Not long ago, all dental practices were owned by the dentist who took care of you. Sure, they might not have given you any anesthetic before they smashed silver crunchy metal into your cavities, and they may have slapped you around and given you Post Traumatic Stress Disorder any time you thought about opening your mouth wide for anyone, but at least you knew that the dentist shoving their knuckles into your nostrils was the one dictating how things were done around there.
Since then, dentistry has gone all Wal-Mart on the public. There are thousands of dental offices that are part of large chains, where the dentists who take care of you are merely employees, where the quality of dental care provided to patients is secondary and instead the amount of profit generated by each provider becomes the indication of that person’s worth within the company. Can you imagine a leaderboard, like in a sales department, where all the dentists’ production numbers are on display for the entire office, so it’s a race to see who can make the most money?
As a patient, don’t you get giddy at the thought of being ridden like a thoroughbred horse? Me neither. My health is not a commodity.
Dentistry is a little different creature than regular medicine in the sense that TEETH ARE OPTIONAL. You can be a very healthy individual, only with no teeth. It’s kind of like having a hand amputated – your quality of life may be affected, but a hopelessly infected hand should be removed and replaced with a prosthetic. If your body is rejecting your teeth for whatever reason, that’s when there are health concerns as well. Dental professionals make it their life’s work to help you keep your teeth in as close to original condition as possible.
The problem is that when money is involved, you can bet that there are those who will abuse this relationship. There’s scare tactics, there’s bait-and-switch, there’s all the usual sleazy sales pressure used to extract as much income from each patient as possible. New patients often bring us treatment plans that they are unsure of, looking for second opinions, trying to figure out why they don’t trust the previous dental offices’ diagnoses. I just want to say it straight, “They’re taking you for a ride, dear.”
Well crud, I never wanted this article to be an analogy of horse racing with the big hats and Bourbon and milk-drinking and jockeys. So, let’s start over and begin talking instead about Red Flags and Grey Areas.
Red flags, of course, are the signals you get when you realize something that seems good, isn’t so good. Red flags are big fat warning signs.
Grey areas, are, well, not really black and not really white. Grey areas are where black and white kind of blur into each other, and sometimes they end up looking a little suggestive (!) like the image above. Yeah, sorry about how weird that looks when I take it out of context.
When it comes to the health of your mouth we usually look at two things: your teeth, and the stuff that holds your teeth in your mouth. That’s what we’re going to talk about in this discussion, what you think of as your gums. Dental professionals call this part of you your periodontium. If your gums are in excellent condition, you have what is called periodontal health. On the other hand, if your gums are seriously letting go of your teeth you have periodontal disease.
As you can see, the biggest part of this diagram is the Grey Area. This is where most people land, especially if they haven’t been to the dentist in a while. Even if your front teeth are mostly healthy often you’re automatically categorized into the Very Diseased category because you have too many spots in your mouth that are infected with bacteria to treat you as a Very Healthy person. That’s when you’ll get a treatment plan designed to minimize the effects of your disease.
When your mouth is in the Grey Area, this is where treatment recommendations can vary the most from office to office and even from person to person. Almost every dentist will prescribe the same treatment course if your case is black and white (very diseased or very healthy). If you’re in the Grey Area though, this is when Red Flags will start to stick out.
There’s one Red Flag in particular that keeps showing up. Arestin® is a yellow powder containing minocycline microspheres – an antibiotic designed to help diseased gums heal faster. The powder is puffed deep into an infected spot under the gumline where it hardens upon contact with moisture and time-releases the antibiotic for about three weeks. Here’s what the package of cartridges looks like, with the yellow powder in the tip:
Arestin is a great product! I’ve seen stubborn gum disease completely disappear when we’ve used it very selectively in our practice. So the Arestin itself isn’t a problem. The problem is how it’s being prescribed.
Say you had your gum disease treated with scaling and root planing (a “Deep Cleaning”), but a few spots are still unhealthy a month or two or three later. If your dentist or hygienist sees that you still have open sores that are higher than a certain parameter (over 4mm is considered the standard) this is when Arestin therapy provides the most benefit.
So when is Arestin a Red Flag? You’ve visited a new dental office, and not only are they recommending that you have treatment for your periodontal disease, they’re also saying you need a course of Arestin to be placed on the same day that you have your initial treatment. It’s even a bigger red flag if you floss regularly and never see your gums bleed.
The thing is, Arestin isn’t cheap. Just a single cartridge costs your dentist upwards of $15. Then there is the insertion fee; in other words, what the patient is billed for placement, and than can run as much as $60 per site.
Here’s where it gets crazy. An average mouth has 28 teeth. Each of your teeth has as many as six sites where Arestin can be placed. Let’s see, that’s $90 in material costs, $360 in placement costs. That’s potentially going to cost you $450 – per tooth.
You’re seeing the big picture now: treating gum disease can be quite profitable! This is why Arestin is such a big deal in the offices that are part of corporate dental chains designed for maximum shareholder profit. This antibiotic is marketed to dental professionals as a way to help us make money, all in the name of “helping our patients.”
