Amy Nieves, RDH Amy lives in Apopka, Florida, and practices clinically in Florida. She devotes many hours of her time to www. amyrdh.com, a dental hygiene Web site that includes the popular RDH e-mail community. Her book, (co-authored by Shirley Gutkowski, RDH, BSDH) The Purple Guide: Developing Your Clinical Dental Hygiene Career, is available at www.rdhpurpleguide.com. She welcomes comments at amy@amyrdh.com.

Q: I get 50 minutes to do scaling and root planing (SRP) on 2 quadrants. I always feel extremely rushed and unsure of myself. What is the average time for scaling a quadrant? The dentist has set up my appointments: x-rays, probing, oral hygiene instruction; SRP on 2 quadrants; SRP on the remaining 2 quadrants. Two weeks after the last SRP appointment, I polish and reprobe. (The dentist believes that a 2-week recall is appropriate for the reevaluation appointment; I say it should be at least 4 weeks.) No one is getting referred to a periodontist. Today, my last patient had 4 mm to 7 mm pockets. I had 50 minutes and I felt that the dentist was practically tapping his foot waiting on me. Should I demand more time for SRP?

A:I have over 20 years experience, and I take 2 hours for 2 quadrants. This allows time for anesthesia. I would not reprobe after 2 weeks. We schedule a 6-week reevaluation and a 3-month periodontal maintenance appointment. At this time we scale, polish, probe, and apply minocycline microspheres as needed. This appointment is 1 full hour, and I use every minute of it. We also decide at this appointment how to proceed depending on how the tissue looks, pocket improvement, bleeding on probing, the patient’s need for oral hygiene instruction, etc. I realize how lucky I am to work with an ethical and knowledgeable dentist.

—Smiling RDH

A:You should definitely ask for and demand more time for SRP. In my office, I see a new patient for a 2-hour appointment. I take a full-mouth x-ray; full-mouth periodontal chart; do a bacterial sample under a microscope; take a BANA enzymatic test; chart existing fillings, crowns, etc; discuss all findings; and have the dentist come in for an exam. If a diagnosis is made for periodontal scaling, the dentist allows me to decide how much time I will need to do a complete job. I feel lucky to be in an office where the dentist works hand-in-glove with the hygienists to do what is best for the patient. After all, isn’t that what it is really all about? Ask for more time. You need to do what is best for your patient.

—Anonymous

A:Assessing the time needed is not always possible until a dental hygienist is actually in the process of SRP. It can be difficult to assess the ease or difficulty of hard deposit removal simply by running an explorer or probe over calculus surfaces. There can be some cases where 25 minutes per quadrant (your 50 minutes for 2 quadrants) may be sufficient, and for other cases, 60 minutes per quadrant is not quite enough time to thoroughly SRP. My dentist routinely allows 60 minutes per quadrant. This helps to eliminate time-crunch stress from the hygienist and, if the hygienist is able to complete the SRP in less time, the extra time can be used to go over home-care follow-up treatment and other oral hygiene instruction. SRP requires fine motor skills, which can be physically demanding, and the extra minutes for the hygienist to rest her working hand, while doing other nonpatient-care tasks is invaluable. For probe readings greater than 6 mm, our office refers patients to the periodontist. Our standard of care for evaluation appointments following completion of SRP is 4 to 6 weeks. Two weeks is insufficient time to evaluate the response of periodontal tissues.

As you know, SRP is a nonsurgical, conservative approach to stabilize active periodontal disease. It is possible that retreatment therapy may be needed if the disease does not become stable. If retreatment is unsuccessful, the next step would be surgical intervention from the periodontist. This information should always be disclosed to periodontal patients. Some offices do not do this and the patients falsely assume that once they’ve had “deep cleanings,” that’s the end to the periodontal disease problem. Good luck with your research and hopeful enlightenment of your employer.

—RDH in Texas