Scaling and arrestin for 4mm pockets?

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chris in Moreno Valley, California

65 months ago

I recently went for my regular 6mo cleaning. I am new to the area I am a new patient to this practice. They were running a "special" for new patients, x-rays, exam and cleaning for $49.00, excluding any perio issues. My hygienist found 7 4mm and two 5mm pockets, all non-bleeding. (All were 1-3 at my last visit). She wants to do a scaling and place Arrestin in all of the pockets. Does this seem excessive? My husband had a few 5mm pockets , which were bleeding, they were reducedd to 3mm with a regular cleaning and rinsing with Chlorhexidine. I will do what I need to in order to maintain good oral health, as I am a monster grinder and worry about developing periodontal disease. I have had moderate pocketing (4mm)in the past, which my Dentist said was do do the bruxism. After having my teeth cleaned and a night guard made, they returned to normal (1-3). I can't help but to feel that at $125 per quadrant, and $50.00 per Arrestin, that this treatment may be more about money. I would appreciate any feedback. Thanks!

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ana2lili in Kennewick, Washington

65 months ago

chris in Moreno Valley, California said: I recently went for my regular 6mo cleaning. I am new to the area I am a new patient to this practice. They were running a "special" for new patients, x-rays, exam and cleaning for $49.00, excluding any perio issues. My hygienist found 7 4mm and two 5mm pockets, all non-bleeding. (All were 1-3 at my last visit). She wants to do a scaling and place Arrestin in all of the pockets. Does this seem excessive? My husband had a few 5mm pockets , which were bleeding, they were reducedd to 3mm with a regular cleaning and rinsing with Chlorhexidine. I will do what I need to in order to maintain good oral health, as I am a monster grinder and worry about developing periodontal disease. I have had moderate pocketing (4mm)in the past, which my Dentist said was do do the bruxism. After having my teeth cleaned and a night guard made, they returned to normal (1-3). I can't help but to feel that at $125 per quadrant, and $50.00 per Arrestin, that this treatment may be more about money. I would appreciate any feedback. Thanks!

Hi, I am going to agree with you, i am a hygienist and find that if the hygienist that finds all of this stuff is working on a commission type of job, alot of unnecessary stuff is diagnosed. If your pockets are not bleeding, it is an indication of it being stable and more frequent recare appts are warranted, if they are bleeding it means unstable pockets and further treatment may be needed.

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chris in Moreno Valley, California

65 months ago

Thank you so much for the quick response. I thought it was a little much- but as I am overly cautious with my oral hygiene, I have made an appointment with the Periodontist. Better to be safe than sorry. The dental world needs more honest people like you!

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chris in Moreno Valley, California

65 months ago

I would to thank everyone for their feedback. I went to see a Periodontist who assured me that I do not need the suggested tx. I do have 2 5mm pockets wihout bleeding. He feels this is probably due to the bruxism. He suggested a routine cleaning, no SRP or Arrestin. He also told me that as long as I keep up with my current home care, I will be fine with a 6mo recall. I'm more comfortable with a 4mo recall, so I think I'll go with that. Again, thanks for the honest advice. Between the people I've met here, and the Periodontist I met with today, my faith in finding honest dental professionals has been restored.

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chris in Moreno Valley, California

65 months ago

I have not contacted them. I don't think I would get any type of response. When I told the office manager who went over the cost of treatment with me that I was going to see a Periodontist, she responded by saying, "OK, then we're done here for today". She then got up and left the room. I have an appointment with another general practice this Tuesday,(the perio office does not do cleanings, only surgeries) hopefully I will finally get my teeth cleaned!

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suzanne in Terre Haute, Indiana

65 months ago

Her comment, we're done for today, was abrupt at best. I suggest you share your concerns and why briefly with the dr at the time of the exam when you go for your cleaning and request perio depths at your next check-up to be sure you aren't getting into trouble. If an office knows you are communicating with a periodontist, they will be more apt to be honest. Also just for thought, I have found time and time again if a dr recommends a certain periodontist, you will get a more objectionable opinion if you go to someone he didn't recommend. Get my drift?

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Tami in Newport, Rhode Island

65 months ago

I had some 4 and 5 mm pockets that I had root scaling and planing for. After a 6 mo recall, I still have some of these 5 mm pockets. One of them is red and inflamed, but does not bleed when I floss or brush...does this mean it is stable?? I do have some mild bone loss and I plan on going to another dentist that recommended an emdogain treatment. I have researched this and it seems promising. It is better than what the perio wanted to do: fillet my gums open like a fish. Why isn't using a perioscope the standard of care?? Most dentists scrape around the gums blindly...any takes on this??

