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Arestin????

My office has really been encouraging Arestin placement lately but I’m not sure how I feel about it. We have another hygienist who uses it on almost every single patient, while I am more conservative & prefer scaling alone. The Dr. continues to pressure me to use it more often, comparing my production to my co-workers, but I just don’t know if it works! I want what is best for my patients & frankly don’t care if it makes him more money or not. Does anyone use Arestin regularly & see results?



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3 Answers

Encouraging the treatment or adjuncts for the sole purpose of production is not good! Like you, I certainly wouldn’t be comfortable with that.
 
The manufacturers of Arestin recommend placement at the time of SRPs, however many hygienists place it as needed if certain sites aren’t responding, conservatively. A study in the Journal of the American Dental Association, looked at the benefits of SRP with and without adjuncts (lasers, antibiotics) and the results showed no clear benefit to locally placed antibiotics such as Arestin over SRP alone. Here’s the link: http://jada.ada.org/article/S0002-8177(15)00334-7/fulltext

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I work for more of a corporate sort of office and they also encourage use of arestin. We have had a few lunch and learns about it and studies do show that you have better results with it than without. Pushing the fact that any other sort of infection you have you use antibiotics. I tend to use more in areas that don’t respond. I know what they see in the studies don’t always make a huge difference in the real world. I personally have not seen these huge responses but they state it’s because I don’t use it regularly. I also like to start suggesting seeing a periodontist when you are getting to the 6mm range, especially if it is not localized.

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I’m an ancient hygienist and over the years, I have put everything from tetracycline, doxycycline in suspension made at a local pharmacy to atridox, peridex, Stannous Fl and almost everything else that has ever been promoted in dental lectures in sulci. After 40 years of practice, I like to think that the tissue will dictate tx. Scale,probe and follow up. That can’t happen if you place Arestin before you know what result you will get with scaling alone and letting the body take care of itself. I am aware you would get more momentum treating aggressively when the situation is “hot” as opposed to not being aggressive enough and being fooled as you burnish calculus in deeper pockets. I haven’t seen any miracles from arestin, but I have seen years of patients’ insurance benefits being exploited.($40 per site) I have been with each of the offices where I have worked for an average of 10+ years and have had the opportunity to see patients for a long, long time. I have only felt guilty for charging/not using arestin as I’ve seen so many meds come and go. I have not been surprised by refractory perio, or tooth loss but once or twice since 1980, both cases were post menopausal women oddly enough. I can’t really say I’m an excellent hygienist, but I am conscientious and make myself aware of condititions before I begin. Smokers and diabetics make me nervous. Arestin will one day go and something new will replace it. If the situation is that unpredictable, the patient should be referred.I know my backside would be in a perio or endo office if I had a 5 or 6mm pocket. How many other ways can you kill Gram neg bugs?

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