Note to Readers: I just want you to know that this is written primarily to dentists and dental hygienists, however because it affects patient care I want patients to be able to read it as well. They should understand what this material can and cannot do in order to be able to give informed consent for its use.
Arestin® (Minocycline HCL 1mg Microspheres) is a locally delivered antibiotic that kills bacteria in a periodontal pocket without significant systemic absorption.
Arestin does not cure periodontal disease and I do not believe it makes enough of a difference during scaling and root planing to warrant the additional expense to the patient.
Where Arestin is very useful is in Periodontal Supportive Therapy (aka Recare or Periodontal Maintenance). Used correctly it can enable patients to not require periodontal surgery as frequently or at all.
How to Use Arestin in Periodontal Supportive Therapy (SPT)
- Always record probing depths at SPT appointments.
- Always note bleeding and probing depth together in the record.
- 5mm pockets that bleed should receive Arestin after light ultrasonic subgingival cleaning. Note in the patient’s record where Arestin was placed. You might circle the number or place “A” nearby.
- Repeat Arestin in the same site up to three SPT visits in a row.
- If the same site remains 5mm and bleeds three times in a row, discontinue Arestin. It is time to consider repeat scaling and root planning (the specific site only), periodontal surgery or referral to a periodontist.
- If 3 months later a site you previously placed Arestin in is still probing 5mm but is not bleeding then do not place Arestin (site does not need it).
- As long as you do not have to place Arestin in the same site three times in a row, you can continue to use it indefinitely (it is proving to be an effective management tool).
- If you have to place more than 5 Arestins at a visit, the cost/benefit ratio is out of whack. It may be time to repeat scaling and root planing. If the interval between scaling and root planings is years apart then this in my mind is fairly normal. If scaling and root planing was recently performed (within 12 months) then this is an indication that something more aggressive needs to be considered. Systemic antibiotics should not be necessary in routine SPT. If the whole thing is unclear, refer.
What about other pocket depths that bleed?
- 1mm to 3mm sites that bleed are usually accessible to brushing and flossing. A high bleeding index consisting primarily of shallow sites indicates either a patient compliance issue or possibly (rarely) a systemic issue (diabetes?). Besides, practically speaking, shallow pockets can’t hold the antibiotic in place long enough to be of any use.
- 4mm pockets receive only light ultrasonic cleaning (repeated root planing every appointment is discouraged because it results in significant loss of tooth structure and increased sensitivity over time).
- 6mm pockets may receive Arestin one time; however remember these are advanced sites. Usually periodontal surgery is the treatment of choice. This is because supporting pockets this deep in SPT usually results in further attachment (bone) loss.
If you have to use Arestin, the recall interval should always be 3 months (not 4 or 6).
The use of an antibiotic implies a problem that needs to be followed on a tight interval. Tightening intervals down to three months is the best first step when conditions are not adequately controlled. If the patient elects to not have a tighter interval, I suppose you can place Arestin, but I personally think this is silly. There is a compliance issue here, not a plaque issue.
Dental offices have my permission to use this material in patient handouts without citing me – just don’t publish it beyond your private use without permission. Thanks.