appropriate time for fmx and perio. cleaning

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ibflossing in Hollywood, Florida

84 months ago

Hi,

What is the appropriate amount of time for fmx and periodontal prophy ?

Thank you

ibflossing

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Tracy Jacobs in Canton, Georgia

84 months ago

If by perio prophy you mean a patient who has already undergone treatment, is stable, has adequate homecare and is "on time" for a 3 to 4 month recall, I would say 1 hour and 15 minutes. That is ideal. It could probably be done in 1 hour but not less than that. That is my opinion.

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ibflossing in Hollywood, Florida

84 months ago

Hello Tracy,

I only wish it was one hour and fifteen mins. Unfortunately, I only get 45 mins and on top of that I have to do fmx too.
I don't want to say that I'm being taken advantage of but, I believe that I am and I'm only getting paid 25 dollars. A better opportunity has to come my way soon, i hope.

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Tracy Jacobs in Canton, Georgia

84 months ago

WOW. Even "Super Hygienist" could not do all that in 45 minutes. I think 45 min is even pushing it for a regular prophy w/ bite-wings. Regadless if you are getting $25 per hour or $50, that is not enough time for the patient. They are the ones who are suffering. Perhaps something else will come your way. Just hang in there until then and just do the best that you can do.

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ibflossing in Hollywood, Florida

84 months ago

Hi Tracy,

If you don't mind me asking , how much time do you get for a regular prophy and bwx? And what about an FMX and a prophy?

Thank you,

Ibflossing

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cavitron in miami, Florida

84 months ago

yes, i do agree with you Cynthi. I'm new to the office too. You can get one complain out of 99 compliments, but they only concentrate on that one single complain.

Cavi

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Tracy Jacobs in Canton, Georgia

84 months ago

ibflossing,

I get one hour for a prophy and bwx. We usually take a panorex instead of a FMX. I can do the Pan and prophy in one hour as well. I get 1.25 to 1.5 hours for a new patient. Many offices do not allow that amount of time (I have worked in a few). I am better at my job when I have time to do my best for the patient AND connect with them on a personal level.

Tracy

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Linda in Walnut Creek, California

84 months ago

I think you can take a FMX and do a Perio Maintenance appt. in one hour if that does not include chair/room turnover time, processing X-ray time, Dr. exam time, or photos, blood pressure and other parts of the visit. I am allowed one hour for the: FMX, BP, HealthHx review, photos, complete exam and questions/teaching/informing for the patient. I am allowed another hour for the perio assessments, oral hygiene instruction, and "cleaning". When I encouraged the dentist to do the exam, fmx in hygiene. Our case acceptance and patient retention went way up. We schedule one hour for Prophy's with or without Bite-wing X-rays and periodic exams, and that includes children. Perio Maintenance appts. are also one hour with or without bite-wing x-rays and exams.

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cavitron in miami, Florida

84 months ago

I get 45 mins for perio.maintenance,4 HBX or if I have to do FMX then that's include in the 45 mins,break\set up room,doctor exam,and OHI. ALL of this in 45 mins and if I run 10 mins late I get the evil eye from the front office / dental assistant person. This is a "getting my feet wet office" and not a " I'm going to be here for as long as possible office".

I was sick and had to called off work and No one called to check up on me to see if I was doing okay. When I had a couple of hours of down time, I helped out with cleaning up the rooms and helped the dental assistant,and not even a thank you from her. They really know how to treat people.

I was told that I was the only hygienist working there but when I look at the schedule it was book on the day that I don't work there. What a liar. Lesson learn.

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Linda in Walnut Creek, California

84 months ago

There is an office out there for you. Keep looking for the "golden rule" office. Remind the dentist in the interview that you are looking for an office that treats the patient the way that they would want to be treated or would want their family treated. Forget the jargon they spout: team-oriented, progressive, professional etc. etc. etc. It's simple and it's out there! If you want an hour, you'll find it. Don't waste your time, Cavitron, you deserve better.

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cavitron in miami, Florida

84 months ago

Linda,

Thanks for the positive words. What worry me the most is this ring worm on my cheek. I've had it for 2 months now. It keeps coming back!!!

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Mike in Clinton Township, Michigan

83 months ago

Walnut Creek needs to understand she is living a dream that 99% of RDH's will never find.

Dentist = Used car salesman.

RDH = Car Detailer

Until we can 'detail cars' on our own, it will always be the rip off career we are all suffering with.

Except for those of us working for CA dentists of course.

