Arestin: Will This Cut Down on Referrals?

Dr. L. asks:
arestin.jpg
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?

76 thoughts on “Arestin: Will This Cut Down on Referrals?

  1. 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. 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. 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. 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. 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.

  6. 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!

  7. 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.

  8. 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!!

  9. 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.

  10. 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?

  11. 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.

  12. 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,

  13. 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.

  14. 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?

  15. 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?

  16. 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?

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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

  22. 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.

  23. 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.

  24. 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.

  25. 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?

  26. Sharon, to follow up with your comment, many corporate dental chains are switching to a product called atridox because of it’s costs and results. It’s much less expensive than arestin.

  27. I just got home with a treatment plan to be carried out in a month that includes 10 blasts of Arestin at $35 each. I really can’t afford that but I’m scared and want the best results. Can I take a systemic antibiotic instead? Is that even necessary?

  28. I just paid $205 for application of Arestin at five locations – $41/site. I was certain the hygienist told me $20/ea when he suggested I was in danger of being moved into a different insurance classification. I know there’s some variation in price – which is more typical, $20 or $41/”injection”?

  29. My gosh. I am reading these posts for the first time, and I am sitting here shaking my head in amazement. I am a hygienist, and I am so sorry for all of you that have been bullied into paying large amounts of money for multiple applications os Arestin.It really angers me.Nothing can take the place of meticulous SRP,followed up by excellent home care(electric toothbrushes, regular proper flossing etc.) I do see the benefit of localized application of Arestin into sites where tissue resolution was less than ideal. But this is weeks AFTER SRP appts. at the re-eval appt. Ughhhh. Too often it’s all about the MONEY.If I’m wrong,,,feel free to enlighten me.

  30. After reading these comments, I’m shocked. I just returned from SRP. Third visit in the span of 1 month. From the start, they have been charging me $70/ea. I have excellent insurance which covers most of my procedures except the Arestin. My visit’s cost $650, $950, then this last visit cost $1100. I am scheduled to continue the present management. I was told, this is the way to avoid oral surgery. Is there an alternative? I can’t continue to afford this therapy.

  31. I’m a hygienist also and my answer to Ken is go directly to a Periodontist. You may need surgery but it won’t cost you much more then what you have paid already and you will have better results. Also…homecare without proper homecare your just wasting your money.

  32. Arrestin does work, has worked and will work if placed as directed. It costs a lot of money, but if a patient could avoid surgery, well why the heck wouldn’t you place it. The literature shows it much more effective in pockets >5mm, so I only place it if a pocket probes 6mm or above. This has worked wonderfully for my patients.

    To those that would deny the published literature, shame on you. If used properly and sparingly, its a great adjunct.

  33. Wow! I am 31 year old patient that was just told by a big Dental Chain that I have gum disease. I have the PPO dental coverage and was told I needed an antibotic called “Arestin” and insurance doesnt cover it. They want to charge me $45 a tooth and need it on 10 teeth. I was astonished that I have infectuous gums and no medication is covered by either my medical or dental insurance. I cant afford it but they are making feel like there is no other treatment. My total quote for deep cleaning with Irrigation and Arestin was $1300. And thats just my portion. How do they expect gum infections to go away with out antibiotics that are affordable. I just dont get it. There has to be other options.

  34. My name is Pedro I am a resident/poet from Minnesota. I recently, have been having some tooth irratations and aweful smell problamatics and was sujested Arestin. As of 09.17.2009 I did in fact get the minnimal Arestin treatment! From Community Dental Located in Maplewood, Minnnesota. The applications are “small” and the price spendy per tooth site! Hopefuly, positive results will occure! Sincelely Mr. Tejeda

