Re: Do you recommend Arestin for 5mm pockets?

philipms@xxxxxxxxx wrote:

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

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).
4) Is it true the more it hurts the better the cleaning? (it's not pain
so much as it is discomfort)


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

Mark & Steven Bornfeld DDS
Brooklyn, NY