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Linda in Walnut Creek, California

83 months ago

Not all CA dentists are like that. There are some. Mike, I agree $$$$$$$ is what most offices are about. They try to push the 50 minute schedule, but most hygienists refuse to work it, and eventually most offices are on the one hour schedule. My dentist listened to my thoughts and lucky for me we tried it. Before that the hygienists just continued to take bitewing xrays not updating the FMX needed. The dentist saw that an FMX and complete exam brought in more $$$$ and more treatment.

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cavitron in miami, Florida

83 months ago

Mike,

Yes, and ALL dental hygienist MUST stand up (get involve) so we can "own the car detailer ourself" We have no right to complain if we don't get involve. Get involve or forever hold your peace. Together, we can do this.

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olivia in Morganton, North Carolina

83 months ago

The office that I work at is the only office where the DAs do the FMX prior to them sitting in my chair and I LOVE IT! It makes sense. If one DA is with the dds and the pt, the other DA is usually free. So, while I am with my pt, my next one comes in 30 min earlier and the free DA does the FMX. I have a 50 min sch. and do 4 digital vbwx. I feel that is can be enough time, but if I run over then I resch. them back for an hour nv. My doc is a SWIFT checker too. As soon as I tell him that I am ready he is in there. I have worked for the complete opposite and that is extrememly stressful. I hate to be behind and make pts wait.

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cavitron in Hollywood, Florida

83 months ago

it does make a lot of sense. i told my doctor that , but he didn't buy it

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olivia in Morganton, North Carolina

83 months ago

Like I said, nothing agaisnt the DAs, but if they aren't with the dr. and everything is caught up, then why not?

You wouldn't have to schedule extra time in the rdh chair and would have enough time to treat them.

Some just don't get it. They think your lazy if you suggest it.

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cynd in ft worth, Texas

82 months ago

cavitron in miami, Florida said: yes, i do agree with you Cynthi. I'm new to the office too. You can get one complain out of 99 compliments, but they only concentrate on that one single complain.

Cavi

I don't get complaints from patients. I love working with my patinets. It was just getting use to the routine. I am there now and love it. things settled, and everyone knows how and what and where. I enjoy fast pase, and keeping busy. Knowing how others are doing and compairing makes it easier. thanks for the support.

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Kristin in Canton, Ohio

81 months ago

I am currently living in Ohio and am looking to relocate to North Carolina. It seems that the job market is pretty good and I have a good friend there. I have to take the CITA clinical exam in order to be considered for licensure. I will probably take it at UNC Chapel Hill in June. Do you have any words of wisdom for me? Do you think it will be worth the trouble?? Oh and having more that one DA in the office must be amazing. I only have one and she is rarely available to take x-rays. I almost take all FUll Mouth's and prophys and am only given 30 mins.

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Jessica in New Haven, Connecticut

81 months ago

I work in a perio office in Connecticut. I get an hour for a perio maintenance visit and BWX's, and an hour and 15 min if they need an FMX or Panx.

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Ella in Mamers, North Carolina

80 months ago

Kristin in Canton, Ohio said: I am currently living in Ohio and am looking to relocate to North Carolina. It seems that the job market is pretty good and I have a good friend there. I have to take the CITA clinical exam in order to be considered for licensure. I will probably take it at UNC Chapel Hill in June. Do you have any words of wisdom for me? Do you think it will be worth the trouble?? Oh and having more that one DA in the office must be amazing. I only have one and she is rarely available to take x-rays. I almost take all FUll Mouth's and prophys and am only given 30 mins.

I just moved back to NC from Arkansas where I practiced in a general office for 3 years. I recently found out I am pregnant and have decided to not work for a while. When I first got back though all I have heard is that the job market for NC is very bleak because NC has flooded the market with several new hygiene schools since I left. My instructors tried to fore warn us this was gonna happen. The problem I think may arise too that even if you find a job your pay may not be great because dental hygienist are a dime a dozen so to speak. That is great if you have connections, but I tell ya I have a lot of connections too from school, and again I will say I think the job market here is bleak. Personally I am not too concerned right now since my focus is somewhere else but it is something I think about for the future. I must say too, upon moving here please become a member of the ADHA, NCDHA, this state needs all the members it can get!!!!!Without members no change can happen. Our membership for this state horrible!!!!! Everyone wants to complain and no one wants to get involved.

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Kristin in Canton, Ohio

80 months ago

Congratulations!!! Thanks for the advice. I have recently decided to complete my BS before I move and build my resume before I decide to make such a change in my life. I am even considering a career change for my experience thus far has not been so great. If and when I move I will for sure become a member of the NCDHA. Thanks again for the advice. One more question... do you know a lot of hygienist's who are using local anesthetic for patient comfort like when performing SRP in North Carolina. It is part of the NERB exam now and is accepted in Ohio for Dental Hygienists.