  35. I am a member of a medical office(not dental) in Orlando and an Ivy League graduate and encourage everyone on here making comments to use evidenced-based medicine when evaluating any product in your practice. Gum disease is NOT just a question of non-surgical or surgical treatment but also HUGE question of bacterial survival. You will be able to remember this when you think about your time in microbiology class probably years ago. Please go to J Perio and research this info presented by your specialists that “the short-term clinical outcomes of non-surgical and surgical treatment are NEGATIVELY affected by bacterial survival.” This is a bacterial problem and also a problem that affects patient outcomes in my practice. I see everyday in my medical office and the hospital the care that is being given in dental offices in regards to periodontal disease and I am not pleased with the results that I see. There are also studies out by Renvert, Takamatsu, and Wilkstrom(independent) showing that the rate of removal of P. Gingivalis is 66%, 68%, and 70% and that is a controlled trial NOT using any LAA(Locally Administered Antimicrobials). Perio disease is cause by an ACTIVE BACTERIAL INFECTION and should be treated as such by the Dental-Medical community. In addition, there are always arguments about subjective data such as pocket depth reduction and CAL. But what about BOP(bleeding on probing)? Have we forgotten why the patient is bleeding? If you don’t know why I encourage you to educate yourself like we do in the medical community. In addition, what about looking at the studies on Biological markers in dentistry? Let me first tell you that a biological marker is for example HDL or LDL in my office! Everyone should know that! What are the biomarkers in the field of dentistry? ICTP and IL1. That is where dentistry is shifting towards which is a scientific measurable approach to treating your patients and yes I do mean TREATING. You can do scaling and root planing but if you are leaving 30-40% of the INFECTION behind(based on verified independent studies) then what are you really accomplishing? Make sure you tell your patient the cost of your scaling is $200 a quad and you will be leaving 30-40% of the bacteria behind. Ask them if that’s ok! I as a patient argue that this is a communication problem and a monetary problem. One for the patients and one for the specialist who are losing business because the general dentists are doing EXACTLY what they should be doing and STOPPING this disease from progressing. That is the ethical thing to do. Lets say I have Deep Vein Thrombosis and I could reduce the problem by a non-surgical procedure that is proven to work instead of doing and invasive procedure. Why would I not want to do the non-surgical option? I would be FURIOUS if my doctor didnt treat me or recommend options other than surgery if they were available. We have an oath to “DO NO HARM” and I encourage each of you as fellow clinicians to live by that requirement! On the other had if I need surgery then I need surgery! That’s ok too if thats the only option. I also recommend that you allow your patients to choose this option but it MUST be presented by you to them! This is their choice and NOT ours! Lawyers will drive your profession if you do not take the lead in this. We are now being held highly accountable for what we are doing in medicine and dentistry is next. Let me tell you why I know this. My friends hosptal death rates are now being reported on the internet. So patients can see which hospitals in their community kill the most patients! But the kicker is not the hospital but rather the doctors in the hospital that are treating! That’s the next reported information in the media. People will want to know WHO are the doctors in that hospital! I will tell you that if I am treating a patient that has heart disease and they die and it is determined that they have perio disease I will not be held accountable for the death of that patient if conclusive evidence makes it out that there is indeed a link with perio disease and systemic issues. I ask you to focus on patient outcomes and treatment protocol! I also encourage you to understand that I have read the article about perio treatment in our medicine peer reviewed magazine NEW ENGLAND JOURNAL OF MEDICINE. I recommend taking a close look at that because what you are doing in your office you may not be able to see with your eyes. What we do has a huge affect on the body that CANNOT be seen by the eyes! This is when we shift to evidenced-based medicine and away from what we “think”. Look in great detail at the report of IL1 from the studies and use of LAA’s. The reduction in that inflammatory cytokine is reduced FOUR(4) times more than that of Scaling by itself! This and the bleeding claims prove that this a MICROBIOLOGICAL problem. Please start treating your patients. Afterall, we have an ethical duty and should care enough about our patients to TREAT them. Thank you for your time. Kind Regards.

  36. I do have a question. I was just told by my new dentist after an oral exam that I had to have Arestin. The pockets I do have are only 3 and 4 mm on about 10 teeth. They are charging me $35 per teeth. Is this a rip off?

