Scaling and arrestin for 4mm pockets?

smile in Calgary, Alberta said: 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.

My husband got tonsil cancer shortly after using alcohol mouthwash, does not smoke or drink, I really think it had something to do with the mouthwash, and normally he did not use mouthwash, but I gave it to him to use because I decided to use non alcohol mouthwash and did not want to throw it away.

trouble in Ottawa, Ontario said: Hi everyone,

I could really use some opinions right now.

I recently had a dental appointment for a routine cleaning and check up. I go twice a year, and have been going since I was a child.

This appointment has left me with some disturbing results. My dental hygienist had found a 9mm pocket in the top, right molar area. My dentist then suggested that I go to a periodontist for a consultation. At the consultation, the periodontist not only observed this 9mm pocked, but also mentioned that I have a 14mm pocked in the top, left molar area. I am not an expert in the dental field, but going to a dentist but since I have been going to a dentist every 6 months since I was a child, shouldn't my dentist have picked up on this issue, before it reached both the 9mm and 14mm mark?

The periodontist recommends surgery a.s.a.p., and I don't see any other option at this point. What should I do?

I am not an expert but I heard that there is something that some periodontists do and that is laser to gums, it is painless but costly and few do it, maybe look for a dentists who does it, let me know how it goes, since I may have to get my gums fixed someday, as I have some painful gums and they won't heal up. God Bless/ In Christ I will say a prayer.

In a nutshell, no you didn't get that 9mm or 14mm pocket overnight it doesn't work like that. So yes you should have been referred sooner to a periodontist. You don't have any other options besides surgery. You might want to reconsider having your cleanings at that office as maybe you need your perio monitored better.

trouble in Ottawa, Ontario said: Hi everyone,

I could really use some opinions right now.

I recently had a dental appointment for a routine cleaning and check up. I go twice a year, and have been going since I was a child.

This appointment has left me with some disturbing results. My dental hygienist had found a 9mm pocket in the top, right molar area. My dentist then suggested that I go to a periodontist for a consultation. At the consultation, the periodontist not only observed this 9mm pocked, but also mentioned that I have a 14mm pocked in the top, left molar area. I am not an expert in the dental field, but going to a dentist but since I have been going to a dentist every 6 months since I was a child, shouldn't my dentist have picked up on this issue, before it reached both the 9mm and 14mm mark?

The periodontist recommends surgery a.s.a.p., and I don't see any other option at this point. What should I do?

Pam Holloway in Bellingham, Washington said: I am not an expert but I heard that there is something that some periodontists do and that is laser to gums, it is painless but costly and few do it, maybe look for a dentists who does it, let me know how it goes, since I may have to get my gums fixed someday, as I have some painful gums and they won't heal up. God Bless/ In Christ I will say a prayer.

Ok so do your research please people, your not a dental professional. Laser assisted periodontal therapy does not have enough research behind it that the ADA is uncertain as well as the studies that have been done have not proved that lasers help periodontal treatment.
www.ada.org/1860.aspx
The common procedures are the bacterial decontamination and the curettage, so read those areas.
The staples of periodontal therapy is STILL thorough root planing and periodontal surgery.

Pam Holloway in Bellingham, Washington said: My husband got tonsil cancer shortly after using alcohol mouthwash, does not smoke or drink, I really think it had something to do with the mouthwash, and normally he did not use mouthwash, but I gave it to him to use because I decided to use non alcohol mouthwash and did not want to throw it away.

Excuse me, are you a doctor? Geez because you sure sound like you know it all. Get a clue, alcohol mouthwash did not give your husband cancer! When we are talking about tissue changes from alcohol mouthwash this is over many years and chronic consistent use. It is not proven to even be linked to cancer. Health is not black and white, just because he didn't smoke or drink does not mean that he has 0% chance of ever getting cancer. A bigger contributed to newer cases of oral cancer especially those involving the throat is HPV and men can have that virus and never know it as well as women.

Hi,

Thank you for your comments.

I don't have a dental plan, and my feeling were the same with regards to the dentist being able to diagnose periodontitis before it reached the point it is currently at. I am now stuck with a bill costing upwards of $3000 for something that may have been resolved before it hit this stage.