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Ella in Mamers, North Carolina

80 months ago

Hey, thanks for the congrats. It sounds like you are doing a great thing by getting your BS. That or getting pregnant were my 2 goals and the latter came first, that's ok. I am 36, and this is my first, so it's about time. I will go back to school in the future. The main reason I wanted to go back for my BS is so I could participate in public health dentistry with out so many stipulations. We are slowly working out a law where community dentistry is available for any hygienist to participate. About local anesthetic, we are not allowed to administer local anesthetic here, yep that's another law I want to see past for this state. I did however, get licensed in Arkansas to administer local anesthetic and though it was intimidating at first, it made my job easier, and I am glad I did it. I think I had a couple of patients that did ok with out anesthetic but the majority were sensitive so I almost always used local with SCRP. Good luck with everything!!!

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stressed out in Palmetto, Florida

30 months ago

I need to know if I am the only one, or if there is someone else out there who agrees with me. I have been in the state of florida for 2 years now and have worked at more offices in the past 2 years than I have in the other 18 years in the state of connecticut, and I find that 90% of the hygienists here cavitron and do not hand scale subgingivally on a prophy appointment, or if they do they do certain areas and do not check the entire dentition. They state that with a healthy mouth you do not have to scale sub. On the contrary, if you do not scale sub, you are leaving calculus behind which in turn causes someone with a "healthy Mouth" to begin to progress to perio. I was astounded when I saw how much residual calculus there was on 6 month patients, and I was cleaning up the mess left behind that should have been taken care of through out the years!! Pt's have even commented that they never felt like they had thourough cleanings like the one I gave them! Just because Insurance companies state that a prophy is a polish cleaning, I do not believe that!! You are doing a diservice to the patient by leaving behind calculus! My last straw was today when I saw a teenager with so much old calculus sub everywhere. She has been coming in every 6 months for routine care and there is no way there should have been so much! Maybe I just need to keep looking for that right office with a team that actually believes in the same ethical value as I do!!! I can't even have anyone clean my teeth because I know they will not remove all the debris, so I am going back up north to my previous employer to have my recall done!!!! Is there anyone else out there who has found this to be the case???

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Cerritos College Grad in Placentia, California

30 months ago

If you can't remove all the calculus during a regular prophy appt, then you need to schedule that patient for SRPs.

I agree that you are doing a disservice to the patient by leaving behind calculus.

But you are doing a disservice to yourself and your practice by attempting to do SRPs during a regular prophy appt.

Using a cavitron or hand scalers is irrelevant; a skilled hygienist can do a thorough job using either or both.

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stressed out in Palmetto, Florida

30 months ago

Maybe I didn't make myself clear!!! I am talking about class 1 patients who never had their teeth cleaned subgingivally and as they come in for every appointment they only get their teeth cleaned SUPRAGINGIVALLY!!! SO WHAT i AM SAYING IS THAT THE HYGIENIST HERE DO NOT SCALE HEALTHY MOUTHS PROPERLY AND THAT THIS IS LEADING TO PERIODONTAL DISEASE WHERE IT SHOULD NOT HAVE BEEN IN THE FIRST PLACE!!! A 16 YR OLD SHOULD NOT HAVE RESIDUAL CALCULUS IF THEY HAVE BEEN COMING IN EVERY 6 MONTHS FOR RECARE APPOINTMENTS! SO MY POINT IS SCALE HEALTHY MOUTH PATIENTS SUB AND SUPRA, DO NOT ONLY USE A CAVITRON AND POLISHER!!!!!!!!!! I HAVE BEEN A HYGIENIST FOR 20 YEARS AND AM WELL AWARE THAT IF THERE IS BONE LOSS AND IF THERE IS POCKETING...YES SRP IS DEFINETLY WHAT IS NEEDED. i WILL NEVER DO A DISERVICE TO MY PATIENTS....TO ALL THE HYGIENISTS WHO ARE OUT THERE TO MAKE A BUCK....PLEASE LEAVE THE DENTAL FIELD!

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stressed out in Palmetto, Florida

30 months ago

PS... IT IS NOT THE PATIENTS FAULT IF THEY ARE BEING TREATED BY A HYGIENIST WHO DOES NOT CARE IF THEY LEAVE CALCULUS BEHIND. AND THE PATIENT SHOULD NOT BE THE ONE WHO PAYS FOR IT!