  37. Dear Dr Travis.

    I am a DDS and I am appalled by your comments, but not by your lack of knowledge of oral pathology as I realize is not in the MD curriculum. Please don’t categorize the dental profession through the few comments you see here or your own experiences.

    I don’t pretend to give you a comprehensive course on periodontology but maybe can clear some confusion to everyone in this site.

    We must first understand that every single healthy human being has bacteria in their mouth. The key issue with periodontal disease is based on the numbers and kind of bacteria that colonizes the teeth when proper hygiene is not performed. We must also understand that proper hygiene is not possible in the presence of calculus and plaque. Plaque is a sticky substance that forms from bacterial byproducts and food debris that promote bacterial attachement to the teeth. Calculus is a concrete like substance formed by calcification of plaque that forms a hard ledge at the level of the gums (gingiva) that prevents the patient from accessing the tooth under the gum to achieve daily hygiene. Bacteria bellow this ledge is protected from the action of the tooth brush and floss, and is allowed to grow in numbers and pathogenicity (gram -). This causes a bodily response (inflammation followed by bone resorption). After a good scaling and root planning (SC/RP) those ledges are removed and a large number of the bacteria is lavaged out of the pocket, thus promoting healing and allowing the tissues to re-adhere to the teeth. The pockets reduce in depth, ideally to not more than 3 mm. This allows the bristles in a tooth brush to reach the end of the pocket and can therefore be maintained by the patient on a daily basis.

    Re-evaluation is always done 4-6 weeks after treatment. If multiple areas persist, a localized SC/RP should be redone to remove any remaining calculus. Persitent deep isolated pockets that have no detectable calculus, may be candidates for local antibiotic therapy such as Arestin. After the application of Arestin, monitoring should be done for about three months to assess the effectiveness. Referring to a specialist is always an alternative and should be evaluated on a case by case basis.

    After SC/RP, if proper hygiene is maintained in a healthy patient, the numbers and type of bacteria return to normal levels.

    This disease can be prevented by proper daily brushing and flossing technique, and regular dental visits to ensure health.

    There is no other profession that advocates and implants more ways to stop the diseases we cure. That includes the use of public water Fluoride, preventive treatments such as sealants for the young, and patient education through in office visits, pamplets, videos, web based, community outreach programs, etc.

  38. Can someone please help me? I saw the dentist today
    and she recommended srp and arestin. I have 2 tooth
    that the pockets measured 5, some were 4 and the majority were 3. Does she need to perform the srp and arestin on all the teeth? I thought srp and arestin is recommended for pockets 5 or greater.
    confused!

  39. Dear Ida

    The reason for doing a SC/RP is not the depth of the pocket alone but there are a number of things that may warrant the treatment. Most often it is related to subgingival calculus as I explained earlier in the thread. Calculus is a shelter for bacteria and it is so hard that is difficult even for the professional to remove. Needless to say it is impossible for the patient to remove once it has harden. The reason for the formation of calculus is often bad hygiene, type of foods, frequency of snacks, poor brushing/flossing technique, or a combination of these. Nevertheless, there are other components beyond the patient’s control, one of them is genetics.

    My best advice would be to have the procedure done as recomended by your dentist. Also, make a habit to floss only those teeth that you want to keep (

  40. continues from the previous thread…

    floss only those teeth you want to keep (is a joke but is also true), brush gently but thoroughly (at least 2 minutes) every tooth, every side with a soft bristle tooth brush right before bedtime and don’t eat or drink anything after brushing except plain water (preferably tap water).

    Visit your dentist at least once a year for an exam and if healthy, have a professional cleaning done twice a year. Your dentist may suggest more than this if you have gum (periodontal) disease.

  41. It is now accepted that periodontal disease has effects beyond the periodontium. Ineffective treatment leaves the sufferer at risk.

    Is SP/debridement/planing capable of removing all plaque, the tenacious biofilm adhering within the depths of pockets? Very unlikely. Missing 1 square mm could leave an advanced bacterial organisation containing many millions of bacteria.

