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Arestin required with scaling/root planing?

Hi, I work for a corporate dental office with several locations. Hygienists are instructed to treatment plan Arestin placement in every 5mm pocket when scaling/root planing is needed. Most times insurance won’t cover the Arestin and patients need to pay out of pocket. Many of my patients can’t afford the Arestin but do understand the need for scaling. Our treatment plan coordinator presents the scaling treatment as a package rather than breaking it up into parts. I have had several patients leave and not schedule anything because they can’t afford it but really their insurance covers most if not all of the scaling. It upsets me because I would rather treat their gum disease and than down on the road maybe recommend specific sites for Arestin placement as needed. Lately there have been instances that have been especially upsetting. Also, hygienists make commission on Arestin so that plays a key role in this. I’m not thinking this is the right fit for me.



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2 Answers

This is totally upsetting and frustrating! I completely agree with you in that patients’ disease needs to be treated and if a site isn’t responding, then Arestin can be suggested. For patients to refuse all treatment because they aren’t given the option to undergo SRP alone because they can’t afford Arestin is such a disservice to the patient. Not to mention unethical of the office to do this. All patients should have the right to choose which treatment they accept based on their needs. Its not like the patients are refusing SRPs and only wanting a prophy here! This is also where commission based on adjunct treatment is a slippery slope, and sadly, sometimes money becomes the focus instead of patient care.
 
I must say that the makers of Arestin do recommend placement at the time of SRPs, however many hygienists do exactly what you would do, and place it as needed if certain sites aren’t responding. On the flip side, 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
 
If you don’t agree with the office’s treatment methods, you are right, this may not be the right fit for you. You have to sleep at night knowing you did right by your patients. It’s never an easy decision to leave an office, but if it doesn’t feel right, you need to stick with your gut feeling. I applaud you for your ethics and wish you the very best luck!

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Thank you for confirming what I already knew/felt. The last situation was a 30 year old woman who completely understood her gum disease and wanted to treat it but just couldn’t afford the Arestin and ending up leaving without making her appointment. That really upset me! I will read the article you posted, thank you! Another hygienist at that practice and I were talking about how scaling someone and placing Arestin with fair homecare doesn’t seem to have as good results as scaling alone with excellent homecare. And homecare is free! Thanks for your quick response and support 🙂

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