At this point, would you suggest taking legal action? I'm quite distraught with the fact that I have to pay such a large bill that doesn't even secure that I keep my tooth (14mm pocket). Not to mention how my teeth are going to look with a lowered gum line.

What are your thoughts?

Thanks again for all your responses.

trouble in Ottawa, Ontario said: Hi,

Thank you for your comments.

I don't have a dental plan, and my feeling were the same with regards to the dentist being able to diagnose periodontitis before it reached the point it is currently at. I am now stuck with a bill costing upwards of $3000 for something that may have been resolved before it hit this stage.

At this point, would you suggest taking legal action? I'm quite distraught with the fact that I have to pay such a large bill that doesn't even secure that I keep my tooth (14mm pocket). Not to mention how my teeth are going to look with a lowered gum line.

What are your thoughts?

Thanks again for all your responses.

What will you gain from taking legal action? Maybe your treatment payed for but you will have to go thru court meetings and court bills.
Do you even know what your pocket depths were the last time they were recorded and when that was? Did you even ask? Do you know if the tooth is mobile or not?
There are 6 pocket readings to each tooth so do you know the measurements at the other sites?
Did you ask the periodontist if he expects a good prognosis after the surgery or if the tooth/teeth are likely hopeless? These are all things you need to answer. For 3000 you might consider an implant if the tooth's prognosis is guarded.

My dental Hygenist cleaned me 4 times a year. The dentist did come I twice a year.. I don't know my numbers or anything. I had a rough cleaning and now all my teeth are aching and shifting. They have cracks in them and seem transparent. Food no longer tastes good. I have swollen cheeks. Saw a new dentist and he did not check for numbers and he did 4000 with of work. Now I am in worse shape. From someone with beautiful teeth and smile to a hideous monster. Pain in nose and hard cactus keeps forming on bottom teeth. Air even hurts the teeth. Saw another dentist and she says I have a cavitation. Work to be done is 15000. No guarantee if I will be pain free. My neck is now swollen and redness face and neck. Where can I go. I am losing my hair and had the hair test done and I am overloaded with mercury aluminum and tin. Please help. 08723 is my zip code.

trouble in Ottawa, Ontario said:
I am now stuck with a bill costing upwards of $3000 for something that may have been resolved before it hit this stage......At this point, would you suggest taking legal action?

I agree that a 14mm perio (not endo) pocket likely means that an extraction and an implant might be the better way to go. I would also suggest that you consult a dental malpractice attorney for advice. If your claim has merit, you might get all your legal costs as well as money for emotional pain, covered in a judgement as well as the cost of replacing the tooth and controlling your periodontal disease on your remaining teeth. Bring any documentation (billing statements) to your first meeting with the attorney as well as all your questions that you need answered. You may need to prove that you have had your teeth cleaned on a regular basis for all those years. Your attorney will get all your records and x-rays from your dentist who did not diagnose and treat your disease. Note to hygienists: DOCUMENT diagnosis, treatment options and patient compliance every time, not just at initial appointment.....

Thank you for your responses. They are helping me in my decision making. I really appreciate it.

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!

I would like to ask what would make a periodontist suggest scaling and root planning with every full exam that walked in the office and then with your return of the exam suggesting an fos?! Does this make me sound cray or are these responsible concerns? I think that he is double dipping if you know what I mean and it does not sit right with me!!

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.

I would like to ask what would make a periodontist suggest scaling and root planning with every full exam that walked through the office door and then with their return of the exam suggesting an fos and bone grafts?! Does this make me sou

So I have approx 44 5mm pockets..hygenist is pushing Arestin between scalings..after reading this thread I'm a bit apprehensive..my copay $100.00 for the medicine and $240 for processing the med. Should I hold off on the Arestin and just complete the rest of the scaling? Nothing impressive on the web about Arestin

Don't do it. People who are pushing for Aresting is a money making deal. For example, I took my wife to this new dentist for a dental cleaning. As soon as she sat in dentist chair they told her she not only needed deep cleaning but also Aresting (by the way, in front of her chair in the wall there wa a huge sign, guess what: Aresting). The charge would in the $1,000s. I told the dentist make the appoinment and I will call you. That never happened. I took wife to another honest dentist, and she did the X-rays and cleaning, no problem, except she would eventually need a filling.
Please don't listen to those fakers
Joseph

Joseph, why did she need deep cleaning? How do you know this other dentist was not misdiagnosing or didnt take perio as seriously as it should be taken? Just because another dentist did a regular cleaning does not mean Oh! The other office must have been trying to pull one over on me.