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suzanne in Terre Haute, Indiana

65 months ago

Thank-you. I was researching on the internet and you are right!

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chris in Moreno Valley, California

64 months ago

You're welcome.

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Miguel Angel in Hollywood, Florida

64 months ago

some one could tell me if there are any good and honest Periodontist in Broward county or Miami dade in florida thanks a
lot good information here

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exp in Massachusetts

63 months ago

Hi Linda, Some feel Arestin is good and others think it's not as great as portrayed by Dentist's , etc. I know that in some offices they split the Arestin in 2 and place 1/2 in each pocket. If you find that they are "taking you for a ride" on this...another suggestion might be to schedule prophy's 3x's a year. I would ask if (maybe at no cost to you) that the hygienist could possibly schedule a short appointment in 2 weeks to see what the depths are...? If you're not happy with this office and they "push" items at you , maybe find another office (through friends)...Good Luck 4mm pockets I feel are borderline, so I would also suggest asking about your history of perio (if any).

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smiledivaRDH in Schnecksville, Pennsylvania

63 months ago

There is also another method out there called PerioProtect. This is a localized antimicrobial/antibiotic system in which the patient wheres prefabricated mouth trays, usually 2xday for 30mins or as directed depending on the severity of the perio condiditon. This route is still expensive because of the fabrication of the trays but once you have them, the gel and antibiotic (vibromycin) which are used are about $30 which lasts over a couple months. Not all offices offer this procedure as they have to go to a seminar to take a course on this method. The one dentist I work for uses it and I find that it has a higher effective rate than Arestin does because it is constantly killing the pathogenic bacteria at the base of the pocket instead of a once and done treatment.

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exp in Massachusetts

63 months ago

smiledivaRDH in Schnecksville, Pennsylvania said: There is also another method out there called PerioProtect. This is a localized antimicrobial/antibiotic system in which the patient wheres prefabricated mouth trays, usually 2xday for 30mins or as directed depending on the severity of the perio condiditon. This route is still expensive because of the fabrication of the trays but once you have them, the gel and antibiotic (vibromycin) which are used are about $30 which lasts over a couple months. Not all offices offer this procedure as they have to go to a seminar to take a course on this method. The one dentist I work for uses it and I find that it has a higher effective rate than Arestin does because it is constantly killing the pathogenic bacteria at the base of the pocket instead of a once and done treatment.

Do you find staining a problem to the teeth with this product: perio protect? I find that Chlorohexidine did stain and alot of times its tenacious to scale. Unfortunately, a lot of Dr.'s today (not all) push procedures $$$$. How long has this product been on the market?

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hyg sucks in Richmond, Virginia

63 months ago

I've read some of blogs here and wanted to comment. If you are in doubt about a treatment always get a second opinion. Get a copy of your x-rays and get a consultation. Most offices wont charge you. Legally with insurance you can do scaling when there are 4mm pockets. I personally will have to check xrays to determine if scaling is needed on 4mm pockets. X-rays are your friend for diagnosing perio. As far as Arestin I offer it and tell pts it can help. I have had pts that didn't respond to it. But its cheaper to try that 1st then to have gum surgery. I don't want to step on toes but some are all about the money and scale 4mm pockets when it really was not needed. But majority of us are honest and want what is best for our pts. And when treatment is recommended ask why.

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afuturedentist in Mercer Island, Washington

63 months ago

hyg sucks in Richmond, Virginia said: I've read some of blogs here and wanted to comment. If you are in doubt about a treatment always get a second opinion. Get a copy of your x-rays and get a consultation. Most offices wont charge you. Legally with insurance you can do scaling when there are 4mm pockets. I personally will have to check xrays to determine if scaling is needed on 4mm pockets. X-rays are your friend for diagnosing perio. As far as Arestin I offer it and tell pts it can help. I have had pts that didn't respond to it. But its cheaper to try that 1st then to have gum surgery. I don't want to step on toes but some are all about the money and scale 4mm pockets when it really was not needed. But majority of us are honest and want what is best for our pts. And when treatment is recommended ask why.

