Getting deep clean and scaling with my dental hygienist vs periodontist.
November 26, 2014 1:26 PM   Subscribe

I went to the periodontist and was told I needed deep cleaning and scaling (4 quadrants). I got the perio charting done and had it sent to my dentist. The dental office said they can do that procedure, which I am happy about. My question: is the dental hygienist (who apparently does 90% of the cleanings there) skilled enough to do this procedure, as good as a periodontist? I have the option of requesting my dentist to do it if I am uncomfortable with her.

When the dental office told me that they do that, I was surprised (I thought it was a specialized skill). I prefer the dentist vs. the periodontist because he is fantastic and I trust him and his practice (and they take my insurance) The periodontist was very catty and aggressive and the office clerks were just incompetent (took forever to send the perio charts, etc.). Another reason for wanting to go with the dental practice is that I was able to enroll in a program which will help cover the costs for me at this dental practice.
posted by xiaobao12 to Health & Fitness (10 answers total) 1 user marked this as a favorite
My frentist (friend who decided after raising her kids to become a dentist) and is now a dean at Tufts University School of Dental Medicine says hygienists do this all the time, no worries. But if you have concerns, ask to be scheduled with someone who's very experienced with scaling.

She also said because dental practitioners often rely upon a professional referral process you should tell your dentist's office about the unpleasant experience with the periodontist. They would want to know.
posted by kinetic at 1:35 PM on November 26, 2014 [5 favorites]

In all my dentistry past, it has been standard practice for Hygienists to do the cleanings, and actively *not* something a dentist does.
posted by Brockles at 1:37 PM on November 26, 2014 [1 favorite]

I had this done and my dentist, not a hygienist, did it. I think it really depends on who has the most experience and who you feel comfortable with.
posted by quince at 1:38 PM on November 26, 2014

As a minor detail, scaling/root planing is generally done under anesthetic, and some hygienists are not qualified/licensed for anesthesia. So, the procedure might not entirely be done by the hygienist, and the anesthesia may be done by a dentist and/or qualified anesthesiologist.
posted by saeculorum at 1:55 PM on November 26, 2014 [1 favorite]

I had a hygienist do the quad scale and put me under nitrous. I believe the dentist was there just to administer local anesthetic for particularly tough quadrants. There was no need for an anesthesiologist at my procedure. I did not have root planing.

If you are at a large dental practice with multiple hygienists just get them to do it. Ask the scheduler at the front desk to have one work with you that meets the required parameters (for example, if you have dental anxiety do let the desk know and they won't schedule you with Ms. Aggressive).

I can't vouch for whether or not the hygienists are as good as a periodontist. I can say that after I had my quad scale done 8 years ago I have had no issues with recurrence and cleanings are now routine. My results were satisfactory.
posted by crazycanuck at 2:15 PM on November 26, 2014

As a minor detail, scaling/root planing is generally done under anesthetic

Must be a question of degree. I have it done pretty regularly (significantly recessed gums) and nobody has ever proposed anaesthetic in 10 years. When I made a comment about it they said I could certainly have nitrous if I wanted it, just let them know ahead of time so they made sure to put me with a hygienist who wasn't pregnant (since it poses some risks).

I have a pretty decent pain threshold and find that if I just prophylactically take some advil an hour before the procedure I can take it just fine.

To the question - it's almost always been with a hygienist for me and it's been fine. Some have been better than others. But holy cow, DON'T GO BACK TO A TREATMENT PROFESSIONAL YOU DISLIKED! The world is full of medical folks and it makes me crazy that people enable the shitty ones by continuing to do business with them. If you decide you want a periodontist get a different referral.
posted by phearlez at 2:18 PM on November 26, 2014 [2 favorites]

I had the same procedure done this morning by the hygienist for the whole thing. They used a local topical anesthetic and did my mouth in two parts (they applied the topical to the left side after completing the right). She mentioned that if the pain was too great (it wasn't) they would numb my jaw, but then I'd have to come in again because they couldn't do both sides the same day. My procedure took 3 hours. I like and trust my hygienist, though, so definitely take that into account.
posted by homesickness at 3:27 PM on November 26, 2014

When I had it done the dentist did it himself, I was not given the choice even though he had a full time (and long-time) hygienist on staff. Since that procedure years ago I've pretty much only seen the hygienist, while the dentist takes a cursory look at my teeth afterward. In other words, I don't think he did my procedure because he didn't trust his hygienist, I think it was a more skilled procedure that he preferred to do himself.
posted by vignettist at 4:05 PM on November 26, 2014

I had this procedure done about 3 months ago. The hygienist both administered the Novocaine and did the root planing.

Dentists, man. That's a gig.
posted by kbanas at 4:25 PM on November 26, 2014

I've had sixish root planing/scaling procedures done and it was always performed by the dental hygienist. In one case the dentist was called in for a tissue check on an extremely inflamed area, which he poked around in to make sure that the pocket wasn't hiding anything the hygienist wasn't finding. I've never once been offered anesthesia and I'm allergic to nitrous. I also have no insurance, so I avoid paying for things like novocaine if at all possible. I did all six with just topicals on tender spots. It's painful but not unbearable.
posted by xyzzy at 10:12 PM on November 26, 2014

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