So how do you end up getting prescribed Arestin therapy if your mouth is pretty healthy? If your hygienist or dentist was instructed to “force the probe” to create a deep measurement, that’s how. Stab ’em hard and voila! Fake gum disease! Here’s a story that exposes some of the bad things that have allegedly happened in corporate dentistry, including this example:
As you can see, lots of other stuff can be exaggerated as well to make sure that the dentistry performed on you is as profitable as possible. For now, though, we’ll stick to talking about the Red Flag, because this one cue may help you decide whether or not you’re being over treated.
Here are the professionally accepted general guidelines about Arestin usage, then:
Now please don’t use this to go and bash your well-meaning dentist and hygienist, or the Arestin company, or worst of all, to justify the reasons you tell yourself why you don’t go to the dentist ’cause it’s all one big scam and you can’t trust anyone. Most of us really do want the best for you.
The point is simply this: if more people understand the difference between dental care that is patient-centered and dental care that is profit-centered, then greedy dental corporations are less likely to thrive.
If you think you have ever had this happen to you, I wrote this story for you. For you, so that you don’t feel so dumbfounded the next time you wonder whether or not a dental office is looking out for your health or only for their own. As a hygienist who knows fraud when I see it, I wanted to be sure that patients have a resource to help them defend themselves against predatory practices.
I’d like to end this with a small confession, then: I actually love placing Arestin, because when the dentist and I decide that it’s a good fit for a stubborn case of gum disease, it just feels so right.
So much for being objective.
References and resources:
Explanation of insurance coding of Arestin therapy after initial SRP: http://www.practicebooster.com
An example of Arestin-based fraud in a DHMO: http://caldentalplans.org/downloads/Henderson.pdf
Arestin drug label and study that shows slight improvement of using Arestin with SRP vs. SRP alone: http://dailymed.nlm.nih.gov/arestin
Criticism of Arestin studies and concerns about Arestin therapy : http://periodontist.org/is-arestin-a-therapeutic-treatment-for-reducing-gum-pockets/
A blogger since 1997, Trish Walraven, RDH, BSDH is a practicing dental hygienist and marketing manager for an indie dental software development company. Her mission with DentalBuzz is to offer a fresh podium of discourse for those involved in dentistry and to expose fun in our professional lives.
Michael W Davis, DDS says
Great job on this post & your entire blog effort.
Michael W Davis, DDS
Santa Fe, NM
bobby venuti says
i had my teeth cleaned and they said that because i had some sensitive areas it may be because its infected….. and have 8 sites and that i need 500 in aresten and the areas 3 4 14 1518 19 30 31 left and right top and botton…. and only had 3 spots that where delicate//?? my gums dont bleed unless i dont take vit c… when ido take the suppliment they never bleed…. but after that heavy duty cleaning after 2 years.. they did abit …but stoped…. im pointing to not to do aressten…. i did it yeas ago and i think it was the same people… im thinking alot of c high dose and saltwater hot gargle for the next week ………..thats alot of teeth that need it i have no bleeding when i brush
Generally speaking, gums can seem healthy and not bleed when you brush, use vitamin C and/or saltwater gargle because these treatments may not do enough to prevent gum disease between teeth. We cannot diagnose online, of course, but thank you for sharing your experiences.
I hate to hear about Dentists becoming employees. I’ve always admired the independence that Dentists had from insurance companies and government regulators. Doctors or medicine have very little control anymore and are pretty much being told what to do on a daily basis. Doctors of dentistry have historically avoided that fate. However, the more they accept employment, the more they will become like us. It’s a shame.
If you are not using Arestin until a few months after initial scaling then are you charging for and performing scrp again upon placement?
We charge for periodontal maintenance. All areas that continue to exhibit bleeding are scaled and root planed per perio maintenance protocol but the only reason we would be seeing excessive subgingival calculus buildup at that point would be that treatment wasn’t performed properly at the initial SRP. Sounds like another red flag to me if SRP gets charged out a second time in that short of a span.
Shelly Young says
I would love to know where your dentist is ordering your Arestin from to get it for 15$ per cartridge. We order fro Schein and its 25$ per cart !!
Craig A. Schlie, DDS says
It appears that Henry Schein now “owns” the rights to market Arestin in the United States for dental use, and it can set the price that it chooses. Why it might choose to set the cost as high as possible can easily be explained. All one needs to do is a Google search for “Henry Schein antitrust lawsuits.”
Michael W Davis, DDS says
One “red flag” which shouldn’t be discounted relating to Arestin therapy is selling the service, even prior to evaluation of periodontal initial therapy of scaling & root planing. This is common at a good number of larger interstate corporate dental clinics. The hygienist is instructed by corporate management to sell treatments of Arestin therapy upfront, w/out later evaluation of tissue healing after sc/rp. This represents the unlicensed & unlawful practice of dentistry, by an unlicensed entity (fraud). Patients are too often given high-pressure sales tactics, to finance dental care in advance, by 3rd party predatory lenders. This was one aspect to the recent settled legal case, in the allegations of the Commonwealth of MA versus Aspen Dental.
