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Periodontics/4-5mm pockets on two teeth - SRP? Arestin?

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Question
Hello, my wife was told by her hygenist (not the dentist) that she had 4-5mm pockets on just two of her molars. The dentist didn't even see her. She immediately recommending a scaling procedure and an expensive Arestin treatment.  I know Arestin can potentially be a huge money-maker for dental practices so I am quite leery.  She has no pain, seepage, or bleeding.  We feel like maybe they are just trying to get their money out of us because she missed two cleanings.  Am I way off base here?  Her "condition" seems mild to me; a slightly invasive procedure and a "drug of the day" treatment just seems like a little much for mild pocketing.  Also the hygenist told her it was safe to take if she thought she could be pregnant (and she could be) and I researched and found Arestin to be Category D. How severe are 4-5mm pockets in the absence of other symptoms. Any help would be appreciated.

Answer
Dear Nic, I have not had the opportunity to examine your wife so I will do the best I can to answer your question.  A pocket means that there is a space between the gum and the tooth that measures 4-5mm.  Ideally there should be a space of 3 or less with no bleeding.  There are many reasons why there is a larger space.  One is that the gums are inflamed and enlarged and this enlargement of the gum makes the space larger, or there is some early periodontal disease or gum disease and there has been some loss of bone and the gum has separated from the tooth causing the pocket to form.  a 4-5mm pocket is not severe at all, but it is also not something that should be dismissed.  Without the hygienist having a radiograph she would not know if there was bone loss, but I commend her for at least probing your wife's mouth.  Only 25% of general dentist actually probe their patients teeth.  Honestly if this was on only 2 molars she should have scaled the teeth at that appointment as part of the cleaning.  She should then have your wife brought back for a follow up or recheck the area again at her next cleaning.  My professional opinion is that bringing her back for the scaling and arestin is aggressive and unnecessary.  For what it is worth, 1 ampule of Arestin costs the doctor about $14. I have seen offices bring patients back for 20 minutes of scaling and 1 ampule of arestin and charge hundreds of dollars.  Many dental offices now are oriented to create profit centers and I am guessing that the hygienist is probably on commission.  Additionally, woman who are pregnant have increased hormonal blood levels and it is not uncommon to see more inflammation and ergo some deeper pockets.  I do think the areas should be scaled, it could have been done at her appointment, but bringing her back for a separate procedure makes money. I would also tell you that you folks shouldn't miss your cleanings, but you knew that.  I am not 100% sure your dental office is just out for the money, but they just might be. At this point it is up to you as to whether you want to seek a second opinion.

Good Luck and if your wife is pregnant best of luck to you both.

Periodontics

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Bryan M. Siegelman, DDS

Expertise

I can answer any question relating to the diagnosis and treatment of periodontal disease. I can also answer questions relating to the placement and restoration of dental implants.

Experience

I have been practicing Perioodontics for the past 20 years. I limit my practice to periodontics and implant dentistry. I am a diplomate of the American Academy of Periodontology. I am in private practice in Pennsylvania and am on staff at the local hospital in my home town. My practice website is www.gumsolutions.com

Organizations
American Academy of Periodontology, Academy of Osseointegration, American Dental Association, American College of Dentists, Pennsylvania Dental Association

Education/Credentials
I have a BS from Muhlenberg College, I did a general practice residency at St. Joeseph's Hospital and Medical Center in Paterson, NJ. I received my DDS degree and specialty certificate from the University of Maryland Dental School.

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