Hyg Sucks,

I agree with your approach. Although I'm an assistant now, I will be I have had slight exp dealing with perio. I'd love some advice from you on how to make the most of my dental hygiene program which I'm starting in the fall at a dental school in DC. Thanks!

afuturedentist@gmail.com

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hyg sucks in Woodbridge, Virginia

63 months ago

I would love to do gross debridement more often but insurance co don't want to pay for it. In those cases a just do quads but I will do it if I have no choice. I think 4mm pockets can be speudo pockets and going straight to quads might be costly to the pt. I had pts whose teeth I had to hold to scale and the DDS refused to refer them out. I think as long as we are on the ball our pts when benefit from us and get their perio on track. I am a big reader and love new things. These can be beneficial to our pts.

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judy in md. in Frederick, Maryland

63 months ago

Arestin placed in pockets of 5mm or more. not 4. all commissioned hygienists do not over sell. Really nice comment. take a course, READ

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hyg sucks in Richmond, Virginia

63 months ago

Everyone should take the time out to read new materials that come out on perio. Most hyg do. I like doing CEs on perio. Not sure what the comment for read was for. Things are always changing it is good to be up to date with your info so you can relay info to pt.

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CSW in Laguna Niguel, California

62 months ago

Thank you to all for all the valuable information. I am a patient at the beginning stages of determining a plan to control my periodontal problems. I have been advised by a dentist that a full mouth scaling & root planing (SRP)would be highly recommended. I have also been researching the Pero Protect System mentioned in this thread (www.perioprotect.com)
My questions:

1. Should/can SRP's be used in conjunction with the Perio Protect System for more effectiveness?
2. If so, which procedure would be recommended to be performed first - the SRP; or a predetermined time period on Perio Protect first, and then the SRP's?

Thanks again!!

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hyg sucks in Richmond, Virginia

62 months ago

If a SRP was suggested then you should have it done. The tartar and unhealthy bacteria needs to be removed or your condition could get worse. I haven't researched the perio protect but I am going to look into it.

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hyg sucks in Richmond, Virginia

62 months ago

Just read the perio protect info. Like I said I'm not familiar with it. When a pt is perio the 1st step is removing the tartar and bacteria. That is done through SRP and antibacterial med. Most offices have a rinse, some have Rx meds for the pt to take, or antibiotics are placed in the pockets. That office seems to have a tray filled with an antibacterial gel. I believe if you do the SRP in combination with the perio protect it should help with your perio. If the SRP and meds doesn't work then the DDS will refer you out to a specialist.

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diane in Batavia, Illinois

59 months ago

I have been told that I need root planing by the hygenist at my recent cleaning. She did take x-rays but did not measure the pockets at all. I'm leary about this procedure without pockets being measured. I've been going to this office for a number of years but recently they moved to a new and very upscale location. I'm wondering if costly procedures will help with the rent. Am I being unreasonable?

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exp in Massachusetts

59 months ago

diane in Batavia, Illinois said: I have been told that I need root planing by the hygenist at my recent cleaning. She did take x-rays but did not measure the pockets at all. I'm leary about this procedure without pockets being measured. I've been going to this office for a number of years but recently they moved to a new and very upscale location. I'm wondering if costly procedures will help with the rent. Am I being unreasonable?

I would ask to have a full-mouth probing: listen for 4 and 5 mm pockets; also , ask why, now , do you need this procedure, and that it was not mentioned in the past? Ask the R.D.H. to look back in the perio charting notes, to see what teeth, and where they are (teeth 1-16 are upper right to upper left, and 17-32 for lower left to lower right), ask which teeth she feels need SRP (scaling and root planning, write them down). Ask the cost,etc. have your questions in hand and take note of "teeth"....GL You may need it and again you may be right in your feeling as to the above.

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new grad.... in Charlottesville, Virginia

59 months ago

How do you deal with a pt that you feel only needs srp in three quads? do you charge for three quads then just clean the fourth on one of the visits. like today for example one of the other hygienists in the office did the new pt exam and said the pt needed an srp on LL and then clean the rest of the mouth at the same time and they only gave me one hour. I really needed an hour and a half to take BP give anes educate plus do a good job removing calc and stain. sometimes if the pt needs more than just a reg cleaning they charge for one quad. Is that normal? I have only worked about 15 days as a hygienist. I just want to do what is right for the patients. I thought that full mouth debridement was never proper tx as the gum tissue can tighten leaving subging calc plaque and bacteria, possibly causing ging abcess. any advise????

