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Dr. L. asks:
I know Arestin (Orapharma) has been around for a long time. I have been using a protocol of scaling and root planning and improved oral hygiene and my impression is that this has worked well in my practice. My periodontist has been using Arestin therapy with great success in treating acute periodontal abscesses. I have referred over patients with this and all he usually does is inject some Arestin into the abscess. He claims that in many cases, this is all that is needed for treatment to reduce the acute symptoms. If this is true, then I might as well start injecting the Arestin in my office and skip the referral. What are your thoughts on this?
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26 Responses to “ Arestin: Will This Cut Down on Referrals? ”
Arestin does not remove subgingival calculus. If you are very skillful with scaling and root planing, I believe you will not see clinical differences with or without.Arestin. If the source and enviornment remain, the inflamation will persist and the abscess could return. Arestin is not a subsitute for surgical access when necessary.
I agree totally with the above statement , there is no subsitute for proper deep root planing . That being said, I have had success on a temporary basis with a local flare up and Arestin.
All studies that I know of for Arestin show that on average you gain 0.1mm of clinical attachment when using this combined with S&RP. Is 0.1mm (not 1mm) of attachment worth the cost? They have decent marketing and hype but that is all it is. Arestin is designed to be used along with S&RP so I do not see the benefit in my office. I have seen some dentists place Arestin in 20 separate sites on a periodontal patient along with S&RP. Other than lining the dentists pockets, I do not see the benefit of this. If you are going to do that, why not just put them on a systemic antibiotic along with S&RP? If you are doing a good job at S&RP than the Arestin is not worth it in my opinion. If you are doing a bad job with S&RP, it is not worth it as well.
Orapharma does a great job of selling Arestin to GPs as their solution of keeping perio in-house. In fact, Arestin may provide an extra 0.3 mm of pocket reduction. This is claimed as statistically relevant but who among us can probe 0.3 mm difference, hence, is it clinically significant. On one hand, there is a greater profit margin with keeping perio patients in-house and applying Arestin as if it were the wonder-drug, but on the other, is it ethical to charge numerous sites per quadrant as a lot of dentists do knowing the marginal benefit at best. Even worst are corporation dental offices which have Arestin use as a treatment protocol irregardless of patient’s overall periodontal status and dentists are “forced” to recommend Arestin application or even better, the hygienists decide without the treating doctor’s knowledge. Arestin may work in isolated cases but old school SRP will always be and is currently the standard of care in cases of sub-gingival deposits.
It is an adjunct treatment. to SRP
It would be an adjunct if initial SRP effects are not adequate but SRP alone or with Arestin is clinically the same. Read the baseline of early Arestin research. ALL patients have gone through a series of SRP before the baseline and again during the treatment itself. Thus, the patients had 2 series of SRP. Again, Arestin does work but its use is limited and shuld not be attempted in more than 2 sites per quad. The AAP position paper clearly identifies LDA use.
Arestine is bactiriastatic (antibiotic) VS PerioChip which is bactiriacidal (2.5m”g chlorhexodine).
So if you already use an adjucent therapy at your office - try this one!
haven’t anyone heard of minocycline stainning , and it that it stains adult teeth with an unknown mechanism? I wouldn’t use it at all.
I am a patient and have been using minocycline for three years ….pulsing100-150 mgs every other day for chronic lyme that grew into sarcoidosis. My dentist is amazed at the condition of my teeth. Having had major tooth decay growing up in the pre-fluoride 50’s I have fairly deep fillings and several old root canals. These have all stabilized in the last three years and I have absotlutely no sign of staining?! Plus my ct scans are showing major healing of lung issues! Minocycline is saving my life and teeth!!
Arestin is one product you can use as adjunct to SRP. Periochip is a chlorhexidine and is an alternative is the patient is allergic to Minocycline (Tetracycline). For Arestin to acheive it’s touted results you have to use one capsule per line angle (a pocket generally has 3 i.e. ml, mb and mesial) and you have to repeat the application two more times with 3 month intervals. Needless to say most practioners are not using it correctly. I find most offices use it for improving hygiene profit. A better alternative is Atridox which is a Doxyclycline product in a gel which conforms to the pocket anatomy. You only need to use it once and studies show pocket reduction, attachment gain and bacteria reduction with or without scaling. The comment about minocycline staining is erroneous, the medication has to be administered systemically and into a growing bone or tooth to see staining.
I used to use Arestin though after using the Periolase I ended up having several boxes expire on me.
Dr. V nice to see you on these boards. I notice on you web site that you have an Nd:Yag. Have you used it for Perio?
I never use Arestin alone. I always put patients on a combination of Arestin and Periostat. This combination is fantastic if the patient is compliant and follows the prescribed regimen. Periostat alone is also not as effective as the joint use of these products.
All: I read your posts with great interest and wanted to respond with a few clinical article references to provide some background. I am a member of OraPharma, Inc, the manufacturer of Arestin so I won’t make any claims and let you all make your own assessment based on the research.
1. Goodson JM, Gunsolley JC, Grossi SG, Bland PS, Otomo-Corgel J, Doherty F, Comiskey J.
Minocycline HCl microspheres reduce red-complex bacteria in periodontal disease therapy. J Periodontol. 2007 Aug;78(8):1568-79.
2. Oringer RJ, Al-Shammari KF, Aldredge WA, Iacono VJ, Eber RM, Wang HL, Berwald B, Nejat R, Giannobile WV.
Effect of locally delivered minocycline microspheres on markers of bone resorption. J Periodontol. 2002 Aug;73(8):835-42.