    Adjuncts capable of destroying those missed should be very useful to aid resolution. As the quality of debridement increases less effective adjuncts may be adequate. At one end of the spectrum many hours of of careful scaling (supported by subsequent excellent home care) may be sufficient to allow healing. At the other end, powerful medication could theoretically cause breakdown of the biofilm and allow long term healing. I don’t believe such a powerful medication exists, and although systemic antibiotics may control infection for a short time, we are aware of the side effects and resistance issues.

    Between these ends of the spectrum we have a variety of adjuncts with reported success (and failures). This allows us to take our chosen position and we can all be right some of the time. Strongly held positions could be harmful to patients, if they are wrong.

    My personal feeling is that debridement alone is likely to be inadequate, so I favour the early use of adjuncts. An observation I’ve made over many years of clinical practice is that some of those treated and re-treated by scaling/root planing exhibit partial healing with tightening of the circumferential fibres, sufficient that adjunctive treatment becomes more difficult to administer. Alternatively, the pocket remains open, doesn’t re-attach, but does not bleed. This leaves a chronically open pocket which will not close with adjuncts (and affects results of trials using pocket depth as an end-point).

    Once a patient has pocketing >=5mm I carry out combined therapy with a view to gaining maximal healing and hopefully reducing systemic markers of inflammation.

    There is a potential new generation of adjunctive treatments on the horizon, which takes advantage of the organisational behaviour of bacteria in biofilms to aid their destruction.

  42. I was looking for information re. Arestin and I found this page. I thank everyone, including the professionals, for taking their time to share their knowldedge and experience regarding this condition.

    Since the healthcare debate has been raging, I can’t help but think that this is one more, of the hundreds of ways in which patients are pushed into treatments that may not be necessary(as we have read here), only to increase profits. It is not difficult to see why everyday folks are so distrusting of the healthcare practitioners.

    Again, my sincere thanks for your postings.

  43. I had to take several xrays to ensure that the post seated fully. It’s also a gamble when seating the post once the cement is in the canal and on the post. Once the fibers engage the walls of the canal, you feel resistance and it feels like the post is seated fully, but it may not be.

  44. Wow – I wish I saw this board earlier. I went to the dentist Monday @ 130 – ended up leaving at 6 p.m. after diagnosis/ xrays/ fill 2 cavities and full root planing (session 1). Was instructed to come back yesterday at 715 a.m. for 2 more cavities, a “lighter” root planing, and Arestin treatments for 33 sites. I didnt do my homework first night (tired/ pain/ no time/ didn’t think I’d get unnec treatment). But it was eating me that I have not-so great insurance and ended up paying $133 per site (x33 – do the math yeesh.) Worse, last night – not having eaten all day – it looked like I had eaten corn on the cob and realized it was the powder arestin coagulating at the gumline of all 33 sites. I’m a layperson so pardon the terminology but was it “squeezed out” by my gums? How do I know anything is left to do the supposed work over remaining time-release? I also seemed to have paid double what anyone else seems to say the normal charge is, and far exceeded the rec max # of sites. At this stage – anything else to be aware of? It was not a pleasant experience – tho it could have been worse – but coupled with the quantity and ESPECIALLY price – I wd highly consider anyone else considering these treatments do much more homework first. I think I learned a lesson the hard way…

  45. Correction on last post – it was 55-60 per ‘injection’ – not 133. I haven’t received my itemized bill yet but thats what reception confirmed so hopefully while still pricey, it is half of what I was told. Just wanted to clarify…

  46. Way back at the begining of this thread references where made to attachment level improvement following sc/rp and Arestin placemnet being in a range of
    .1-.3mm. It is true that even with a 4mm pocket this is a less then dramatic result. It should, however ; be only one “measure” of positive results. We know that if inflammation is not present at the base of a pocket, that pocket is stable and thus at a reduced risk of worsening, at least in the short term. It is an ongoing push and pull for some patients to keep their mouths free of disease and products like Arestin have a place in our arsenal.

