Most patients are well served to have their overall dental care managed by a
single dentist (assuming well versed and well trained).  I see a lot of
problems when patients run from perio to pros to endo with no one coordinating
the overall care.

Even if you are ultimately referred to a periodontist, many gp's do first phase
perio preparation before the specialist ever sees the patient.

Charlie Ruff, DMD
Specialist in Orthodontics
Diplomate American Board of Orthodontics

You could go to a periodontist and have their hygienist do your scaling and
root planing.

If the hygienist is competent, there is no problem.  If you trust the
dentist, you should trust their ability to hire and train a good hygienist.

Depending on which hygienist was working for me at the time, I have varied
my approach to this subject.  When I had a hygienist who was excellent at
scaling and root planing (S&RP), they did all the initial therapy, and then
we switched off back and forth on the follow-up care.  When the hygienist
working for me was not good enough at S&RP, I did it myself.

If you trust your dentist, you should trust the hygienist.

Dr. Steve

| A new dentist I just visited for the first time wants to charge me $200
per
| quadrant ($800) for his DH'ist
| to do the above.    Is it common for DH'ists to do this?   He says HE does
| the anasthesia.   I'm sure there's a variety of skill levels of
hygienists;
| but
| i have no way to judge.      It will
| be 2 visits.   My insurance won't even cover any periodontal procedure.
I
| wonder if I should find a
| periodontist.   I'm pretty sure I DO actually need this procedure, and
| possibly more periodontal work
| (since my gums show some bone loss, etc., and several measurements of "4"
| and "5".
|
|
|
|
|
|
|
|

Thanks for keeping a negative image of me in your mind.

By train, I do not refer to the ability to perform S&PR, but the ability to
perform as a team member within his/her office.  Train as to a uniform
method of charting within the office.  Train as to a specific protocol for
handling perio patients.  Train as to how to handle the processing of
instruments. Etc.

Please don't tell me you think every dental hygienist is fully qualified to
perform S&RP on 6-9 mm pockets on molars with furcation involvements.  Many
are very adept at this, but many are not.  The challenge is for the dentist
to find a hygienist who can perform the procedures needed in that particular
office.

Some dental offices refer out all their perio Tx.  They do not need an RDH
who can S&RP.  Some offices don't need an RDH who can place sealants.  Each
office has different needs.

Happy Holidays to you Pat,  I hope your celebrations are as full of life and
family love as possible.

Dr. Steve

| Hello Dr Steve and all,
| Ouch!  There you go again  "train" a hygienist. Hygienists are well
qualified by
| their education
| to scale and root plane teeth.  Just as dentists are educated and receive
| training in dental schools, hygienists are prepared for their profession
in
| accredited schools of dental hygiene.
| I'll give you that not all of us, dentists or hygienists,  are the
absolute best
| at each and every procedure.  This is why dentists specialize and sometime
a
| hygienist must return to polish her skills.
| When I began working in a perio practice I had been a hygienist for 20
years,
| the most recent
| 3 years in pedo, plus a year of temping.  I had worked with my boss for
4months
| just one day a month when he offered me the position. He had mentored me
| discretely and continues to mentor me now.  I would like to think I taught
him a
| thing or three too, but not in the clinical area.  I attended the Penn
root
| planing course.  We shared the cost.  It's one of the best courses
| I've ever taken.
| If your dentist thinks his hygienist is qualified to scale and root plane,
I
| would assume she is, unless  you don't trust the DDS.  If you are only
having
| two appointments,  this is 1/2 mouth
| treatment.  Two hundred $$$ seems a reasonable fee.  Is there a re-eval
| appointment?  There should be,  although in some cases it is done at the 2
or 3
| month check-up.
| Pat Buss RDH
|
|
| >
| >
| >
| > |
| > |
| > |
| > |
| > |
| > |
| > |
| > |
|

(Joking! Only joking about that.)

REAL QUESTION ONE: What is the diagnosis about your gums? That is the
number one question.

Figure a treatment plan first . . . .

How many missing teeth? How long since your last dental visit? Any
cavities? Any need for crowns? Etc.

Does this apply for othodontics as well? Do you prefer that the
general dentists do orthodontic preparation before seeing the
specialist? Many dentists are well-trained in this.

Cheers,

Joel

---

Charlie
Charlie Ruff, DMD
Specialist in Orthodontics
Diplomate American Board of Orthodontics

then $400? Jeez, I am going to dental hygiene school!

Let us know when you finish.