Anyone told they need a deep cleaning probably needs it. Having anything greater than a 4mm pocket is not good and usually is recommended to have a deep cleaning. However you can say no to this and just have regular 6 month cleanings. OR go to another dental office for a 2nd opinion if you don't believe the first office. I would recommend getting 1 deep cleaning if you have several deep pockets AND haven't been getting regular 6 month cleanings. Or you can choose to go back every 4 months instead of every 6 months to have a cleaning done. Have them charge you for a regular cleaning but instead one of the cleanings won't be covered by your insurance because you are going every 4 months instead of 6 months.

setting the record straight in Stockton, New Jersey said: I have to take the time to reply because you are simply UNEDUCATED. What you are telling your patients should be a punishable crime and it is very disheartening to know that there are "healthcare professionals" like yourself that are mis-informing their patients. Listerine is the ONLY ADA approved Mouthwash to control and reduce plaque and gingivitis. It is the MOST studied OTC product on the market backed by 150 years of research. Yes it contains Alcohol, but a denatured Ethanol that goes through a pharmaceutical grade process in which it gets denatured. It is therefore, not at all the same as the Alcohol that you would find in your Beer or Wine. Although 21.6% is listed on the bottle one can not get drunk off of this and it is NOT related to OP Cancer or any other tissue changes in the mucosa. Alcohol in beverages is because that Ethanol goes through the Fermentation process where it picks up carcinogens that will contribute to OPC with long time exposure. As for Pro Health - it does in fact stain because the active ingrediant, CetylPiradiumChloride (CPC) reacts with toothpaste as well as chromagens in food or drinks and a cationic reaction occurs leading to a brown staining on the tooth's surface. So once again, please DO YOUR RESEARCH - IT IS YOUR DUTY before you go giving poor advice and let your patient's suffer your consequences. Thank you.

Well said, I couldn't have said it better myself!

Is it painful while doing and after???????

Why would a patient suddenly need periodontal work when no less than 6 dentists as well as hygientists said nothing? Moreover, the last cleaning that was done they indicated that my mouth was very healthy. There is no bleeding; absolutely nothing to indicate any problems or disease. This office appears to be upselling unnecessary services. Something else that has really bugged me once we moved further south. The dentist does not check what the hygientist does in her cleaning. They use x-rays as their diagnostic tool exclusively because the only examination that is done is for cancer which lasts all of 1 minute or less. We are almost convinced that we must travel back to Richmond, Va in order to get half way decent dental care because the Charlotte area is a joke.

I was diagnosed with many 4 and 5 mm pockets, that have bleeding, and the hygenist recommended arrestin. my insurance doesnt cover it so it would be an extra $1000 in expenses. Do I need to get this procedure? I dont have a lot of money to spare, so I want to get it only if it will help.

Hi Broke Grad Student.

It sounds like you have been diagnosed with periodontal disease. Arestin is usually recommended for 5-6 mm pockets and I have seen terrific results in my patients. Periodontal disease has been linked to many health risks, so please do not ignore it. I have a good suggestion for you. Find a reputable dental hygiene school near you (one of long standing, associated with a college or university). If you have the time, the students will provide the care for you at a much lower cost. Plus,you will have the student and instructor give you a second opinion so you can proceed with confidence.

Chris
Honestly they charged you very reasonably, for a box of 24 sites has a cost of over $550.
not including the shipping fees, you always have the option of refusing treatment and going some where else.. BUT yeah i would never recommend that when you have found a dental office that truly cares for your oral health Nd health over all.
Their is many dentist out there that will be willing to compromise your oral health to keep you as a patient. That's is sad and NOT to your best interest as an Office that's willing to preform a bloody Prophy on you and not properly educate you on whats needed, It's truly harming you not helping you. You need to look up Periodontal Disease. It not only affects your oral health but your health overall, and I always educate my patients, and do a full periodontal charting every cleaning , for their is life ordeals, medications and negligence that can affect your oral health, Your at the Right Dentist, They care and show it.