ARESTIN® is an antibiotic, minocycline hydrocloride, which is manufactured into microspheres. It is placed inside gum pockets with the expectation that it will kill the bacteria that cause gum disease. Because of the way that it is manufactured into microshperes, it can last inside the gum pocket for up to 21 days. OraPhrama who manufactures ARESTIN® claims that it will help reduce gum pockets when used in combination with deep cleaning (scaling and root planing).
Although ARESTIN® is used widely throughout the dental community, it has only made minor in roads with the periodontal community. Why is this? Well, lets look at some of the data behind this product.
The primary study used by OraPharma for their claims was performed on 748 patients. These patients had full mouth deep cleanings. One group of patients received ARESTIN® in gum pockets 5mm or greater and the other group (control group) did not. The gum pockets were measured at 1, 3, 6 and 9 months following the deep cleaning. There data suggests that using ARESTIN® statistically reduced gum pocketing compared to the control group. So far so good, so whats the issue?
Here is the problem: people with gum disease or who have been treated for gum disease need to have professional cleanings at least every three months. This is irrefutable in the periodontal literature. What we know is that these patients experience progression of gum disease if they are not keeping up with that schedule.
The ARESTIN® study is not valid because it did not follow that model whereby these patients should have had cleanings at 3, 6 and 9 months, not just measurements. Its more than likely there would have been no difference in these two groups had there been adjunctive cleanings at 3 and 6 months.
Furthermore, even in their own studies gum pockets greater than 6mm to begin with had less than a 1mm reduction at 9 months. Gum pockets are considered problematic at 5mm. Thus if you start with a 7mm gum pocket and you end up with a 6mm pocket you still have problems.
ARESTIN® is typically not covered by insurance so it is an out of pocket expense. As a patient I believe you are much better off investing in extra cleanings, every 3 months, vs having ARESTIN® placed in your gum pockets. The effect of a professional cleaning vs just an Antibiotic is like comparing an Atom bomb to a fire cracker, and this is also documented throughout the literature.
ARESTIN® is not without its applications, when used properly. It may be beneficial in trying to maintain 5mm gum pockets to prevent gum surgery. This would be if you had isolated / localized 5mm gum pockets.
It can also be useful around dental implants where the interface of the implant is deep below the gum margin. Sometimes this can lead to gingivitis and ARESTIN® is useful to help control that.
For gum pockets greater than 5mm conventional periodontal therapy is much more therapeutic and cost effective than ARESTIN®, and should be the first line of defense.
I have a lot of 4 mm and 5 mm gum pockets and I’ve been getting deep cleanings every 3 months for about 5 years. About 2 years ago, a hygienist recommended Arrestin for a single pocket of 8 mm. I happily chose to have it done. The pocket did shrink, but I don’t know how much. (I should find out next time.) But even if it shrunk only 1 mm I still consider it a benefit. I don’t notice a difference, but that tooth never bothered me. I have other teeth where I can smell bacteria when I floss if I haven’t flossed in 18 hours or so. I have a couple of questions. If I have the Arrestin treatment on that same tooth again, will there be further benefit? And should I have arrestin on the teeth that get the bacterial build up after 18 hrs of not flossing? Thanks!
From a Periodontist’s perspective a 7mm gum pocket is still unacceptable and requires active treatment to get it reduced. That could involve more deep cleaning or surgery. Using Arrestin as an active treatment is nonsense. It would only make sense to do that if you weren’t a candidate for surgery or deep cleaning as a result of a medical condition. I would recommend a consultation with your dentist and or a consultation with a Periodontist for your treatment options.
Hi again,
Thanks for your reply. I’m sorry I didn’t check back until now. I was at the dentist yesterday and the pocket that had the arrestin treatment is now 3 mm. When I said to the hygienist that maybe I should get arrestin in all my pockets she made a face. I’m not sure of the current depth of the rest of my pockets. (I shoulda asked), but maybe they’ve shrunk. For the past few visits the hygienist has said that I didn’t need to have irrigation with antibiotic after the cleanings because there was little to no bleeding. So I’m hoping this is a good sign. I usually floss after every meal so might this explain the lack of bleeding? I actually have a small callous on one of my fingers from flossing.
I would like to know who wrote the article “Is Arrestin a therapeutic treament for reducing gum pockets?”
I did