  47. They have decent marketing and hype, but all it is. Arestin is designed for use with S & RP, “I see no advantage in my office. I saw some dentists Arestin place in 20 different locations on a patient’s periodontal Combined with S & RP. Unlike dentists bags along I do not see the usefulness of this. If you do this, why not just put them on systemic antibiotics, with S & RP? If you have a good job S & RP Arestin claim that the trouble in my opinion afterwards. When you do a bad job with S & RP is not worth it, too.

  48. Wow. Stumbled upon this site after doing a search for Arestin drawbacks. I had S&RP done last month, and was told I needed Arestin in two sites (5 injections) to help close the pockets. My insurance covered the medicine, but I had to pay the “application fee” per site at $40 each.

    $80 is not bad I guess, compared to what some of you in this thread paid, but now I see why Delta Dental doesnt cover the Arestin treatment unless it is deemed necessary 6 weeks AFTER the S&RP treatment.

    I wish I had done this research prior to my sessions, but the hygienist seemed so reassuring that it was a medically necessary option. I should have seen the red flags when they told me DD wont cover it.

  49. My name is Pedro I am a resident/poet from Minnesota. I recently, have been having some tooth irratations and aweful smell problamatics and was sujested Arestin. As of 09.17.2009 I did in fact get the minnimal Arestin treatment! From Community Dental Located in Maplewood, Minnnesota. The applications are “small” and the price spendy per tooth site! Hopefuly, positive results will occure! Sincelely

  50. I had to take several xrays to ensure that the post seated fully. It’s also a gamble when seating the post once the cement is in the canal and on the post. Once the fibers engage the walls of the canal, you feel resistance and it feels like the post is seated fully, but it may not be.

  51. continues from the previous thread…

    floss only those teeth you want to keep (is a joke but is also true), brush gently but thoroughly (at least 2 minutes) every tooth, every side with a soft bristle tooth brush right before bedtime and don’t eat or drink anything after brushing except plain water (preferably tap water).

    Visit your dentist at least once a year for an exam and if healthy, have a professional cleaning done twice a year. Your dentist may suggest more than this if you have gum (periodontal) disease

  52. 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!!

  53. A little upset reading about this. I went in for a cleaning about 2 years ago and was told that I needed the SRP and Arestin and that they couldn’t do a simple cleaning. I couldn’t afford the $1,200 bill so I have put it off until now, I called my insurance carrier and was told that the SRP would only cost me $100 total(the arestin is out of pocket), after reading this I now know that I can have the SRP done without Arestin, now did my dentist do my any favors? Two more years worth of damage done because he wanted to make more money than what my insurance would have paid for the SRP alone. Very upsetting.

  54. 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?

  55. 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 jus

  56. I’m 31, just got a new Denstist (corporate). Had lots of 4s, some 5s and one 6 on perio exam. Got quoted $90 apiece for 7 applications of Arestin. I have been doing some reading and have come to the conclusion that wheter or not arrestin is effective, I don’t think it is $630 effective. Should I expect the hard sell when I refuse my “treatment plan?

  57. I am scheduled to go in for scaling and Arestin in 84 sites..84..on July 20th. The pharmacy just called me and told me that my sucky health insurance wont pay but 7.00 for it. (apparently a lot of insurances wont) and my out of pocket costs for this is 2000.00 and that is not including the visit and everything else. I am scared but i told the pharmacy no, that i couldnt afford it. A single mom with two kids having to spend 2000.00 on a prescription? No I dont want my teeth falling out of my head, but I dont want to forclose on my house to pay for my teeth. The cleaning I had helped with my swollen gums and any bleeding i was seeing, but if there is something else i could have been doing in the 6th months since this diagnosis, why wouldnt someone have told me or given me a different regime? If anyone knows of any good dentists in Pikesville, md, please let me know and soon.

  58. After reading these comments, i come to conclusion that No wonder American Healthcare is so fucked up.. with stupid rat asses like these people working in healthcare..

  59. I have been reading all of the above threads and am in complete shock with what some dentists/hygienists tell patients.

