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Periodontal disease is a progressive disease of the structures (bone and gingival tissues) surrounding our teeth. It is believed that about 65 million americans have some form of periodontitis. Periodontitis is the advanced form of periodontal disease. Once the disease state reaches periodontitis it means there have been some form of permanent loss of bone or gingival tissues to the disease. In those 65 and over this number jumps to 70% of that population. These numbers are startling. Luckily, there has been extensive research into periodontal disease and new treatment modes have been developed. One such method is treating periodontal disease with Arestin.

What Is Arestin?

Arestin (minocycline hydrochloride) is an antibiotic that comes in the form of micrspheres. These microspheres are placed locally into areas of concern. Periodontal disease generally hits certain areas over others initially. This gives us a chance to localize treatment of periodontal disease with arestin.

Treating Periodontal Disease With Arestin

Periodontal disease if left untreated will develop deeper and deeper “periodontal pockets” around out teeth. The normal space between our teeth, gums and bone is approximately 3 mm. When periodontal disease begins to damage these areas these pockets can widen and deepen as bone is lost and gum tissues lose their connections to our teeth. As the periodontal disease develops and progresses it is not unheard of to have periodontal pocketing in the 6-8 mm range. That is a doubling over normal pocket size. This allows food and bacteria to penetrate these areas and create even more damage to gingival tissues and bone. Once these support structures become damage they can cause our teeth to become loose and eventually lost them.

The standard course of treatment for periodontitis is scaling and root planing (S&RP). This treatment is highly effective for treatment of periodontal disease.

-Periodontal scaling of teeth with instruments involves manually removing all the plaque, tartar, and food from on and around our teeth.

-Periodontal planing can smooth out rough areas on our teeth’s roots where bacteria and plaque can attach.

Scaling and root planing has been our #1 treatment for periodontal disease for decades. Where does treating periodontal disease with Arestin come in? Combining the use of Arestin with the traditional scaling and root planing gives dentists and periodontists a real chance to reduce the periodontal pocketing around our teeth. In routine scaling and root planing, depending on depth of pockets, it may be difficult to reach to the entire depths of those pockets. Everyone’s anatomy is different so some areas are easy to reach while others might be more difficult based on root structures and how the periodontal pockets form. None are uniform. Using microspheres of Arestin allows your dentist to reach the bottom of those pockets and destroy harmful bacteria before further destruction of tissues can occur.

Treating Periodontal Disease With Arestin Procedure

The following is what to expect if you are undergoing treatment of periodontal disease with Arestin.

Diagnosis of Periodontal Disease. In its earliest form (Gingivitis) there is no damage to bone or gingival tissues and can be reversed thru professional cleaning and increased at home dental hygiene care. In periodontitis, destruction has begun. A simple professional cleaning is no longer as effective. Diagnosis of periodontal disease is achieved thru x-rays and use of a periodontal probe. This dental instrument allows your dentist or hygienist to measure around the teeth and see what areas might be affected by periodontal disease. A normal reading of 3 mm means tissues are healthy. Anything over that raises a red flag and leads to a diagnosis of periodontal disease.

-Treatment Plan To Fight Periodontal Disease. Your dentist will explain these results to you and discuss treatment necessary. The first line of defense is always a scaling and root planing (also called a deep cleaning). Your dentist may now offer Arestin in conjunction with this type of cleaning to give you a better chance of stopping this problem from developing further and also repairing tissues around our teeth.

-Treatment With Scaling And Root Planing.

-Arestin Application Following Scaling And Root Planing. The arestin is in the form of a microsphere. This allows the arestin to release the antibiotic gradually over time to fight the bacteria in the deepest depths of those periodontal pockets. It is able to target areas scaling and root planing instruments just cannot reach.

Is Arestin Effective?

Yes! Studies have shown that is more effective in treating pocket reduction when paired with Scaling and Root Planing Vs S&RP alone. In fact clinical trials have shown significant pocket reductions in as little as 1-3 months and maintenance for at least 9 months. It has also shown significant reductions in our more difficult to treat patients. Those include the smoker’s, ones with a history of heart disease, and those over age 50. The chart below shows those statistics.