Michael W Davis, DDS
Santa Fe, NM
I just started seeing a new dentist. I had a deep cleaning three months ago (after being stubborn and lazy and not going for several years). They wanted me back in in three months to make sure everything was ok and for a normal cleaning. I’ve never had a cavity and in general take good care of my teeth. Immediately after the cleaning they came in with the Arestin pitch, saying I had two pockets that needed immediate attention or I would have serious tooth issues. I declined ($50 each for two teeth and it not being covered by insurance tells me it’s not needed). They tried to get me to make payments on it, anything to make that sale. I felt like I was getting the add on pitch like when I get my oil changed! The receptionist at the front hit me up again when I rescheduled my next visit! Needless to say I’ll be shopping for a new dentist soon.
The treatment that you’re describing doesn’t sound like a scam to me, and in fact appears to be the appropriate protocol for Arestin usage. Possibly you felt “taken” because the practice didn’t take enough steps to instill your trust in them and forgot to treat you like a person instead of just a warm body. Sadly, I’ve had bad days where I know I could have treated people better myself. By and large insurance doesn’t cover Arestin but we rarely have people decline its placement. I believe in its efficacy, regardless of what someone’s plan does and doesn’t cover. If insurance companies did what was in patients’ best interest all the time, well, we wouldn’t all be so frustrated with them, would we?
Good luck with your continued oral health!
james hill jr says
I read your article called my dentist office explained I prefer the scaling and root planing. The office manager told me he needs to discuss it with the hygentist, which I replied my VA hygentist is against it. I just got a called before I finished typing to you, their hygentist recommended scaling and root planing as well. They are refunding $463 back to me thank you very much for your wisdom.
Is it true that if you can’t afford Arestin you can still use the antibiotic Doxycycline 20 mg, usually prescribed twice a day, for a period between 3 and 6 months? Why doesn’t my dentist agrees to prescribe the second option? My insurance won’t pay for Arestin unless I try other medications first…
Thank you for this article. I was kinda worry about the arestin issue. I freely admit I brush but flossly well I need to work on that. I did a lot of bad things, like use baking soda to brush my teeth since I was a child I am in my late 30s and I have a serious sweet tooth. My teeth look great but was told I am between 6mm-7mm so yeah I am going to get the Arestin like recommend and after reading this article. It will be costly but lesson learned. No more baking soda I will try the Toms and of course I will be flossing. Thanks again for your honest aritcle.
I am very close to the Dental Profession. I will give you some advice.
1.- Avoid Dental Chains .
2.- Go to a Private Dentist.
3.- Trust your Dentist and be respectfull.
4.- Pay you Bills. So your Trusted Dentist can pay his bills.
If you choose not to follow my advice. Do not complaint.
We did that and still got scammed. The hygenist applied Arestin on first visit with deep cleaning for 78$ per injections 11 sites. Did whole thing cleaning and arestin treatment all 4 quadrants in one visit -2 hours- 1500$. Private office.
Marcella d says
11 sites….???!,,,,,,,!!!!, omg! Run for the hills
Terry Smith says
I just got back from Aspen dental in Kissimmee, Florida and their recommending 31 sites for Arestin. I do have a little bit of bleeding when flossing but not when brushing. I think I’m getting taken.
Pat Flanagin says
Mine charged $125 for 1st injection and $85 for second and applied right after cleaning. Had no bleeding or pain.
P Delory says
Thank you for the article. I recently changed dental insurance and had to locate a new dentist. I have been scheduled for a deep cleaning and a quote was provided (before any measurements were taken) for Arestin to be placed in 4 quadrants during cleaning, for a total of $1000.00!!! After measurements, I did have several places in the back teeth that were 5’s and two 6’s. My gums look healthy and no bleeding. Its good to know this is not a necessary procedure/cost during cleaning and should be re-evaluated a few months later. Guess I’m back to looking for a reputable dental practice.
One thing anyone can do during these visits is ask for a mirror and request to see the pockets, and have them explain where each of the 5s or 6s are at… YES, IT IS POSSIBLE TO ASK FOR THIS. IF THEY DECLINE, ASK TO BE SAT DOWN, and WALK OUT. Go look for another place.
Can a dentist/hygienist legally give me Arestin without advising me that there is an additional cost for it? Or how much I will be charged? I hate surprises!
Jo Smith, RDH says
It’s my understanding that Arestin is placed at the time of scaling and root planning, as an adjunct to scaling and root planing and then can be reapplied to 5mm pockets or greater at the 3mos periodontal maintenance visit. This is the accepted standard for placing Arestin and should not be considered a “red flag.” Also there is an RX Program available to patients that helps reduce/eliminate the cost of Arestin by billing the patient’s medical insurance directly. More information is available on the Arestin website.
Andy, RDH says
Thank you for your reply. I was wondering where she was getting her research for her protocols. I have been following the above protocols for our Independent Practice with consistent positive results. We have also incorporated the use of a dental laser treatment protocol. Great success in pocket elimination. We are also successful in reversing perioimplantis. Why, when given the opportunity to give the patient 21days of antibiotic coverage in the site of infection, would I not encourage that option? Studies show that Debriment alone will not remove all bacteria from the site of infection which is why they are still showing the symptoms of infection at the revaluation. The protocol that she adhears is dated. Of course, our office philosophy is for our patients to keep their teeth in fine form and function for the whole of their life. I guess if you feel there is an acceptable loss of dental tissue and function you don’t treatment plan for health.