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hyg sucks in Richmond, Virginia

59 months ago

Sometimes by looking at x-rays you can tell a scaling is needed. I personally show the pt their xray and explained why. I don't always do the perio charting then because it is more comfortable to do it when the pt is numb. I can get more accurate readings that way. Some hyg do the readings after they scale so they can get better readings. If a pr only needs srp in three quads you only charge for three quads. Insurance is only going to pay for those three quads. You can't charge for a pt for srp if their 1-3mm readings. That is healthy. You can do a gross debri and have the pt come back for a prophy. I like to have the pt come back for a perio maintenance after a srp. Once you have a srp you are perio and will always be perio and will have to be charge as such. Insurance fraud is committed when you charge a pt for srp and they are not perio. Remember your name is on the line also when that office commits fraud.

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cavitron in Hallandale, Florida

59 months ago

hyg sucks in Richmond, Virginia said: Sometimes by looking at x-rays you can tell a scaling is needed. I personally show the pt their xray and explained why. I don't always do the perio charting then because it is more comfortable to do it when the pt is numb. I can get more accurate readings that way. Some hyg do the readings after they scale so they can get better readings. If a pr only needs srp in three quads you only charge for three quads. Insurance is only going to pay for those three quads. You can't charge for a pt for srp if their 1-3mm readings. That is healthy. You can do a gross debri and have the pt come back for a prophy. I like to have the pt come back for a perio maintenance after a srp. Once you have a srp you are perio and will always be perio and will have to be charge as such. Insurance fraud is committed when you charge a pt for srp and they are not perio. Remember your name is on the line also when that office commits fraud.

do you alternate between a pm and pro. after they have gone through sc/rp?

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afuturedentist in Washington, District of Columbia

59 months ago

This is all so exciting. Hygienists really play an imp role in oral health:) I'm in my 1st semester of hyg and I'm loving it!

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hyg sucks in Richmond, Virginia

59 months ago

cavitron in Hallandale, Florida said: do you alternate between a pm and pro. after they have gone through sc/rp?

This is no longer allowed with insurance. Once perio always perio. It would be nice if you could because it would save the pt out of pocket expense when they are on a 3 or 4 MRC.

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Suzanne in Terre Haute, Indiana

59 months ago

diane in Batavia, Illinois said: I have been told that I need root planing by the hygenist at my recent cleaning. She did take x-rays but did not measure the pockets at all. I'm leary about this procedure without pockets being measured. I've been going to this office for a number of years but recently they moved to a new and very upscale location. I'm wondering if costly procedures will help with the rent. Am I being unreasonable?

No, you are not! Is this the same hygienist you have been seeing? You know she should have measured those pockets so don't be afraid to call the office and ask her why she didn't. Also, if she tells you she can see it on the x-rays, don't buy it. She has to submit those measurements to your insurance for payment. If you don't have insurance, you still need the numbers to know if you are getting anywhere with your treatment or if it's progressing. Don't be afraid to tell her so. Call her on it and see what she says and you will have your answer to the new location and the money. Also, do you know the number one lawsuit in dentistry is from patients who were not diagnosed with perio or after they were did not receive proper referrals or treatment? Ask what your previous numbers were. If you get some answer that another hygienist saw you blah blah, keep in mind and tell her the same dds saw you and he/she is ultimately responsible for you oral health. Afterall, you get charged for an exam EVERY time you get a cleaning. That's why you pay for it. If she tells you she'll have doctor call you, you now have the ball in your court. You may very well need perio treatment, but maybe you needed it before. If they aren't probing (measuring) you have a lawsuit that's winnable. I know, there I go being on the patient's side again. It's what I do best! :)

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Suzanne in Terre Haute, Indiana

59 months ago

PS Please let us know what happens! If the dr tells you that you have needed it for sometime, tell him in that case you expect to be getting it done at his expense since it has been their oversight. Afterall, periodontal disease is a life long disease. There is NO cure. The best you can hope to accomplish is to stay on top of it and keep it from progressivly getting worse. Who knows how much trouble you're going to have in the future from poor diagnosing!! You can also ask for referrals to periodontists to corroborate the diagnosis. Personally, I'd go to the one he says to stay away from. The ones they recommend are usually a friend and they often send patients back and forth and cover each other's backs. Good luck.

