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Medical Forum / General / Dentistry / November 2005Do you recommend Arestin for 5mm pockets?
Hi, I went to the dentist for the first time in 3 years and it took about 5 hours until I was done (includes some waiting around time too). I didn't have any problem (discomfort) areas to my knowledge before entering the dental dungeon. It was very uncomfortable (more than I remember) receiving the deep cleaning. The sound of the motorized instruments was painfully loud to my ears during the procedure (while she had the instrument buzzing like a chainsaw in my opened mouth). I don't know if the novacaine made this appear louder, but it did hurt my ears. Like many people, I hate going to the dentist, because it's just uncomfortable (this one more than prior experiences). I'm generally a healthy 38 year old, don't smoke, run marathons, eat well, brush my teeth, etc. Anyhow, since I'm back on insurance I wanted to go to keep healthy. I had Arestin periodontal treatment in 7 locations to treat some 5mm and a 6mm pocket. This cost $560 or $80 tooth (which I had to pay for bec insurance doesn't). I had Periodontal scaling and root planing on all four quadrants ($110/each), irrigation for inflamation of gums ($80), and composite surface posterio on teeth 13, 14, & 20 for $67/each, composite three surface porterior 19 ($117). and resin-one surface anterior on tooth 11 ($67). The total was $1,465, and insurance is supposed to pay $528. This is more than I ever remember spending at the dentist, but I wanted to get it done in one visit & get outta there. So my questions are: 1) Did I pay the going rate, a bit higher, or a bit lower? 2) Is the Arestin (minocycline hydrochloride) antibiotic powder treatment a good investment to heal my gum pockets from 5&6mm back to healthy levels, or is this experimental. Would you have done it? 3) Am I going to have to budget for regular Arestin treatments for the rest of my life? (My gums have a healthy pink color, and I wonder if the pockets are from my 3x a day brushing (so I can avoid the dentist). www.arestin.com 4) Is it true the more it hurts the better the cleaning? (it's not pain so much as it is discomfort) thanks, Philip > Hi, > I went to the dentist for the first time in 3 years and it took about 5 [quoted text clipped - 39 lines] > thanks, > Philip Dear Marathon Man: There is no way for me to tell if your treatment was appropriate. There are a few facts to clear up: Intrapocket medications such as Arestin are not generally a first-choice treatment. There should be some response to scaling and root planing. If there are some borderline situations (from the point of view of whether an area needs periodontal surgery or not) then a round of treatment with intrapocket medications MAY improve things. If it does not with a single treatment, I personally would not try it again. I have myself not used these materials (Arestin, Atridox, Perio Chip, the old Actisite) and generally the results I hear about from my specialists is underwhelming. Sometimes these periodontists will also try these medications AFTER surgery, where there has been suboptimal healing. But the virtue is that it's quick and easy, and it MIGHT help. Repeat treatments with these medications IMO is beating a dead horse. If there are any doubts, and esp. if your treating dentist is a general dentist and not a periodontist, I recommend a second opinion with a competent periodontist. The fees look OK to me. Is it safe, Lord Olivier  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I have myself not used these materials (Arestin, Atridox, Perio Chip, the > old Actisite) and generally the results I hear about from my specialists > is underwhelming I tried some of that. I found improvements in the first few months which had me excited. 8 months later, the tissues were exactly as they were before treatment. No long term changes. If you look at research for Arestin, the amount of tissue change is less than the statistical error of measurement. Which keeps me from trying this one. he only thing I have ever found to improve periodontal health (after a good scaling and root planing) has been to get the patient to change their life-style and hygiene habits. Without that, no changes are long term. Signature/ Amatus / > >> Hi, [quoted text clipped - 64 lines] > Is it safe, > Lord Olivier >> I have myself not used these materials (Arestin, Atridox, Perio Chip, the >> old Actisite) > >I tried some of that. I found improvements in the first few months which >had me excited. 8 months later, the tissues were exactly as they were >before treatment. No long term changes. One explanation is found here. http://www.iian.ibeam.com/events/penn001/14296/ The antibiotics work by interefereing with processes in a living active cell. Alas, in pereiodontal biofilms there are always some portion of the flora that are dormant, and thus unaffected by antibiotics. When these dormant bacteria become active, they restore the biofilm to its old status. Worse yet, they can even feast on the carcases of the bacteria you managed to kill with the anitbiotic/anti septic treatment That said, modest gains using antibiotic therapy have been persued by some http://www.clinicaltrials.gov/ct/gui/show/NCT00066001 >modest gains Clinically significant ? Signature/ Amatus / > >>> I have myself not used