    I am a hygienist and have been practicing for 3.5 years. I use Arestin in my practice and really believe in it. What I don’t believe is the price, but that I am not in charge of. I only RECOMMEND Arestin to my patients during scaling and root planing in pockets that are 6+mm. I do not force the issue, but I have seen GREAT results. I NEVER tell patients that it is a CURE for their bone loss, just a treatment for the infection in the pocket. Arestin is not a miracle, and without patient compliance (home care) Arestin will not do the work for you (brushing/flossing).

    I just wanted to place a positive about Arestin, since one of my patients did come in the other day after telling me that she researched Arestin and declined it due to all of the negatives that she read from other patients.

    I am sorry for all of the hygienist/doctors that FORCE Arestin, or make it part of the treatment plan!! I also feel bad for the patients that get informed they need scaling and root planing when they really don’t!!

    It seems from reading these threads that a lot of dental professionals are not being honest?? I just wish that wouldn’t be true. They are really giving the dental profession a bad rap.

    Good luck to all of the patients above. I can only hope you find an honest dental office that will not lie to you about your condition or what your treatment needs to be in order to correct it.

    I honestly love what I do, but I also love my patients. I would NEVER recommend something I wouldn’t use myself, or recommend/use on a family member!! Just wish every dental professional had the same outlook!!

    smiles

  60. I have read most of the comments above and feel that I must address the issue of these antimicrobials placed in pockets.
    So here it is. First and foremost the literature is quite clear. Arrestin should not be used solely by itself but in conjunction with SRP. Furthermore, SRP w/ arrestin is only more effective than SRP alone by 0.2mm which in my opinion is not significant. Yes, it is more effective in deeper pockets, however, not more effective than SRP alone! to any significant degree. Big corporations use it to make up for the fact that they signed up for HMO’s and PPO’s whereby they are required to do SRP at low or no cost!
    If you really believe that antibiotics will benefit your patient for the SRP then I suggest you use systemic antibiotics which the studies have shown are released from the periodontal crevicular fluids in significantly higher concentrations and for longer periods of time ( and hence better ability to kill bacteria in the pockets). Note: Slots et. al.
    Why use something that has limited benefit, great expense, and the disease is not removed but rather just delayed ie. the disease will be back in a short period of time? If you are going to use it use it judiciously meaning in conjunction with a very good SRP and no more than one tooth. Your patient may have been better served to have perio-surgery and get rid of pockets completely than to come back to you in 3 months with the same pockets. “Doctor I spent $300 dollars and I still have the same problem as before!” That is a recipe for disaster in a dental office.

  61. A teabag–cjina black/orange pekoe placed next to gum inside the jaw, and removed when soaked, and replaced will alleviate gum pain/infection due to the tannic acid in tea. And, I noticed after I held the teabag tight in my jaw and removed when not quite soaked, that I would a suction action from the gum. I have used Arestin at about $100 for one application and used a teabag. The teabag took the pain away for me.

  62. Last month I went to the dentist because an old root canal was causing the gum at the root area to swell and I could feel a dull ache there every time I smiled. Even though I’ve participated in a dental plan for the past 15 years, I had not seen a dentist in over 5 years and expected a deep cleaning would be required. Well, the dentist on duty spent about 10 minutes checking my teeth and looking over my x-rays before telling me that I had to schedule a consultation with an endodontist for the swelling and as for the rest of my teeth, he recommended that one of my molars, which was about 50% filling, should be crowned.

    Then he turned me over to the hygenist who immediately started probing my gum pockets and calling out pocket depths to his assistant. I heard him call off a lot of 3′s and 4′s and occasionally a 5. The hygenist said the treatment would consist of S&RP and Arestin. They would treat half my mouth then and there and treat the other half the following week. I’m 50 years old and have been subject to a deep cleaning quite a few times throughout my life but, I’ve never encountered a deep cleaning treatment that involved something like Arestin.