Cheers,

Capt. O

To the patient asking the original question,
1.  Periodontists have the same degreed hygienists doing the exact same thing.
A lot of the hygienists that work for periodontists also work in general
practices.
2.  Make sure that the hygienist is licensed by the state, and ask to see the
license.  That ought to make you feel better.
3.  With the level of pockets that you have described here, it is perfectly
natural to have the periodontal therapy done in the general practice
4.  There are only a few states that "allow" dental hygienists give local
anesthesia.  Wisconsin is one (yeah, ask me about it in March).  It is not
uncommon for the dentist to give the local prior to periodontal therapy.  At
the level of your pockets, a great many patients don't NEED anes.  A topical
will do.

TIPS:
1.  If you can take ibuprofen, take it 2 hours before the procedure.  What do
you say doctors 200 or 400 mg?
2.  Floss gently and properly from now on.
3.  Ask your hygienist to teach you how to use a water jet.
4.  Ask to rinse with Listerine or chlorhexidine before any treatment is begun.

Shirley Gutkowski, RDH
The harder you work, the luckier you are.

Ortho by G.P.

Hello Charlie!

I am holding in my hands the before and after models of the
last orthodontic case that I treated. It looks pretty decent.

In fact, it was actually a  "minor tooth movement" case which
I did in 1965. Like other dentists of that era, we
straightened out minor crossbites and stuff like that.
Towards that end, I purchased and studied plenty of the
standard textbooks and took those three-day hands-on courses.

Now we all know that this does not make me an orthodontist!

In fact, we dentists of that era got away with that kind of
stuff because "tooth straightening" was not so ingrained in
our society.  This little child looked woeful because both
upper lateral incisors were in cross-bite. After my
treatment, they were no longer that way.  Improvement!

Did I do this patient a service? Possibly yes, possibly no.
Did she really need complete orthodontic care? Possibly yes.
Again, I am not the expert. Unfortunately, at the time there
were no programs that would accommodate her.

What I soon discovered was that I could not bring all of the
knowledge and all of the judgement that you guys (the
orthodontists) bring to our respective patients. Over the
years, I continued to take the courses.  You know, I am
referring to those little courses that general dentists take
to skim off the easy cases. But unlike my colleagues, I vowed
never to TREAT any more orthodontic patients. I recognized
early on that malformations and malocclusions need to
evaluated and treated by 'professional' orthodontists, not
amateur ones like me.

Over the next 35 years, I was very fortunate to participate
in some extremely busy practices. This I attributed to the
fact that I chose my work carefully and I became an expert in
those areas that suited me best. Similarly, I suspect that an
orthodontist would be lacking if he chose to treat an
immediate denture case here and there. My patients also
appreciated the fact that I had their best interests at
heart.

I continued my interest in orthodontics. It is a fascinating
discipline.  Understanding how teeth and jaws, tendon and
muscle all work together is no simple process, but a very
important one.

Cheers,

Joel M. Eichen, D.D.S.

TANG SOO !

Mike

Please read my reply to Pat's remark about this post.

Thanks for ganging up on me.

I wish you nice ladies did not have it out for me.

Best wishes at a time of the year to appreciate your love and your families.

Dr. Steve

|
| >If the hygienist is competent, there is no problem.  If you trust the
| >dentist, you should trust their ability to hire and train a good
hygienist.
|
| Dr. Steve!!!  I know you were probably in a hurry and didn't catch this
little
| "wording problem".  A hygienist is licensed by the state to do the
procedures
| that this patient is asking about, except in Alabama.  Some are better
than
| others, just like some doctors are better than others.  SRP is not a
procedure
| that is "trained" by the doctor to the hygienist.
|
| To the patient asking the original question,
| 1.  Periodontists have the same degreed hygienists doing the exact same
thing.
| A lot of the hygienists that work for periodontists also work in general
| practices.
| 2.  Make sure that the hygienist is licensed by the state, and ask to see
the
| license.  That ought to make you feel better.
| 3.  With the level of pockets that you have described here, it is
perfectly
| natural to have the periodontal therapy done in the general practice
| 4.  There are only a few states that "allow" dental hygienists give local
| anesthesia.  Wisconsin is one (yeah, ask me about it in March).  It is not
| uncommon for the dentist to give the local prior to periodontal therapy.
At
| the level of your pockets, a great many patients don't NEED anes.  A
topical
| will do.
|
| TIPS:
| 1.  If you can take ibuprofen, take it 2 hours before the procedure.  What
do
| you say doctors 200 or 400 mg?
| 2.  Floss gently and properly from now on.
| 3.  Ask your hygienist to teach you how to use a water jet.
| 4.  Ask to rinse with Listerine or chlorhexidine before any treatment is
begun.
|
|
| Shirley Gutkowski, RDH
| The harder you work, the luckier you are.