Not to start a heated debate on the topic, but I was bothered by the implication of Terri Gallion-Osman`s response to the article, "The Ease of a Squirt" (January 2000). I felt she was implying that unless periodontally involved patients see a periodontist, they are receiving inadequate care.
I work four days a week in a general practice and do 85 percent of the periodontal cases, and have been working one day a week in a periodontal practice where I do 100 percent of the periodontal cases. Do I have more specialized skills one day a week when I am in the periodontist`s office? No! I am a highly skilled, competent practitioner all week long.
She states, "It usually takes two years of comprehensive training to prepare or teach a hygienist to meet the challenge of providing quality periodontal therapy to patients, despite previous work experience." Excuse me, what was dental hygiene school all about? What is my day-to-day experience worth?
I do use some of the "so-called `substitute` therapies;" however, we call them "adjunctive therapies." Does one therapy work for all patients? Of course not! In the general practice, we treat patients on an individualized plan. I am as completely capable of providing scaling and root planing procedures within the four walls of the general practice as I am in the periodontal practice.
In the periodontist`s office, it seems to be a "one size fits all" therapy. First, scaling and root planing by the hygienist, then surgery for all remaining pockets over 5mm.
Is this really in the best interest of the patient? I don`t know. Of the patients that I treat in the periodontal practice who have had surgery, the biggest difference that I see is most of them have extreme sensitiviy - not just during maintenance therapy appointments (which precludes being able to use the Cavitron), but cold sensitivity all the time. In the general practice, we offer the patients a choice. We lay out all of the options and they choose whether or not to seek specialized treatment. Some do, some don`t.
Is this supervised neglect? Of course not! This is allowing the patient to make an informed choice. Many patients choose to have scaling and root planing completed in the general office. Why? They know me and the dentist, and trust us.
I have no problem referring to the periodontist if that is what the patient chooses. However, I am finding that it is mostly the Type V refractory cases that aren`t responding to the therapy implemented in the general practice. Is referring them to the periodontist going to make them healthy? No! Will surgery improve their odds? Maybe.
I`m not questioning the value of quality periodontal therapy. I`m just offering the opinion that it can be accomplished successfully in the general practice and that it does not constitute being unaware, unethical, or incompetent as Ms. Gallion-Osmon implies. This is just my own opinion based on my own observations.
Pam Mecagni, RDH
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