Arestin: Will This Cut Down on Referrals?

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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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13 Responses to “Arestin: Will This Cut Down on Referrals?”

  1. jerry drury on July 24th, 2008 5:54 pm

    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.

  2. Lawrence Villarreal on July 24th, 2008 6:16 pm

    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.

  3. jon on July 24th, 2008 8:23 pm

    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.

  4. Dr.F on July 24th, 2008 8:25 pm

    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.

  5. Fadi on July 24th, 2008 8:47 pm

    It is an adjunct treatment. to SRP

  6. DrF on July 24th, 2008 11:26 pm

    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.

  7. LBS on July 25th, 2008 12:47 am

    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!

  8. dr p. on July 25th, 2008 2:07 am

    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.

  9. Lee on July 25th, 2008 9:36 am

    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!!

  10. Dr. S on July 25th, 2008 1:30 pm

    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.

  11. John McAllister DDS on July 28th, 2008 12:56 pm

    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?

  12. David E Stall, DMD on August 7th, 2008 4:49 pm

    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.

  13. Ben Sandefur on August 8th, 2008 11:47 am

    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,

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