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

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Question
Hello, I have a question about periodontal disease. 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  Arestin treatment.  I know Arestin can potentially be a huge money-maker for dental practices so I am quite leary.  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.  Any help would be appreciated.

Answer
Well, periodontal disease and gum infection only rarely cause pain, and bleeding or seepage often is not evident.

It is very hard for me to think that a hygienist would suggest scaling and Arestin treatment just to make money for the company. Most probably there is a real need to treat these pockets.

Whether scaling alone is enough or whether Arestin also should be applied, I cannot judge without seeing the situation. If that were my mouth and my teeth, I would definitely let the hygienist use Arestin, just to make sure that healing occurs properly.

Your wife could, of course, ask your dentist to show her the x-rays and to explain whether there is bone loss and a need for a procedure. Unfortunately, however, a hygienist often is more skilled to judge the situation than a general dentist.

It might be possible to cure or inactivate a max 4 mm pocket by just brushing and flossing very carefully and regularly. If there is no bleeding even after flossing all the way down to the bottom of the gingival pocket, then there probably is no hurry with the scaling. On the other hand, a pocket of 5 mm or more usually does not heal by home care alone.

Arestin, when placed into the gingival pocket, enters the blood in only very small amounts. However, It should not be used during pregnancy. I suggest that you let your wife decide whether she wants to have the scaling done after she has checked whether she is pregnant.

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Marketta Hormia, DDS, PhD

Expertise

I am a periodontist living and working in Helsinki, the capital of Finland, where I have my private dental practice. I am an international member of the American Academy of Periodontology. I have a Ph.D degree and a long background in research and teaching at the University of Helsinki and at the University of Turku, Finland. I function as an adjunct Professor at these Universities. I have also worked as a visiting scientist at the Scripps Clinic and research Foundation, la Jolla, CA. I can answer any question in the fields of dentistry and periodontics.

Experience

Private practitioner in Helsinki, Finland over 20 years. Former researcher and teacher at two Finnish Universities.

Organizations
The Finnish Society of Dentists, Division of Periodontology, American academy of Periodontology

Publications
Over 30 scientific research articles published in peer-reviewed international scientific journals (can be found on PubMed)

Education/Credentials
D.D.S., Ph.D, Specialist in Periodontology. Adjunct Professor.

Awards and Honors
Visiting Scientist at the Scripps Research Foundation, San Diego, California, 1992-1994. NIH grant

Past/Present Clients
Dental patients, national and international. All kinds of dental, oral and temporomandibular joint problems

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