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Matthew in Brighton, Massachusetts

58 months ago

I work as an RDH and I am not a firm believer in Arestin. Periodontal disease is a chronic disease that is very difficult to treat. You CAN NOT cure periodontal disease, once you have it you have it for life. I am not even really a firm believer in quadrant scaling unless it's 5-6mm pocketing or less. Good luck trying to instrument to the base of a 7mm or > pocket and remove all of the subgingival calculus (can possibly be done by experienced hygienist, but I would say there are few out there). I am a FIRM believer that once a patient has periodontal disease they should be under the CONSISTENT and FREQUENT care of a periodontist...not a general dentist who thinks they know what they are doing. Periodontal disease is with you for life, so investing $1000 at one visit is not going to cure your disease. I see patients that would probably do fine for their whole life with 4-5mm pockets as long as they stay on a routine cleaning schedule (4-6 months). GENETICS plays a HUGE role in periodontal disease. Yes, brushing and flossing help significantly...but I see patients on a daily basis that haven't flossed a day in their life and DO NOT show any signs of periodontal disease (generalized mild to moderate gingivits). I also see patients that floss 2x daily and still cannot reduce the 4,5, and 6 mm pockets. Many factors come into play with periodontal disease....hygiene, genetics, TOOTH POSITIONING, composition of minerals in your saliva (which may allow you to build calculus/tartar quicker). They only perio procedure I would invest time or money in after 5mm is flaps. You cannot be sure the root surfaces is completely debrided unless you see it. That or a subgingival cam/microscope.

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smile in Calgary, Alberta

58 months ago

Matthew in Brighton, Massachusetts said: I work as an RDH and I am not a firm believer in Arestin. Periodontal disease is a chronic disease that is very difficult to treat. You CAN NOT cure periodontal disease, once you have it you have it for life. I am not even really a firm believer in quadrant scaling unless it's 5-6mm pocketing or less. Good luck trying to instrument to the base of a 7mm or > pocket and remove all of the subgingival calculus (can possibly be done by experienced hygienist, but I would say there are few out there). I am a FIRM believer that once a patient has periodontal disease they should be under the CONSISTENT and FREQUENT care of a periodontist...not a general dentist who thinks they know what they are doing. Periodontal disease is with you for life, so investing $1000 at one visit is not going to cure your disease. I see patients that would probably do fine for their whole life with 4-5mm pockets as long as they stay on a routine cleaning schedule (4-6 months). GENETICS plays a HUGE role in periodontal disease. Yes, brushing and flossing help significantly...but I see patients on a daily basis that haven't flossed a day in their life and DO NOT show any signs of periodontal disease (generalized mild to moderate gingivits). I also see patients that floss 2x daily and still cannot reduce the 4,5, and 6 mm pockets. Many factors come into play with periodontal disease....hygiene, genetics, TOOTH POSITIONING, composition of minerals in your saliva (which may allow you to build calculus/tartar quicker). They only perio procedure I would invest time or money in after 5mm is flaps. You cannot be sure the root surfaces is completely debrided unless you see it. That or a subgingival cam/microscope.

One thing to keep in mind is that in a periodontist's office, most often, it is a hygienist that does the initial SRP and the pmt's. We as trained hygienists are very capable of performing non-surgical periodontal treatment.

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Matthew in Brighton, Massachusetts

58 months ago

From what I have seen there are very few patients with >5-6mm pockets that respond well to a single quadrant scaling/root planing. I can break it down into 3 groups that most of the pt.'s I see fall in to.
1) scaling and root planing is performed with Arestin placement - pt. is completely non-compliant with home care (generally the reason they have 5-6mm pockets in the first place).
2) scaling and root planing is performed with Arestin placement - pt. does not respond as they are GENETICALLY PREDISPOSED to having periodontal disease
3) pt. responds well if they are absolutely diligent with home care and follow up with perio maintenance every 3 months

I see far too many smoking patients with poor hygiene that are investing thousands of dollars into scaling and root planing with Arestin when it is obvious they are not going to respond. In fact I think a prerequisite to scaling and root planing is quitting smoking. The tissue is not going to reattach to the tooth surface if it is so fibrotic and diseased from the smoking.
Also, I have yet to see any 5mm pockets that do not bleed upon probing (whether it be delayed bleeding, or pouring blood). The only time I ever see this is a malpositioning of teeth where it's basically a pseudo-probing depth due to attachment variation on two adjacent teeth).
I'm just saying pt.s with gen. 4mm pockets should not be investing money in scaling and root planing. Also, patients with severe, advanced periodontal disease should not invest money into scaling and root planing unless they are completely convinced their home care will be immaculate, and they are willing to invest the time and money to keep any achieved results stable for the longterm.

