Last month, the Unique ePerspective question surrounded the use of Arestin. The reader who originally sent in the question, Norma, provides follow-up information and resources to further assist the readers of RDH eVillage. In the e-mail below, Norma is thanking Kimberly Miller, RDH, BSDH, a senior consultant of JP Consultants Institute, and newly appointed faculty member of the hygiene program at the Nash Institute.
Hi Kim,
Thank you for your response to my question. I did go to the site you indicated in your answer. I found several interesting studies, which I believe do support what I have seen clinically.
When Arestin was first introduced to another office I was working in, I did use it as recommended. Again, the results were inconsistent and not impressive clinically to make it cost-effective to the patient to continue reapplying it. Then I moved away from that protocol, and began using it at the re-evaluation periodontal maintenance appointment.
I am aware that the area has to be rescaled to remove the biofilm before using Arestin. In the office where I currently work, other hygienists use Arestin frequently at the time of SRP. We often see each other's patients at recall appointments. The results have not been overwhelming. I think we can agree that certain bacterial strains are resistant to this antibiotic therapy. Unless we culture the infected pocket and determine that this antibiotic is the appropriate one, it is a hit-or-miss situation. To continue reapplying the same antibiotic without further testing does not make sense to me. If there is a reduction in periodontal disease, is it because of Arestin or the repeated scalings before its application?
I believe that if a patient has multiple pockets deeper than 5 mm in the same quadrant, systemic antibiotics should be considered instead. I am not against the use of Arestin; I think it is a great product. I just think we need to use it on a case-by-case basis — not automatically on every patient we do SRP on. I'm interested in seeing the responses from hygienists across the country and reading about their experiences with Arestin.
Below are the articles I read at the Journal of Periodontology Web site:
• Academy Report — American Academy of Periodontology Statement on Local Delivery of Sustained or Controlled Release Antimicrobials as Adjunctive Therapy in the Treatment of Periodontitis. May 2006; 77(8).
• Greenstein G. Local drug delivery in the treatment of periodontal diseases: assessing the clinical significance of the results. Journal of Periodontology (Abstract) 2006; 77(4):565-578 (doi:10.1902/jop.2006.050140).
• Walker C, Karpina K. Rationale for use of antibiotics in periodontics. Journal of Periodontology (Abstract) Oct. 2002; 73(10):1188-1196 (doi:10.1902/jop.2002.73.10.1188).
I would be more than willing to read any other articles regarding this topic. I appreciate all of the feedback I have received thus far.
Thank you,
Norma C. Laurent, RDH, BA
Dear RDH eVillage:
Regarding Arestin — I use it and have had good results.
Judith, RDH
Dear RDH eVillage:
I almost deleted "Hygiene Village" from my mail before reading it. I'm glad I looked at it first though, because I really enjoyed the collegiality of its format. As a dental hygienist in a private practice and usually in a hurry to get ready for the next scheduled patient, I'm sometimes left with a few questions about the approach to various patients. I'm retired from a full-time state-funded dental clinic that I really enjoyed, for the most part, during my 25-year practice there.
Since I only work one day a week, I didn't realize that I still cared so much for each patient I see and want them to be able to keep the teeth they have.
RDH eVillage gave me the opportunity to hear from other hygiene practitioners and explore some helpful devices that have come on the market — and all this without the "sales pressure" somehow. I'm more likely to place an order this way. I look forward to your next issue, but please do not send me oodles of advertisements or I'll have to delete it all.
Good presentation!
Thanks, Noele