Interestingly, your stance is refuted by this study:
American Dental Association JADA. Christopher J. Smiley, DDS et. al., Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. JADA July 2015 Vol 146 Issue 7, pgs 508-524
Since this post about Arestin continues to be used as a reference by patients, it seemed appropriate to affirm that the ADA’s research agrees with my own.
Patients, keep in mind that you should always seek a second opinion if you don’t feel comfortable with any treatment plan you receive.
Deb T says
” Also there is an RX Program available to patients that helps reduce/eliminate the cost of Arestin by billing the patient’s medical insurance directly. More information is available on the Arestin website.”
I had a private practice dentist that started using Arestin on me. For a number of reasons, I left his care and started going to a chain practice. There too, I was told at each visit that I needed Arestin. They charge $95 per capsule/placement. That adds up fast as there always several teeth that “need” the Arestin.
I have a very good medical insurance plan with an excellent prescription plan. I inquired about having the Arestin billed to my insurance. My copay for generic is $1 and $4 for brand name. And that $4 is for as many capsules as the dentist prescribed. That means I could get 8 of them for $4. So they started doing that – the dentist would provide the Arestin company [Schein?] a script; Arestin company called me to get additional info and they billed my medical insurance. They would order the Arestin at my cleaning and then when it came in; I’d go in to have it placed. I don’t remember if they charged me to place them. This went on for a year or 2. Then; knowing they would get the Arestin; they would use “their stock” of Arestin and when mine came in, it went into their inventory. If 8 came in and I only used 6, I’d have a “credit” of 2 remaining capsules. This worked well for the next year or 2. Then suddenly; I was told that the Ciorporate Office won’t let them do that anymore. I had to pay the $95 per capsule. I left them at that point. I am trying to find a dentist that will continue getting the meds paid for by my insurance. I don’t mind paying to place them, but really, this is clearly a case of taking advantage of patients.
Perhaps I should get an appointment with Mike W. Davis in Santa Fe; I am in Albuquerque!
I recently visit my dentist for general cleaning, my last visit was about 9 months ago. After my first assessment I was told that most of my pocket measurement were 3’s, 4’s and 6 5’s. I was advised to take care of them in order to prevent further damage. The cost is only $40 each. Should I go head with treatment?
Trish, I know you are well meaning, but you really do not understand periodontal disease. First, Arestin MUST be placed when the root surfaces adjacent to diseased tissues are primarily bacteria (red bacteria)-free. This is immediately after the SRP’s are completed. Can arestin be abused? Sure, but I’ve seen it mostly abused by private practitioners who do not understand it and need to make their Mercedes payment.
Most dentists, including docs working for a DSO (where they are NOT employees of the company, but contractors employed by the owner-dentists on behalf of the complany) do not diagnose perio disease based on pocket depth alone. Periodontitis is primarily a disease of the attachment and supporting bone.
I could go on for several pages, but the bottom line is that you are misinformed about the nature and treatment of periodontal disease and it’s diagnosis. If you really want to do your patients a favor, go take some current CE concerning perio disease and it’s treatment.
BTW, I’ve been practicing for about 40 years in both DSO and private practices. My focus has primarily been on periodontal disease.
You’re probably well-meaning, too, and while I admit that this article goes all over the place and didn’t quite explain periodontal disease as well as I’d hoped, it’s not off-base as to the abuses that occur with the use of Arestin.
Were the attacks on my knowledge and education really necessary?
I went to a dentist I’m not sure how many of the arestin thing she used she finish the job in one hour my bill was $2700 Is that normal?
I think he was attacking you because of your comments regarding Corp Dentistry. Your knowledge and education of this group is highly lacking. I agree there are more than a few that abuse Arestin ,but there are also private practices that do the same. Telling people to stay away from Corp docs is somewhat ignorant. I can name 5 Doctors that are Corp Docs that are some of the highest regarded people in our industry. Maybe your article should have focused more on the facts of when you should and shouldn’t place Arestin rather than grouping people together to make private practice seem superior. You wouldnt know the difference in my office now and when i was private except now i dont have the headaches of the business side.Ethical people are in both groups and so are unethical. The news and articles like this are what leads the public to distrust all of us!
Thanks Jay. I never said to stay away from all corporate dental practices, just the ones that provide inappropriate care. Like you said, private practices aren’t immune to this either, but patients need a way to discern whether or not the treatment plans they are given are appropriate. Ethical corporations have nothing to worry about here. But even now the American Dental Association is questioning the efficacy of Arestin (it’s less than “Weak” evidence of benefit in the results that came out this week).
Shawn B says
I’m a patient, not a doctor. Interesting article.