these materials (Arestin, Atridox, Perio Chip, [quoted text clipped - 21 lines] > > http://www.clinicaltrials.gov/ct/gui/show/NCT00066001 >>modest gains > >Clinically significant ? Hafajee says meta analysis indicates it is clinically significant (slide 19) http://dentalschool.bu.edu/ce/spring2005/OralHealth/HaffajeePresentation_files/f rame.htm "Meta-analysis indicated that antibiotics provided significantly better AL "gain" of 0.3-0.4 mm at 6 mos. post-therapy than the control groups not receiving antibiotic" This benefit is seen at 12 months (slide 24) The benefit depends on initial pocket depth, the greater the depth the greater the benefit (slde 25 and 26) >>>modest gains >> [quoted text clipped - 13 lines] > The benefit depends on initial pocket depth, the greater the depth the > greater the benefit (slde 25 and 26) I think that what AC means is clinically significant, and not statistically significant. It is doubtful that a gain in attachment level of .3-.4 mm is going to make a significant difference to the long-term prognosis of a tooth (though it may well be highly significant statistically). Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I think that what AC means is clinically significant, and not >statistically significant. It is doubtful that a gain in attachment >level of .3-.4 mm is going to make a significant difference to the >long-term prognosis of a tooth (though it may well be highly significant >statistically). Good point, Here I rely in part on the author's use of the phrase "clinically significant" Also ., the mean AL change for initial AL from 3 to <5 mm was , itself, ~0.3 mm for SRP ( it's really hard to read slide25 ) . Thus the addition of anti-biotic doubles the depth reduction. In this regard a doubling of AL reduction is clinically significant. . I've seen other studies, using pocket depth as the metric, that show a pocket depth reduction of ~ 1mm. The difficulty with these studies is the effect is on the same order as the standard error ( ~1mm) for small initial pocket depths. Back to Hafajee.. the abstract and reviewers comments are found here http://www.electronicipc.com/JournalEZ/detail.cfm?code=02250020080109&cfid=&cftoken= "Systemic Anti-Infective Periodontal Therapy... ReviewersÂ’ Conclusions 1. The use of systemically administered adjunctive antibiotics with and without SRP and/or surgery appeared to provide a greater clinical improvement in AL than therapies not employing these agents...." >> I think that what AC means is clinically significant, and not >>statistically significant. It is doubtful that a gain in attachment [quoted text clipped - 26 lines] > and without SRP and/or surgery appeared to provide a greater clinical > improvement in AL than therapies not employing these agents...." I don't have the references at hand. But those I've heard about show far greater attachment gains for scaling/root planing than for antibiotics overall. Of course, the actual differential may well change depending upon when the measurements are made. Steve > I don't have the references at hand. But those I've heard about show >far greater attachment gains for scaling/root planing than for >antibiotics overall. > Of course, the actual differential may well change depending upon when >the measurements are made. Just to clarify, the results I quoted were anitbiotics in addition to SRP, not in place of it. --G > >>>modest gains > >> [quoted text clipped - 23 lines] > > -- "I think that what AC means is clinically significant, and not statistically significant." > Mark & Steven Bornfeld DDS > http://www.dentaltwins.com > Brooklyn, NY > 718-258-5001 Steve, I think you probably meant to say that study showed statistical significance, but likely this holds no clinical significance. (I think you flipped "clinical" and "statistical") -Sue >>>>>modest gains >>>> [quoted text clipped - 38 lines] > > -Sue Not really--I was referring to what AC wanted to see, and not the converse--which as you say is what the study did in fact show. I think we agree, though I may not have been clear. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >So my questions are: >1) Did I pay the going rate, a bit higher, or a bit lower? This largely depends on your geographic region. The fees don't appear to be out of line and are a bit lower than my area. >2) Is the Arestin (minocycline hydrochloride) antibiotic powder >treatment a good investment to heal my gum pockets from 5&6mm back to >healthy levels, or is this experimental. Would you have done it? My vet friend uses something similar with very good results. The key is to have the areas re-scaled and re-root planed after the pockets diminish. It's a legitimate treatment IMO and yeah, I would. >3) Am I going to have to budget for regular Arestin treatments for the >rest of my life? (My gums have a healthy pink color, and I wonder if >the pockets are from my 3x a day brushing (so I can avoid the dentist). > .arestin. Can't predict but, after sucessful perio treatment (pockets eliminated) *and* good home care, *and* with regular professional cleaning it is unlikely that you would need to have arestin tx again. >4) Is it true the more it hurts the better the cleaning? (it's not pain >so much as it is discomfort) Nope. >thanks, >Philip -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com |
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