Arestin

 

S.G., 74 years old, African American, Female. Medium calculus case value/ Type II- Localized III Perio.

Patient reports no chief complaint and came for a cleaning. Patient presents with history of hypertension and DMT2 which are controlled by Enalapril (20 mg) and Metformin (500 mg) once daily. BP: 136/85. Patient reports using medium bristled manual toothbrush twice daily with Colgate Total dentifrice and no floss/oral rinse. Last cleaning and FMS was in October 2016.

Patient presents with Class I occlusion tendency towards III bilaterally, 100% overbite, and 6mm overjet. Abfraction is found on #4, #8,  #13, #21, #28. Tooth #17 presents with mobility class I, furcation type III. Generalized moderate recession of 2-3mm found. Localized moderate attrition found on anteriors of both arches. Gingiva presents with generalized moderate inflammation showing fibrotic and edematous gingiva with lack of resiliency and stippling. Generalized embrasure type II shown with localized embrasure type III on #10.

Patient recently retired and reports she now has a lot of leisure time. She reports she has not been thorough with her oral self care but is now ready to change her old habits.

For intervention, I introduced the interdental brush for the patient’s embrasure spaces and powered toothbrush due to accumulation of plaque in the posterior areas of the mouth. Patient was educated to dip the interdental brush in a cup of antiseptic oral rinse in between cleaning surfaces. Due to the radiographic evidence of generalized moderate bone loss and localized PD up to 7mm, Arestin was recommended and administered as an adjunct to SRP to reduce pocket depths.

Treatment plan:

V1- Perform assessments. Expose 4 vertical BW and discuss findings with patient. Debridement of Quad 1 & 4 with ultrasonic and hand instruments.

V2- Re-evaluate gingival tissues for changes and check for residual calculus. Reinforce oral hygiene instruction. Debridement of Quad 2 & 3 with ultrasonic and hand instruments. Engine polish with fine paste. Administer Arestin (Minocycline Hcl 1mg- 1 carpule per site) to #5DB, #5MB, #6DB, #7ML, #26DB, #27MB, #27DB, #28ML, #28DL. Provide patient post-op instructions of: avoid eating/drinking 30 minutes following treatment, avoid touching the treated areas, wait 12 hours to brush, wait 10 days before flossing, and avoid abrasive foods for 1 week.

V3- Re-evaluate pocket depth for areas treated with Arestin and record changes and findings.