As a patient, I was told in early June that I had deep pockets from between 5-10mms. I was shown the immediate (digital) x-rays of where my alveolar bone was ‘decayed’. Saw it, had to believe it. My last visit to the dentist before that was about 5 years prior when the hygienist told me I had ‘deep pockets’ and they performed an root planing/scaling. She recommended a follow-up but…
I changed jobs for a bit, didn’t have a dental plan, then when I did I just didn’t go. Nobody’s fault but my own. I wasn’t aware of such as thing as periodontal disease. The hygienist mentioned it but I blew it off as a money making scheme. I was also a smoker at that time (quit for 4 years now) and I’m sure that didn’t help. So, my dentist referred me to a periodontist. The referred periodontist wasn’t in my dental plan network so I fumbled around on the phone one day until I found a “good” one who is. She wen to Harvard, is a D.M.S as well and has a good record on paper.
Anyhow, about 2.5 weeks ago I had LANAP surgery on my entire mouth. I was on doxycline antibiotics and Chlorhexidine mouthwash. My 2nd maxillary molar has some mobility and during the initial consult my Perio said it will have to be pulled at some point. I’m hoping not to have that done.
So, I’ve been researching the heck out of this disease. Have set myself up a regimen of CoQ10 supplements and fish oil pills. JASON Sea Fresh toothpaste with CoQ10. Periobrite Mouthwash (again with CoQ10). Caltrate Vitamin D and mineral supplements and of course a daily vitamin.
Came across your site while researching toothpaste.
Isn’t Arestin just an antibiotic that is applied locally instead of systemically?
Do you think there is any benefit to the CoQ10 toothpastes, mouthwashes and all the supplements? I’m a fairly healthy (otherwise) and active 43 year old living a regular Colorado outdoors lifestyle (much easier now that I no longer smoke).
Thanks for reading. This has just been on my mind a bit.
Dr. Howard Katz says
Arestin is basically a money making scam.It has been shown in evidence based reports that the measurement reporting and techniques used to support Arestin’s value,are statistically and clinically insignificant.Measurements of .04 mm are not considered as a real measurement when diagnosing and treating gum disease.As a dentist and microbiologist,Arestin is a patient’s nightmare.Prescribing and placing this material is done only by greedy dentists that do not read or are uninformed.
Last Thursday I received an Arestin treatment after deep cleaning. One of the applications was forceful and the hygienist slipped and it went between gum and cheek. Right side of face is swollen and painful. Now on antibiotics and steroid pack. Have you ever heard of this scenario before. Any insight?
I am quit worried because it is not improving that this can be releasing for three weeks.
Bud Leffler says
I had a peridontist that did every red flag in one visit and only finished the lower jaw. She then said I had to have Arestin today or loose a tooth. They charged $730 for the lower jaw only. They scheduled the upper for the following Monday and then she wanted to treat the upper another $400. I refused and I handed them a letter based on research and your website. I got the credit card company to put a hold on the credit charge and send the letter and web site links to the bank. The Dr. has not protested the return of the money but the bank wants to resolve the situation and has requested I get a professional to write a letter regarding these charges. They also said they could only use web info if it was from a .org.
I would rather give the money to charity. I am over 65, I feel this is a practice they are regularly doing on elderly patients and unless stopped will continue. Where can I turn to resolve this matter before the bank just gives him the money? I filed a complaint with Delta Dental the day I handed the Dr. the letter but nothing has happened.
Honestly as someone who already tries to avoid the dentist every step of the way after many bad experiences, this just makes me feel more ill at ease. Just found a new dentist recently and was told by the hygienist after testing that I needed Arestin placement because many of my numbers were between 5 and 7. I declined having the placement done immediately mostly because I am uncomfortable about medications period but also because I wanted a chance to read more about its use .What I find myself wondering after reading this article is what are the conventional ways of treating gum disease and given how expensive this product is, why wasn’t I offered an initial plan of treatment with Arestin being recommended if that treatment was not effective. Apart from that I was told my teeth were in good condition for the most part. Now I’m just wary about the entire experience and wondering if I should be in search of a new dentist once again. Tired of the dental experience.
Katie Clark says
I had Arestin placed in all 4 quadrants with pocket depth of no more than 3mm. Now it is clear I was taken for a ride. The bill they presented in the dr.’s office was $1,300, now it is $2,300. Was this clearly unethical behavior? I also point blank asked my dentist if this was absolutely necessary (the arestin) and asked if we should administer the arestin after the deep cleaning and see if it cleared up. He said it was absolutely necessary saying that I risked losing my teeth. Also, I had never had a deep cleaning before. He also told me I could eat within 30 min of Arestin treatment and continue flossing, which I was skeptical about. Later I found out you’re supposed to wait 10 days to floss?
What are my steps for recourse? I am planning on filing a grievance with my insurance company but also wondering if I will need to take this to court.
I went to a dentistry chain last year after not seeing a dentist in several years because I didn’t have dental insurance during grad school. They had Arestin posters all over the wall, and after the tech gave me the most painful measurments I have ever experienced before she did anything else in my mouth (she really jabbed the scale in every pocket) she was telling me I had a bunch of 5, 6, even 7s. She then “recomended” arestin, and explained how it works, and had me sign some sort of waiver so she could “order the drug while they checked with my insurance company for coverage.” I thought I was getting x-rays and a teeth cleaning this day… Next thing I knew, she was numbing me up and injecting a quadrant of my mouth with arestin… I was in shock, I thought she was going to clean my teeth, and by the time I realized what was going on she was already going to town with the stuff. She then told me I needed a particular electric toothbrush for my condition. When I checked out and saw those exact toothbrushes as the only ones they sold behind the counter where I paid for my services (including the arresting I was misled into approving) I started searching for a private dentist. Their measurements were on the worst spots were a few 3s and 4s. These chains disguist me.