    There must have been about 10 dental chairs in the work area and multi-sided placards for Arestin were prominently displayed at every chair. I discussed the fees with the file clerk who, after checking with my dental plan, quoted me my portion of $1800.00 for the cleaning, Arestin and crown. I naively submitted to the treatment and paid for everything then and there.

    After waiting for about a half an hour, they started to S&RP the left side of my mouth, I was given a desensitizer which, by the way, cost $50.00 per dose and not covered by my insurance. The reason I bring this up is because when they S&RP’d the other half of my mouth the following week, I needed no desensitizer. I think it’s kind of strange that one half of my mouth required a real deep cleaning and then the following week the other half required a not-so-deep cleaning. I’m thinking that maybe my gums did not require Arestin at all. Even though I couldn’t articulate it at the time, I got the feeling I was being played and after reading through the previous entries, I now know that I should have concluded the appointment and went looking for another dentist. Last week the hygenist checked on my gums and said everything looked fine and he would need to see me again in 3 months as a follow-up.

    At this same dental group, I showed for an appointment the other day to see an endodontist who kept me waiting for about an hour which is not really much longer than the wait for all my other appointments. This appointment was about the tooth infection and swollen gum, the thing that got me in there in the first place. Well, this doctor spent about 10 minutes checking my gum, looking at my x-ray and listening to my recital of the trials and tribulations of my multiple root canalled molar #14. The endodontist recommended drilling through the crown and right up to the root apex, flushing out the infection and placing some sort of antibiotic in there, if required, and then plugging up the whole mess. Sounds kinda like the BP gulf disaster. Later, the receptionist/cashier ran the numbers and they want $3000.00 for the treatment. And to add insult to injury, they want $160.00 for the consultation. I’m thinking about finding another dentist.

  63. Thanks for the great information. I just moved to a new area ad my wife and I have had to find a new dentist. We went in for initial exams and she came out with the dentist saying that she would need a S&RP along with arestin treatments. I was disappointed to find that that the arestin portion of the diagnosis was not covered by my insurance. After hearing the diagnosis directly from the dentist’s mouth and hearing how she was selling the arestin treatment, I got very concerned that this was just another way for them to seperate me from alot of our money. this site has been beneficial in many ways but mostly to hear both sides of the story.

  64. I’m so glad I found this blog. I went to a Bright Now Dental office for a first time visit. I went through the probing others have mentioned and heard mostly 3’s, 4’s and 5’s with an occasional 6 being relayed to a dental assistant. I had no measurements deeper than 6. The dentist did a very thorough exam and concluded that I had moderate Periodontal Disease and would need 3 “small” fillings, 4 quadrants of SRP deep cleanings and 11 Arestin injections at a “discounted rate” of $125 per location; total bill, $1720 after insurance. They had some literature that seemed to support this conclusion and strongly promoted the use of Arestin. The dentist didn’t really “push” for the Arestin but made is sound like it was a necessary treatment to counteract the Periodontal Disease. After reading this blog I realize that there seems to be NO reason why I should have been scheduled for the Arestin treatment on my first visit before they even tried an SRP session. I don’t know if it is ignorance on the dentist’s part or a real scam but I am kind of upset either way. The office seems clean, professional and nice but I am not sure if I will return for any work there. Thanks again to all the professionals that commented on this blog.

  65. promoted the use of Arestin. The dentist didn’t really “push” for the Arestin but made is sound like it was a necessary treatment to counteract the Periodontal Disease. After reading

  66. Thank you very much to all the hygienist for the honest advice, it has been of great help. Last week I made a dentist appointment after 2 years (shame on me) and was told I needed Aresting in 5 locations, along with the PERIO SCALE. I felt it was a lot of money, so I have been researching on “Arestin” for the last days and since I read many people felt they have been ripped off I wanted to find a second or third opinion, so I visited two different dentist offices along with a copy of my X rays, and was told I didn’t need Arestin,that it should only be used in more serious conditions since it’s an strong antibiotic. They said the deep cleaning should do it with no need of Arestin, even though I had a variation of 6,5 and 4 mm’s. Unfortunately I will not get my deep cleaning done at neither of those dentist offices, I have a discount plan that I will use at the dentist office where I was first checked. After visiting this site, I called the office and told them I needed an appointment and I didn’t want the Arestin to be applied. The receptionist said, I only had to sign a form which states that I’m refusing Arestin. So yeah, I have earned myself $300 dls..
    :)

  67. I always wanted to learn more on this topic and you sure do know how to explain it all in great detail. I’m going to look more into this and follow up with your new additions too.