Periodontal disease is just like heart disease, it's a disease and has many factors that come into play. I just see people think of SRP as the "magic bullet" when it is so archaic as far as solid treatment for perio.

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smile in Calgary, Alberta

58 months ago

hyg sucks in Woodbridge, Virginia said: I would love to do gross debridement more often but insurance co don't want to pay for it. In those cases a just do quads but I will do it if I have no choice. I think 4mm pockets can be speudo pockets and going straight to quads might be costly to the pt. I had pts whose teeth I had to hold to scale and the DDS refused to refer them out. I think as long as we are on the ball our pts when benefit from us and get their perio on track. I am a big reader and love new things. These can be beneficial to our pts.

According to the school I went to, the periodontist I worked for for a few years, the parameters of care issued by the AAP & current literature, gross scaling is not recommended. Quadrant scaling & root planing is the perferred treatment as residual calculus & granulation tiissue promotes the developement of perio abcesses. I have seen poor healing because of gross scaling too many times in the perio office. It's really hard to be diplomatic when recommendin flap surgery or even extractions to patients because of incomplete debridement. Quadrant scaling is the optimal treatment if you cannot complete treatment at 1 time. (or series of appointments)
A non-staining chlorhexidene product is perioplus by oraldent pharma. It comes in 5 formulations. It's worth checking into.

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Rosa in San Diego, California

58 months ago

My husband and I went to see a new dentist yesterday for "new pacient" for regular cleaning, exam and x-ray, cost $25.00 each. After the examination , the dentist said that both os us need the SRP in full. The reading was some 4 in some ,two tooth was 6, but the majority of the readings was 3, I would I lso say 85%. he said that he could not do the cleaning, because what we need is the SRP. I ask the manager to check with my insurance and she told me that the price that she gave us was not for insurance, I would pay from pocket, if she send the bill to insurance it will cost more. She checked and called me saying that the insuarance does not cover the SRP, but cover the cleaning twice a year, and resin. I told her that is kind a cacht 22, my insurance pay for the cleaning do not pay for the SRP, but the dentist do not do the regular cleaning in our case. In my opinion he doesn't want to do the regular cleaning because doing the other will cost us much more. We paid $50.00 for nothing. They are very pushy in make you schedule an appointment. Is there any honest dentist in this country??? I appreciate any comment. Thanks a lot!

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ncl in Miami, Florida

53 months ago

The hyg. says you have 4mm pockets, the dentist says, you need flap reduction surgery???? Holy cow, what a discrepancy! I'll tell you what you really need, another opinion.
With 4mm pockets, your gums should respond beautifully after scaling and root planing. Especially if your homecare is excellent.
Good Luck,

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ncl in Miami, Florida

53 months ago

I forgot to mention, if you are unable to buy the Oral B Triumph now, look for the Oral B Vitality. It usually sells for about $20. It comes with a base to charge it and it is a good alternative. When you can get the Triumph, it's the best, in my opinion. I've seen patients homecare and soft tissue improve dramatically with this brush. It simply removes more bacteria.
This is all assuming your pocket depths are 4-5mm. If the subject of surgery comes up again, I would get a second opinion.

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smile in Calgary, Alberta

53 months ago

ncl in Miami, Florida said:

Crest prohealth rinse is newer but the antimicrobial action lasts much longer than listerine & it has no alcohol. Great advice though!

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ncl in Miami, Florida

53 months ago

smile in Calgary, Alberta said: Crest prohealth rinse is newer but the antimicrobial action lasts much longer than listerine & it has no alcohol. Great advice though!

Hi, The reason I don't like Crest ProHealth mouthrinse is because it stains as badly as Peridex. I learned my lesson, after spending almost an entire hour removing stains on patients that never had that problem before. The only difference in the hygiene routine was the Prohealth. After removing it, they did not have stains again.
I know Listerine has a lot of alcohol, but it is the only mouthrinse approved by the ADA, for killing bacteria, that is OTC.
And if used with the waterpik, the results are outstanding, without the staining. Thanks for the feedback :).