The one thing that I don’t like about the dentist here in florida is they all want to sell me this arrestin to treat my gums. I have had this applied about 4 different times and have seen no improvement in my pockets, so why keep doing it? Also if a dentist sells you something that in the end does not help improve your condition why are we not allowed to get a refund just like any other business. For all i know they are shooting water in my gums and charging me 50 per shot. All dentist now a days private and corporate are like car saleman trying to meet a quota rather than actually do what is best for the patient. Stay away from up charges like arrestin Dentist are trained to get as much cash out of you as they can and if you say it is not true why is there not a cheaper alternative to arrestin that is covered by my insurance?
Interesting to read about this. Practising for thirty years now and always hoping to help our patients as much as possible, with respect they deserve, as We would hope others treat us. There are lots of dentists out there who think the same way, others…….. Not so much.
Great information here. Never used arestin, as was not sure if it really was beneficial.
Thank you so much for this article. After receiving a diagnosis from a very Arestin-happy dentist, I am not seeking a second opinion.
Dennis Kazich says
I’m pretty sure the scam procedure about Arestin has been put on me too. Have been seeing a regular dentist for years and getting teeth cleaned every 6 months. I recently changed insurance and dental plan and poof out of no where this time round my gums are in dire need of this Arestin treatment. No cavities, no loose teeth, everything looks great but in the last 6 months my gums went bad. I barely eat any hard foods or sweats, I brush everyday and floss, even rinse with mouth wash. Still very questionable about this whole deal. They are still not sure if my insurance will cover it. RED FLAG FOR ME!!! If the insurance will not cover it, they know something we don’t know. Probably not necessary and they don’t want to be scammed.
Searching for Arestin and landed here. Visited one private Dr for cavity pain and the Dr did cleaning then recommended for Arestin and got some signatures on my first visit.
Now I see that the prescription insurance fully approved and paid 4600$ and sent to Dr ..Shocked to see this as this was approved in March 2016 and I am yet to undergo SRP and Arestin placement.
Not sure if I really need this or should I ask my insurance company to cancel this and cancel what they paid.
Would there be other charges dentist would charge for placing other than Arestin medication cost?
Also fear of side effects this may cause.
Please advice as I don’t want to call the insurance company then run in to other issues
Just went to my dentist for a scheduled cleaning this past Thursday. New hygienist I’d never met previously did the most aggressive pocket measurement I’d ever experienced. I’ve been having these every 3-4 months since i had a gingivectomy in the mid-1980s so i have lots of past experience to go by. Subsequently the aide came in with a sign up sheet and cost explanation and they wanted me to undergo the SRP and Arestin placement right then and there. I was already suspicious over the deep probing so deferred. After reading this I’m glad I held off. I’ve asked my dentist to explain his protocol and business practice — in my view even if the pocket measurement were valid, there were several flaws here: the dentist never came in to explain this; the patient should not be rushed immediately into this treatment during a routine cleaning; there should have been a discussion over the pros and cons of doing this in conjunction with an SRP versus doing the SRP and holding off on the Arestin until the followup visit.
Thank you for the article. Today at my office (I’m a dental assistant) an Arestin sales rep came in to speak to us about the product. She didn’t quite give us any information on how it exactly worked or when it’s best applied. Even though I’m not a hygienist, I still would have liked to know about that because I have felt skeptical about the product. I felt like I was busting her chops when I told her that I wanted to see photos and evidence of it working but I felt that I was just thinking how a patient would think. I work for Heartland, and I feel that the treatment plans presented to patients with perio are massive. So many sites of application. I’ve just never heard of this drug until I’ve started working for Heartland.
Robert Perlberg says
My dentist had to close his office and went to work for a clinic. The first time I went there, the first thing they did was X-ray my mouth and after just examining the X-ray they told me I had gum disease and needed a whole-mouth Arestin treatment costing $1,600 which was not covered by insurance. I wish I had read this article before I agreed to it because I now know I was majorly scammed and I will never go back there.
Frett D. says
I am a general dentist and I am thoroughly frustrated with Arestin treatment. I rarely if ever used it when I had my own practice for almost twenty years. I sold my practice and went to work for a small dental practice company (with 6 or 7 offices). The dentist-owner told me that we needed to be placing more Arestin because he sincerely believes it helps perio disease. However, almost all our patients get HEAVILY discounted Arestin treatment due to the plans mentioned above and also because quite a few of their HMO plans dictate the fee charged and it is LOWER THAN OUR COST! So for our practice, it is NOT a money maker–if anything, we lose money due to the time it takes for the hygienist to place it.
And by the way, It is RARELY effective if placed after an SRP (deep cleaning), according to research.