There are at least 2 dozen peer-reviewed articles available on PubMed.gov
As well, we have programs to provide lower cost access to our products.
Regards,
I work for a corporate dental office and they regularly have meetings at which the hygienists are pressured into using Arestin. They are actually given guidlines as to how many sites are to be placed per quadrant. If the doctor doing the evaluation of the patient does not recommend the corporate protocal for Arestin placement then the hygienist present is to report the doctor to the office manager and the doctor is ultimately reprimanded. I have seen first hand the use of Arestin to increase perio revenue. Will this abuse ever stop? I have a great relationship with a number of my local periodontists and none of them use Arestin to the extent that this corporation recommends. Unfortunately too many patients are spending way too much for inferior perio treatment and they are being led to believe this is a “cure” for the disease. There are also practice management groups that work with hygiene progams, in office, and they pressure the hygienists to sell Arestin in order to increase revenue. I hope the AD
A, FDA and other organizations ultimately get this under control.
Can a patient have S & RP without the addition of Arestin? What could they use after the S & RP to fight the infection and to help close pockets?
how much arestin would you say an average perio pt needs i have seen a hygienst recommend 90 some sites and above i think thats over kill. and which corparate offices are you talking about that push arestin?
Can a patient have S & R without the addition of Arestin? What can one use after S & R to fight infection and help to close pockets?
I’m a hygienist and I have been practicing for 30+ years. I have used every product that has come out, with varying degrees of success,nothing overwhelmingly impressive.
Personally after using Arestin for over 4 years, I just stopped recommending it. I don’t find the results match the literature. In my opinion, thorough,well done SRPs, excellent home care using a power toothbrush(correctly)my favorite being the Oral B Triumph,flossing daily will get the best results. I also like the waterpik with Listerine. Unless the homecare is excellent, no amount of scaling,Arestin,whatever…will get achieve long lasting results. Homecare is essential. Until the patient “gets it”, that they have to actively participate in their treatment, results will always fall short.
I’m in the dental field. I used it and it didn’t work. I had a 6 mm pocket without bleeding and was told that it will reduce however, it didn’t. After a year it is still a 6mm without bleeding. I floss correctly and everyday and use the electric toothbrush. I, too, also stop recommending Arestin.
I have been an excellent hygienist for 20 years. I am about to be fired from a corporate job in Atlanta because I am not selling enough Arestin. I was told I am the best hygienist they have ever had but patients home care is so good now that I am not using enough Arestin. It is sad that clinicians have sales quotas in coorporate dentistry.
to sadaboutsales, I completely empathize with you. In every office I have ever worked in, including my current one, I have always been told I do an outstanding job, by patients and drs. alike. Not a day goes by that someone doesn’t compliment me. But does any of that matter, no! What matters is production. I’m constantly educating my patients on homecare,consequently on recall appointments, they usually look so good,that I would not even think of recommending Arestin. Fortunately for me, my employer does not demand that I use Arestin, but I know he would like it if I did. I made a decision long ago, that I would follow my conscience and let the chips fall where they may.
Arestin Questions: It seems like there is a real push to sell Arestin, do the hygenists get a percentage of the sale? The dentist recommended one dose, the hygenist said three more were needed. How accurate are their readings of the depths from the gum probes? I go to one of the large corporate chains with dental insurance I buy and wonder if there is any regulation of their practices. On my last treatment I read the post treatment which said no flossing at the Arestin site for ten days, but the hygentist said they recently changed that to only one day. I hate to lose the $240 by flossing too soon. This is a great site, thanks for the info. Bob
I went to a coporate dental office and I believe I was frauded..My insurance company and I were billed for services that were not rendered.. In addition I was bullied into Arestin. I was told that if I rejected the Arestin treatment..they would not do the root scaling and planing that they claimed I needed. I initiated an investigation and complaint against the office.
Yes Bob, in many offices the hygienists receive a commission on Arestin. I’m a hygienist, I would also receive a commission if I place it, however, I only use it if I really believe it’s worth a try.
Consequently, I rarely use it. I find that time and time again if scaling and root planing is done properly and oral hygiene is taught and stressed, that the best results will be obtained.
My dental office is part of a corporate chain which displays plaques on the wall relating to measures that affect profitability (e.g. reduction in missed appointments).
I had a checkup 2 days ago and the treatment plan includes full mouth perio scaling (PERIO 4+T) in 2 sessions. I accept that this is required. However, the treatment plan calls for Arestin on teeth numbers 2,3,4,5,6,29,30 on the first visit and 12,13,18,20,21,23.
At another, less “corporate type” dental office I had Arestin about 3 years ago but it was only applied on both sides of one serious location. My checkup 2 days ago identified only one pocket of 6 mm depth and (from memory listening to the dentist) between four and six 5 mm pockets and approximately three “4 mm call it 5 mm” pockets (i.e. dentist was erring on side of 5 mm).
Of course, the dentist didn’t discuss the merits of the proposed treatment plan with me - it’s something you’re presented with by the office personnel on your way out. Even before finding this site, I was both concerned and a bit suspicious about the extra $560 that the Arestin will cost. I’m supposed to go for the first appointment on Saturday so I’d appreciate some advice asap.
Thank you.
I just went to the dentist and had $600 worth of Arestin applied. I was extremely hesitant about such an expensive treatment. I just had a baby but I have never had any gum problems. They made me think I would eventually need dental surgery if I did not have this done. It is over and done with…but what other options are out there? Are they any more affordable?
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