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exp in Seabrook, New Hampshire

53 months ago

ncl in Miami, Florida said: Hi, The reason I don't like Crest ProHealth mouthrinse is because it stains as badly as Peridex. I learned my lesson, after spending almost an entire hour removing stains on patients that never had that problem before. The only difference in the hygiene routine was the Prohealth. After removing it, they did not have stains again.
I know Listerine has a lot of alcohol, but it is the only mouthrinse approved by the ADA, for killing bacteria, that is OTC.
And if used with the waterpik, the results are outstanding, without the staining. Thanks for the feedback :).

Hi, I have not experienced the staining...does this pt. use both Peridex and Crest ProHealth? Does this pt. smoke (even occasionally)/ or use chaw? Tea/coffee/soda? Sometimes it can be more than one item and or their homecare of pt. that may be causing the stain. Also, sometimes you have to "list" all types of products, foods, etc., that may be the cause of the problem.

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ncl in Miami, Florida

53 months ago

exp in Seabrook, New Hampshire said: Hi, I have not experienced the staining...does this pt. use both Peridex and Crest ProHealth? Does this pt. smoke (even occasionally)/ or use chaw? Tea/coffee/soda? Sometimes it can be more than one item and or their homecare of pt. that may be causing the stain. Also, sometimes you have to "list" all types of products, foods, etc., that may be the cause of the problem.

You've been fortunate, how often do your patients use it? The patient I had, is someone, I have been seeing for over 10 years. When he opened his mouth and every single tooth was stained, I was stunned. He does not smoke, I started interrogating him. LOl. What are you using??? We went over everything and it was the ProHealth.
He was not the only one, I've had a few patients that this happened to. There are 4 hygs. in my office, when I commented it to the other one I work, she told me she noticed that too. So we don't recommend it.

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smile in Calgary, Alberta

53 months ago

ncl in Miami, Florida said: You've been fortunate, how often do your patients use it? The patient I had, is someone, I have been seeing for over 10 years. When he opened his mouth and every single tooth was stained, I was stunned. He does not smoke, I started interrogating him. LOl. What are you using??? We went over everything and it was the ProHealth.
He was not the only one, I've had a few patients that this happened to. There are 4 hygs. in my office, when I commented it to the other one I work, she told me she noticed that too. So we don't recommend it.

I have alot of patients using the prohealth & have never seen the staining. Prohealth's sustainsibility is is up to 75% after 8 hrs whereas listerine only lasts 30 min. One of the selling points of using prohealth over chlorohexidine is the non-staining property. Also long term use of an alcohol based rinse causes tissue changes. This is the same affect as alcohol on a liver. Alcohol based rinses are being researched for potential cancer-causing agents with long term use. It's easy to research this yourself. Alcohol rinses contain more alcohol than "drinking" alcohol. I would rather my patients deal with stain (although, as stated, I've never seen this) than cancer.

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ncl in Miami, Florida

53 months ago

I don't know, you've been lucky, because I have seen the staining and have had to deal with it, wasting valuable time removing it, instead of focusing on the patients' periodontal issues. I know what you are saying about the alcohol content, but Listerine has been around for a long time. I have not seen any patients develop cancer from using it and I've been a hygienist for 36 years.
Until I see some concrete evidence to the contrary, I'm going to recommend it.

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smile in Calgary, Alberta

53 months ago

ncl in Miami, Florida said: I don't know, you've been lucky, because I have seen the staining and have had to deal with it, wasting valuable time removing it, instead of focusing on the patients' periodontal issues. I know what you are saying about the alcohol content, but Listerine has been around for a long time. I have not seen any patients develop cancer from using it and I've been a hygienist for 36 years.
Until I see some concrete evidence to the contrary, I'm going to recommend it.

Tissue changes related to alcohol rinses include a white film that manifests on the oral mucosa including the throat. I have seen quite a few cases of this, in fact more of this than staining from Prohealth (that I've never seen). I wouldn't be surprised if there was some sort of chemical reaction with some other habit/food/drink they are doing. You really should do some research on this topic as there is alot of info. FYI, original Listerine alcohol content is 26.9 %, wine tends to be b/n 11-14% & a can of Coors light beer in Canada is 4%. The fact that this alcohol contributes to cancer is well documented providing concrete evidence. Even if prohealth did stain, I would prefer to deal with stain than knowing that I may have contributed to a patient developing cancer. If you have been a hygienist for 36 years, you should remember that not everything has been good for Listerine, in fact at 1 time, it almost lost its recognition but was grandfathered in back in the '80's or '90's. Also remember, an antimicrobial agent should not be used long term as opportunistic bacteria develope perpetuating the perio disease cycle.