That said, in some patients we see a big improvement, but in others not so much. And then in some patients who DECLINE Arestin therapy, we still see a big improvement (which is what happened for decades before Arestin was even invented).
I don’t like it because the product is not super effective and OraPharma makes an obscene amount of money from it–not because of the antibiotic material but because of the special tips designed to deliver the minocycline deep in to the pockets. Most of the dentists I know are not making a killing off Arestin, but clearly some of these chains are.
My suggestion to patients is trust your gut and second opinions. Also, asking around for a good dentist is helpful. Be careful with home remedies and anecdotal evidence. I did not treat perio disease aggressively in my old practice, but we are seeing so many problems with it nowadays, I am trying to get better about it. The problem is that we are living so long and getting dentures at 50 is not a choice most people want to be making. So now we need to be more active about getting the gums healthy. Arestin is not all that, but in some cases it does seem to help.
You should check out PerioProtect. They offer a non-invasive treatment that uses hydrogen peroxide instead of antibiotics. My dad is a dentist and he talks about its benefits all the time.
Thank you for writing this post!
Michael W Davis, DDS says
Here’s a link to the American Academy of Periodontology’s (AAP) position paper. It may serve as evidence in any dental civil or criminal case, or a state dental board hearing (state administrative law). http://www.joponline.org/doi/pdf/10.1902/jop.2006.068001
Obviously, products like Arestin are grossly overused & abused. In clinical environments in which upselling & maximal production dollars take place over patients’ interests, one will witness high-pressure sales of the service of these antibiotic products, even prior to evaluation of the positive effects of S/RP by itself. The AAP makes it clear that only certain specific sites may potentially benefit from this therapy (i.e. deep infrabony pocket defects). Further, studies have demonstrated on average, this therapy offers minimal value in pocket elimination or reduction.
However, there are statistical outlier cases in which pocket reduction was favorable. In essence, this is a “wing & a prayer” therapy for only the most challenging sites, w/ less than ideal outcomes. It’s no wonder that no insurance company I know will cover benefits for this therapy w/ guarded efficacy. But, that doesn’t stop high-pressure sales to patients (now called “consumers”) by corporate dentistry. BTW- I can virtually guarantee this therapy WILL be covered by a clinic’s in-house discounted dental plan. It’s usually just another mechanism to separate people from their dollars.
Things to look out for:
1. Dental hygienist & doctors working on a strict commission basis for a corporate clinic.
a) The hygienist works for the entity which pays their paycheck, which isn’t the doctor in these settings.
b) The doctor is under the thumb of a non-doctor business manager, who has zero concern for patients beyond production dollars.
2. Often discount dental plans are utilized as a mechanism to sell unnecessary dental services, of which no valid insurance company would cover.
3. Often patients won’t know they are visiting a corporate controlled dental clinic, because of the company’s policy of “stealth branding”. See: http://blog.dentistthemenace.com/2016/12/corporate-dental-branding-what-dental.html
Michael W Davis, DDS
Santa Fe, NM
Thank you for your post. I believe I just got ripped off with Arestin in private practice!!! which I trusted so much and that’s most painful. Just Arestin alone was 1000$!!! My old hygienist left and new one changed plan of care. I researched Arestin and I’m so upset and I’m pretty convinced now this was scam. I found studies. How can you measure 0.1 to 0.5 mm improvement!!! It was my first deep cleaning and she did not use injectable anesthesia like it was planned by my previous hygienist and only some gel. That is probably next red flag.
Thank you so much for this blog. I have a suspicion my dentist, who sadly, is part of a chain, is using scare tactics on me. As an older woman who takes extraordinary care of her teeth: Sonicare, WaterPik, floss, proxabrushes, mouthwash, etc., every time I visit the dentist, he says I need Arestin in one 4mm pocket, fluoride varnish and anything else they can scare me into getting.
Here’s something I don’t see being addressed here: Older people on Medicare are being taken advantage of by over-prescribing costly services and sometimes double billing both the patient and Medicare. I’m on my second dentist since I aged into Medicare and Delta Dental, sigh! Both dentists are motivated by greed and it’s unconscionable. I’m a pretty smart and savvy cookie. I can spot a ruse a mile away, but I want to take good care of my teeth. What on earth is someone to do when there’s so much fraud and greed in the dental industry?
I realize you say to find a private dentist, which I’ve attempted to do. But, many, many private dentists don’t want to take Delta Dental, and I can understand why. This is a predicament and it won’t be solved until we fix our broken system. Dental care shouldn’t be this difficult to obtain and greed shouldn’t be part of the equation.
Robert Cole says
Trish, I think it’s time for a new blog on arestin or at least an update on cost! Or am I being gouged?
Trust my dentist in DC who’s treated me for 15 years. Have had 5, 6 and 7mm pocket measurements and arestin in the past.
Just came from cleaning and periodontal exam today. Needed 4 more arestin injections today. But at $92 each, Henry Schein could take on Donald Trump in 2020 !! Isn’t there a competitive product or alternative ? !
Greg Palmbach says
Over the years I have had enough dental work in root planing, crowns, oral surgery and root canals that I could have bought a new house. Time to throw in the towel I think and get dentures.
Thank you so much for writing this!