  68. I recently had perio scaling and root planing. I was told it would be expensive and that insurance would not cover Arestin or the rototel toothbrush I was required to buy. My estimate was 2400.00 .1400.00 would have to be paid out of pocket I reluctently agreed I knew my teeth were in rough shape. After the hygenist finished scaling and planing my entire mouth she went around and measured my gum depths re-calculated the cost and came back to tell me it would be an additional 1500.00 on top of the 1200.00 I had just paid. Sitting there mouth entirely numb, worn out from a long procedure and my mouth bleeding I agreed feeling I had no choice. Its been a couple days since and I really feel that I’ve been ripped off and taken advantage of. Am I wrong to feel this way?

  69. I am a graduate student, and thus I have been very poor for a very long time. We finally got dental insurance as part of a union adjunct position, but it covers very (VERY!) little. As I am approaching 30 and a dissertation, health is finely coming back as a priority, as the stress, lack of sleep, and overall poor eating habits really became apparent at my last check-up when I was informed of my moderate periodontal disease (all of my molars have 5mm pockets with bleeding!). Problem: I am still poor and remain afraid of being taken advantage of due to the general distrust of dentists in the NY area (please excuse this statement as it is not meant in insult but as a realitic appraisal of the situation, as there are bad apples in every field), though I do feel (and trust)that my dentist is a stand-up guy.

    Thus, as a researcher in the neurosciences, I understand the importance of following treatment plans and believe that there is a real risk to my overall health (especially stroke and heart-related events). Therefore, I would like to do all that I can now, as I want to get ahead of the disease so that my efforts can be directed at better hygiene habits, as I will now be battling this chronic disease. Yeah.

    So, my questions are:
    1) What are the primary literature sources that I can read? Was the .1mm deemed statistically AND clinically significant?
    2) If antibiotics treat bacteria, then what would be a recommended minimal dosage? No, I cannot afford 90 injections of $42 each. But, if it only needs one per site, then my dentist may be willing to work up a payment plan, which would be worth considering.
    3) The hygentist indicated that the meds would be given at the time of the SRP. Is this not standard? Are there other options for my particular case?
    4) Expensive toothbrush? To get or not to get? If so, what is recommended?
    5) Thanks to this website, I have learned a lot of information about the potential link between gum disease and health problems, is it advisable to schedule an appointment with my PCP to investigate whether the bleeding is indicative of another problem. If so, what are the questions that I should ask him (or what are the symptoms of which I should make him aware)?

    Understandably, the persons on this site are busy professionals, so I appreciate any advice that you can give me. As a member of the public, I am hoping that any answers to these questions can also benefit the next person, whose dentist visit was less than desirable and is now spending the night trolling the internet for any information they can get regarding this condition.

    Thank you in advance.

  70. One periodontist I worked for insisted that all pockets over 7 mm should be singled out for Arestin injections. Because many of the patients had residual deep, yet TAUT soft tissue, it was difficult for me to get the Arestin tip into the pocket, and sometimes the solution would just be partially wasted since it couldn’t be placed deep enough. The fee charged was ridiculous. When working for a different periodontist, I had better results mixing a solution of tetracycline(taken out of the capsule) in hot water and using a fine-tipped blunt needle to get the antibiotic into the pockets. Patients tolerated that well. There was NO charge to the patient. I felt like I was, at the very least, not ripping the patient off. As for improvement in probing depth, with either method I saw no significant difference.

  71. I want to know if you should get the arresting after deep scaling and root planning or wait. My hygienist wanted to do 52 sites the following week. Is this right?

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