Periodontal Disease With Arestin Marielaina Perrone DDS

Is Arestin A Miracle Drug? Conclusion

Arestin is not a miracle drug. But it will help controlling a very difficult progressive disease. Periodontal disease is difficult to control because it relies on many factors. The biggest one is at home dental hygiene. Patients need to understand their dental care does not begin and end inside the walls of their dental office. Fighting periodontal disease is a daily battle. Periodontal disease treatment with Arestin can help reverse some of those issues but it will not be a cure for it.

 

 


Periodontal Disease– is a group of diseases that affect the tissues that support and anchor the teeth. If untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root. The earliest form of periodontal disease is called gingivitis. Gingivitis is reversible with proper treatment.

Once a patient is diagnosed with advanced periodontal disease (also called periodontitis), their dentist will recommend procedures above and beyond that of a normal professional cleaning to properly treat and manage the periodontal disease. In the initial stages, most treatment revolves around non surgical intervention but as the periodontal disease progresses surgical treatment is often recommended and required.

Periodontal Disease Treatment

Non Surgical Procedures

Scaling and root planing. This procedure is a special type of cleaning that removes plaque and tartar from under the gum line and makes the root surfaces smooth. The smoother root surface is thought to promote reattachment of the gum tissue and promote healing. This type of cleaning is the only way to remove tartar from below the gum line. This is usually completed in multiple visits utilizing a numbing anesthetic to make the procedure more comfortable..

-Drug Therapy. In some cases, antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early periodontal disease, scaling and root planing in addition to continued daily cleaning at home (flossing, brushing , and rinsing) will achieve a satisfactory result of reversing periodontal disease.  A wide array of antibacterial rinses such as Peridex, antibiotics taken in pill form such as  Periostat, or localized placement directly into the affected pockets with an antibiotic such as Arestin, can aide in, and promote healing of the affected gum tissue.

-Periodontal maintenance or supportive periodontal therapy: Following a scaling and root planing, routine specialized  cleanings (every 3-4 months)  to target your periodontal problem area, can minimize the recurrence or progression of periodontal disease.

Surgical Procedures

-Pocket depth reduction procedures: Your dentist or periodontist will open up the affected gum tissue so that periodontal disease causing bacteria and calculus build up can be easily seen and removed. Some cases may require contouring and smoothing of the damaged bone and root surfaces to allow the gum tissue to reattach to healthy bone during the healing phase. The procedure also repositions the gum tissue so that it is easier to keep clean going forward.

Perioscope cleaning: A deep cleaning requiring a microscope to be placed below the gum line to remove tartar, cement, or other debris.

-Regeneration. Your dentist will treat the affected gum tissue in the same way as in pocket depth reduction procedures, with the additional procedure of using membranes, bone grafts or tissue-stimulating proteins to stimulate the body’s natural ability to regenerate healthy bone and gum tissue. A good example of this is a bone and tissue growth factor called Emdogain.

-Soft tissue grafts. Your dentist will take synthetic tissue such as Alloderm, or healthy gum tissue from the roof of the mouth (palate) or other areas of the mouth and use it to repair receding gums and cover exposed root surfaces.

-Hard Tissue Bone Grafts.  This procedure is needed when periodontal disease has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. The dentist can use your bone, cadaver bone, cow bone, or a lab created calcium based bone matrix material.

Conclusion

If you have been diagnosed with periodontal disease please take the news very seriously. Periodontal disease is a progressive disease that will continue to get worse without treatment. Periodontal disease  leads to tooth loss and oral infections. Your dentist can help you with diagnosis, prevention, better oral hygiene methods and instruction, and proper treatment for your particular needs.  Studies have shown time and again that there is a link between oral health and your general health. Keeping your mouth healthy will lead to better overall health. As always visit your dentist regularly for dental examinations and regular professional cleanings to stave off the onset of periodontal disease.