I left the dentist today (an Aspen dental office in Texas) with a $4,403.60 estimate for a “hygiene treatment” which apparently is a trumped up scaling and root planing for moderate periodontal disease. That is for 25 (TWENTY-FIVE!) Arestin placements ranging from 1 site at $81 to 5 sites at $183. Heck, all I went in for was an abscess on a front tooth. They also tacked a $135 tooth brush on to it. Reckon I’ll be finding a different dentist to see to take a different course of action.
Holy crap.. the exact same thing just happened to me at Aspen. I just needed a new filling but came out with all kinds of stuff needed for over 5,000 . Horrible!!!
Marie Evans says
Watch out for aspen dental, i came out with 8,000 bill, i guess i get denture soon, i 65 yrs, so who really care.
My dental provider charged me $45 each for eight Arestin treatments right after perio scaling and root pin on the same day. My initial out-of-pocket exceeded $700.00. Before agreeing to the treatments, I called my insurance carrier and was informed that they would not cover the Arestin treatment until my gums healed after 31 days. Then if the treatment is still needed, my cost would only be $9 per treatment, and I have up to three years to receive the treatments. Also, I requested that the provider submit a pre-determination to the insurance carrier so that everyone would be on the same page. The dental provider knew the deal, but wanted me pay the full cost of $360.00 for the Arestin treatments. My total cost was $210.00, which included $100 deductible and my 20 percent. You have to do your homework, or else you will pay through the nose.
Thank you for this article. I recently had a visit at a dental chain and almost every red flag came up—forcing the prob, pocket measurements of mostly 4s and a few 5s, no SRP first, 8 teeth recommended for treatment at a cost of ~$400. I got a second opinion and I didn’t even need the SRP, just a basic cleaning. I’m glad I found an honest dentist but it really leaves a bad taste in my mouth about the industry in general.
Had a deep cleaning last month and there were two gums that just wouldn’t heal, bled a lot. For $140 ($70 each tooth) they scraped the tooth for like 20 minutes then applied. Looks better after one day, but now my skin is itchy. Called to report it but they said no big deal.
Bernadette Cherubin says
This is eye-opening. I’m 47 years with periodontal disease and I’m always concerned about the Arestin treatment. It’s so expensive. I had one dental hygienist tell me that cleaning my whole mouth was going to cost $2000 because of the Arestin application. I said NOPE and chose another dentist!!
Terry Smith says
I just got an estimate of $2100 with most of it being the arrest . Not sure what to do it’s Aspen dental.
Trish Walraven says
Aspen Dental is a dental corporation. You may want to look up complaints against this corporation to determine whether or not you trust their course of treatment; however, that estimate does seem very, very high for an antibiotic that may not be necessary. If they are placing the Arestin the same day as you are having periodontal scaling and root planing performed, it is suggested to get a second opinion before consenting to treatment.
Aspen Dental uses high pressure tactics to get new patients to pay an exorbitant amount for teeth cleaning with arestin. I had it done there and found the scaling and planing to be no different than the cleaning I get from a dental hygienist except that Aspen doesn’t polish the teeth afterwards. I thought that the arestin was unnecessary. I had no infection in my gums that I could tell. I’ve since learned to get a second opinion from a reputable experienced dentist and to stay away from the dental chains.
Jamie Greene says
I was given two “doses” of Arestin by my “holistic” dental hygienist. She charged $40 per tooth and said she would reimburse me if the insurance covered it. Then she gave me $30 toothpaste to apply to my teeth and gums at night, and an iodine rinse. She wanted to do more teeth, but said she didn’t want to charge me too much so we would wait on the other teeth. My measurements included one 7mm and one 6mm and the rest were 4’s and 5’s, so wouldn’t she only need it for the 6 and 7? Also she asked beforehand if I was allergic to tetracycline antibiotics and I said I didn’t know. So I took a Benadryl before the appointment just in case per her instructions. This last Saturday 5/22/2021 was when we did the “deep cleaning” that ended with two Arestin doses on the left side in the back two molars. She told me that I should not floss or water-pik in the area (as is standard so Google says). So I have been following her instructions. Since then I have been having multiple side effects listed when you Google the side effects. So today I told her about the side effects because I am miserable (nauseous, puffy face, sore teeth where there was no pain before, itching, diarrhea and loose stools, weakness/lack of energy etc.). Now she is saying there is no way I am reacting to the Arestin because she says “it doesn’t enter the bloodstream”, but I am calling BS. Any advice for next steps? I will be refusing future Arestin treatments. I can’t afford it anyway.
Natasha M adams says
I got suckered into this the first visit i had to a new dentist they also said i had 4 cavities. Ive never had teeth issue or cavities. I was 26 at that time. They numbed my face so much i could barely feel my eye.
My current dentist who Ive been with for 8 yrs. The first time I saw him he told my I have never had cavities, he sees no fillings. But that I did have a dead tooth but we didnt need to do anything since it wasnt loose or bothering me and we will just watch it.
Are there ways you can just be given regularly prescribed oral antibiotics instead of taking it injections? I heard the bacteria clears up on its own if you are following proper dental hygiene measures.