaces” that seems like a great guideline and motto to remember, sometimes we (or maybe just I) go crazy with SRP over small irregularities, it is a great reminder that it is a fragile area that requires a fragile balance to heal. Thanks for throwing this out there; I think the fact that you are still concerned about proper treatment is the pinnacle of ethical treatment. (sorry so long)
Thank you so much for your advice! I was of similar opinion when I dismissed my patient. The hard thing for me is that I have to wait 6 weeks for the re-eval to check the tissues to see if I did get all the calc out of there like I thought I did. This waiting game is tough on me....Thank you anway. I needed your help!!!
Hi! It's been a long time. I can't believe how busy I have been. Most nights I am just so tired. I am working in an office for the rest of Aug 4 days a week and it's double hygiene. Double hygiene kills me. Anyway, love your blog still
Hey! That was so fun to see Hairspray! :) We will have to go to one of the plays soon...I really want to see Mousetrap, Matchmaker, and Lend Me a Tenor...you don't have to go to all of those, but let me know!
missing mary ann :o( I am hoping this means you are having SO much fun this summer that your blog is not even hitting your radar. :o)
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