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rdh54 in Mississauga, Ontario

30 months ago

Often times temps or subs go to offices and blame the existing hygienists that calculus remains. There is a general ignorance amongst hygienists who believe that if they find calculus, their work is superior.
Before you have a hissy fit stressed out, be aware that this comment is directed solely at you but to many hygienists with your point of view.

Read more for clarification, and continue to read many other articles re/calculus.

www.dimensionsofdentalhygiene.com/ddhright.aspx?id=7876

Q Why do the burnished pieces of calculus need to be removed if cavitation kills the bacteria in the pocket? Aren't the acoustic streaming and lavage from ultrasonic scaling enough to insure a good clinical result even if calculus is left behind?

A This depends entirely on how much calculus is left behind. Although it is impossible to remove 100% of the calculus from the tooth, all clinicians should strive to remove as much calculus as possible. Classic periodontal studies show that as much as 50% of subgingival calculus is left after initial deep scaling.14-17 Scaling with the aid of a dental endoscope can result in removal of 99% of the calculus, with only 1% of residual burnished calculus left primarily at the CEJ.18 Whenever even small, smooth pieces of calculus remain, bacteria embedded in the porous surface of the calculus soon begin proliferating and recolonizing. Within hours, biofilm is reestablishing on the root surface.19,20

In other words, the pocket can never be entirely sterilized—not with ultrasonic scaling, hand instrumentation, irrigation, a laser, locally delivered antibiotics, periodontal surgery, or even systemic antibiotics. All of these therapies can temporarily and even profoundly decrease the number of bacteria and pathogens in the pocket but none can ever eradicate them completely.

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stressed out in Palmetto, Florida

30 months ago

unfortunatly---i have a record of removing 100% of the calculus. when you see black sub calc -don't tell on every tooth sub, that the hygienist did her best. go back to school and re learn your debridement skills. ps, i am not a temp and the hygienists in these practices have been long term hygienists seeing the same patients! Sorry, but they need to go to a diff career.!!! Yes , no one is perfect, but when distal of 2nd molars, mesials of premolars, anterior teeth have sub calc, something is not being done about it!
And it isn't burnished calculus!!!! it is large spicules of calculus, not flat tenacious calculus that takes possibly a few appointments to remove.

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stressed out in Palmetto, Florida

30 months ago

I am not a temp! I work full time and the hygienists there have been seeing patients on maintanance visits. I am not talking about burnished calculus - there is a difference between burnished and residual OLD calculus deposits. I have had worked with many excellent dentists who found some of their hygienists not removing accretions properly and were sent back to classes to re learn their clinical skills. I remove approx 100% of calculus. I can understand no one is perfect, but when there is old calculus sub that isn't burnished the hygienist is NOT doing their job, but only trying to stay on a schedule and getting a paycheck!

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stressed out in Palmetto, Florida

30 months ago

Please - re read what I am trying to convey!!!! burnished calculus and residual calculus spicules are a different story@!!! especially on a class 1 patients with no bone loss. srp is recommended with bone loss seen radiographically and with periodontal pocketing. not on recare visits with 1-3, poss 4mm pocketing and no bone loss!!!! If no one gets this, maybe you went to the wrong dental hygiene program!
I am not perfect - no one is, but there is a difference in srp with bone loss and pocketing don't get me wrong. In the state of florida, assistants mostly work in pedo practices and can only scale supra. I worked in a pedo office in the beginning of my career and KNOW there is almost always sub calc....when the patient finally goes to an adult practice they are already in perio trouble because they never had a sub scaling done!!!! this is part of my point

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SoapBoxLady in Oceanside, California

29 months ago

stressed out in Palmetto, Florida said:
I am not perfect. I remove approx 100% of calculus

Having been a hygienist for many years, I can tell you that upon starting a new position, one will always find patients who have deep black subcalculus that should have been removed since they have been coming in for years on a regular basis. NO ONE can get 100% of the calculus off. NO ONE. BUT you are correct in that one can tell which patients have not been properly taken care of. Often these patients have only been scaled "by the dentist".
Now I use the ultraqsonic first, then I always use the explorer around every tooth to check for any subcalculus left behind. Then I use the hand scalers. BUT the current standard of care in dental hygiene is to use the cavitron even on healthy appearing patients. I even use them on children (low power). Hygienists who use only the cavitron and hygienists who use only hand instruments are probably both missing some calculus, especially if not given enough time for each patient. I have always insisted on having an hour or more per patient. This actually results in more production as I can do the FMXs and sealants too as well as use the intraoral camera to get patients to schedule needed treatment.

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