Team Approach: Controlling periodontal disease

March 21, 2012

Year after year, survey after survey, DPR’s readers affirm that when it comes to choosing new dental products for their dental practices, colleague recommendations are vital. Here, we provide space for dental professionals-like you and your team-to reflect on the products they see making a difference.

Year after year, survey after survey, DPR’s readers affirm that when it comes to choosing new dental products for their dental practices, colleague recommendations are vital. Here, we provide space for dental professionals-like you and your team-to reflect on the products they see making a difference.

Periodontal therapy is just as rewarding for me as it is for my patients. I consider it an honor that they trust me to help bring their mouths from a diseased state to a healthy one. That is why learning new techniques and products that will assist me in treating my patients’ infections is a must.

ARESTIN is a product I go to quite often, especially in my periodontal maintenance patients. We all have those cases that seem to be going along fine. Four quadrants of periodontal therapy were completed two years ago and the patient probing depths are normal with minimal to no bleeding.

The patient has great home care and comes in every three months like clockwork. But during your full mouth probing you fall into a 7 mm pocket on the distal lingual of tooth No. 3, and there’s some bleeding. The patient hears these numbers and his or her eyes open wide as if to say “Did you say seven?”

Ten years ago I would have cleaned the area as best I could, irrigated with chlorhexidine, reviewed home care techniques and brought the patient back in two weeks to evaluate for healing. If after two weeks the pocket was still present I would then recommend either retreatment of the entire quadrant with SRP or refer the patient to a specialist. That was before ARESTIN came into my life.

What it is
ARESTIN is an effective antibiotic treatment that comes in powder form. This powder is placed inside infected periodontal pockets just after periodontal therapy procedures. The powder contains “Microspheres,” which are tiny, bead-like particles that are smaller than grains of sand and are not visible to the eye. They are filled with the antibiotic minocycline, and they release the drug over time into the infected pocket, killing bacteria that live there. ARESTIN can continue to fight the infection for up to 21 days after mechanical debridement. Clinical studies show ARESTIN is more effective than mechanical debridement alone and significantly reduces the size of periodontal pockets compared to periodontal therapy alone.

How I use it
Today my treatment plan is periodontal therapy using code 4342, 1-3 teeth, and the placement of ARESTIN code 4381, site specific antimicrobial. I love being able to place the minocycline spheres directly into the area where the infection is located, rather than having to expose the patient to systemic antibiotics. Each dose is measured and easy to load into the specially designed syringe.

The tip fits easily under the gum and with a slight push all of the powder is plunged into the pocket. Patients are always amazed that it is administered so quickly and painlessly. I have never had a patient tell me of any post placement discomfort.

The results
The patient returns to our office in 3-4 weeks for an evaluation. If the pocket has healed and a normal depth is measured, I schedule a 3-month maintenance appointment. If the pocket has improved somewhat but is still red and measurable, I may opt to place another dose of ARESTIN and check again in one month to evaluate for healing. After the second placement the infection is gone and there is no longer bleeding on probing.

Why you should give it a try
I know clinicians are hesitant to recommend ARESTIN merely because most insurance companies will not cover it, but patients often decide to pay out of pocket to keep their disease under control.

The fee for ARESTIN placement varies from $35-to-$75 per site or tooth. Some insurance companies will cover it, but it is easier to tell patients they won’t. That way, they’re pleasantly surprised when they do!

When I go to offices I coach through HygieneFusion and share how to implement ARESTIN therapy, team members are amazed at how easy case acceptance is. Patients come to your office expecting the best care. They trust you to get and keep their mouths and bodies healthy. ARESTIN is a key tool in doing just that and my patients love the results they are seeing from its placement. Most practices have many patients who could benefit from ARESTIN therapy, and that benefit translates into increased production.

Our patients deserve every chance to have their periodontal disease under control and maintained. They faithfully come in for preventative appointments and expect us to offer every tool/technique available to them. It is something they will share with their friends, and their friends may just decide to see you, too!