Scaling and root planing is one of the most conservative and effective procedures to treat periodontal disease before it progresses. Scaling is the removal of calculus (commonly called tartar) and plaque that attach to the tooth surfaces. Scaling and root planing cleans between the gums and the teeth along the roots. Scaling and root planing specifically targets the areas below the gum line (along the root).

Scaling and root planing are sometimes referred to as a deep dental cleaning. Scaling involves removal of built up plaque at the gum line using either manual hand instruments or an ultrasonic cleaning tool (the vibrations break up the tartar and plaque). During root planing, your dentist or hygienist will be gently cleaning the roots of your teeth, and removing any rough spots along the roots and teeth. These rough spots tend to be a trap for bacteria and plaque. Plaque is far more likely to stick to rough surfaces. As the bacteria builds up in the form of plaque it creates a sticky surface for even more bacteria to accumulate. The root surface is made smooth in a process called root planing. Root planing removes any remaining tartar and smooths

Root Planing and scaling

Scaling and Root Planing

irregular areas of the root surface. This procedure is usually performed using local anesthesia, because the roots of teeth are unprotected by enamel and are very sensitive. Your dentist will use a local anesthetic to numb your mouth before starting the procedure. Local anesthetic should prevent you from feeling discomfort during the root planing and scaling. Instead, you’ll just feel the pressure of the instruments in your mouth.

It usually takes more than one visit to complete scaling and root planing. Since all of that deep cleaning can leave your teeth pretty sensitive, the dentist or hygienist will only do one part your mouth at a time. The number of treatments can depend on how severe your periodontal disease is and your personal oral hygiene habits. It generally takes 2 visits to complete the scaling and root planing procedure. You will schedule your follow up appointments about 1 week apart from each other. It will also be recommended that you schedule more frequent cleanings (every 3-4 months) after scaling and root planing to help prevent the return of gum disease.

Why is Scaling and Root Planing necessary?

Scaling and root planing actually helps gums heal. The gum tissues will have an easier time reattaching themselves to a smoother root surface than a rough one. The smoother surface also helps keep dental plaque from attacking the tooth’s root surface. This makes it far easier to maintain the gum tissue following treatment. Scaling and root planing has been shown to help prevent periodontal disease from spreading and it can also reverse the signs of ginigvitis (the earliest form of periodontal disease).

Following Scaling and Root Planing Treatment

Once the scaling and root planing is completed, oral hygiene preventive care is necessary to keep gums healthy. Periodontal disease can not be cured but it can be held at bay with proper oral hygiene techniques and practices. Brushing and flossing will help fight the dental plaque that is constantly forming around teeth. Antibacterial rinses, such as Peridex, and stannous fluoride rinses help keep bad bacteria at bay. Tartar dissolving products such as Periogen will help keep teeth cleaner between cleanings and allow for greater healing to occur. Regular dental examinations and visits to your hygienist are required to clean areas we are unable to.

Risks of Scaling and Root Planing

Scaling and root planing can introduce harmful bacteria into the bloodstream through the process. Gum tissue can also be at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you. You may need to take antibiotics for the following reasons:

-Have certain heart problems that place you at increased to get a heart infection called endocarditis.

-Have a weakened immune system.

-Had recent major surgeries or have man made body parts, such as an artificial hip or heart valve.

A simple, conservative procedure like scaling and root planing can reduce periodontal disease’s effects and restore the gum tissue to a healthy state. Without proper treatment, periodontal disease will progress. It will progress past the gingivitis stage into periodontitis. Periodontitis is not reversible like gingivitis. Remember: Once gum tissue is lost, it doesn’t grow back. The earlier you treat gum disease, the better chance you have for recovery. To promote healing, stop all use of tobacco. Smoking or using spit tobacco reduces your ability to fight infection of your gums and delays healing. The earlier you start treating gum disease, the better your chances of being able to take care of the problem without surgery and the lower your risk of losing any teeth. So make an appointment to see your dentist today and put an end to your periodontal disease.