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exp in Seabrook, New Hampshire

53 months ago

ncl in Miami, Florida said: I don't know, you've been lucky, because I have seen the staining and have had to deal with it, wasting valuable time removing it, instead of focusing on the patients' periodontal issues. I know what you are saying about the alcohol content, but Listerine has been around for a long time. I have not seen any patients develop cancer from using it and I've been a hygienist for 36 years.
Until I see some concrete evidence to the contrary, I'm going to recommend it.

Hi, Might this staining be related to a high iron content in their drinking water? Sometimes, this can occur if they are drinking alot of tap water...??? I still think this pt. is?...drinking alot of staining type of bev's or ? smoking...can you smell it on their clothing or breath? Also, some have that black line stain....Question further....would really like to know the truth about this one....GL Have you googled possibilities...and presented that info to the pt...get back to us...curious...

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Suzanne in Terre Haute, Indiana

53 months ago

My daughter was using Prohealth and her teeth turned a yellowish brown within a couple of weeks! I don't know if it was her ph or diet or what but we threw it in the trash. She bleached and all went back to normal. Now I can tell in the office immediately when a pt opens their mouth if they are using it or not, as it is a distinctive color different from other staining.
I wrote the company and never got a response but I don't recommend it.

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smile in Calgary, Alberta

53 months ago

Suzanne in Terre Haute, Indiana said: My daughter was using Prohealth and her teeth turned a yellowish brown within a couple of weeks! I don't know if it was her ph or diet or what but we threw it in the trash. She bleached and all went back to normal. Now I can tell in the office immediately when a pt opens their mouth if they are using it or not, as it is a distinctive color different from other staining.
I wrote the company and never got a response but I don't recommend it.

Interesting, I've never seen the staining before. I'm sure pH has alot to do with it though. Is it from the green or the blue rinse? What do you recommend for people who cannot use an alcohol based rinse? I will still recommend it but I will now warn people about the staining. The other alternative is CHX but we don't want stain.

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ncl in Miami, Florida

53 months ago

Thanks for the education. You should do some research as well about ProHealth:www.newsinferno.com/archives/11922
BTW, I don't recommend patients drink Listerine.
As to long term use of anti-microbials, the same advice goes for ProHealth, since the effects of it last 8 hours vs. 30 mins. for Listerine. That white film you say you've noticed in the mouth including the throat, are you sure it is not from alcohol consumption, instead of a mouthrinse? Or tobacco use?
Interesting, how I have never seen that white film you speak of from mouthrinses and we do routine cancer screening on all patients.

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smile in Calgary, Alberta

53 months ago

ncl in Miami, Florida said: Thanks for the education. You should do some research as well about ProHealth: www.newsinferno.com/archives/11922
BTW, I don't recommend patients drink Listerine.
As to long term use of anti-microbials, the same advice goes for ProHealth, since the effects of it last 8 hours vs. 30 mins. for Listerine. That white film you say you've noticed in the mouth including the throat, are you sure it is not from alcohol consumption, instead of a mouthrinse? Or tobacco use?
Interesting, how I have never seen that white film you speak of from mouthrinses and we do routine cancer screening on all patients.

LOL! How many people would recommend drinking Listerine?! That stuff is vile. Yes I am sure it is from alcohol rinses, I've worked in perio & oral surgery offices where biopsies were/are done so there are histological reports. The common link is alcohol rinses. Thanks for you info though. I will look further into prohealth, I only want the best for my patients & I like to stay on top of current scientific research/findings. The difference b/n 30 min & 8 hrs is the same as not completing a prescribed dosage of antibiotics. It allows time for the dangerous bacterium to proliferate but not enough time for the antimicrobial action to take place resulting in stronger resistant microbes.

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michelle_nahlis in Odessa, Texas

53 months ago

I have had a white film on my gums after about 5 weeks of using a rinse called biotene, so i quit using. Had a question hoping some one could help me with, as i have mentioned before i was told i have a 4mm pocket and had the scaling and root planing done this week, and was told if the gum doesn't attach back to the tooth i may need flap reduction surgery, the tooth has a filling close to the gum line could this affect healing, and how deep does a periodontal need to be to warrant the gum reduction surgery?

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