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Oral Exam

What Is Arestin?

For patients with chronic gum disease, there are a variety of local antibiotics that promise to improve gum health. Perhaps the most common local antibiotic is Arestin. But, unless you work in the dental field, you have probable never heard of Arestin. So, what is it? Do you really need it? And why is it so expensive?

Arestin is an anbibiotic called Minocyclin in the form of millions of microspheres. The tiny microspheres are injected into the space between the gum and the tooth. If you’ve ever had a popcorn kernel husk stuck in your gums, then you know the space I’m talking about. Over a period of days, the Arestin microspheres dissolve, leaving behind enough Minocyclin to obliterate nearby bacteria for weeks to come.

Do I Need Arestin?


If you aren’t aware already, there are two kinds of gum disease. The first is gingivitis, which is entirely reversible and will not lead to long-term problems. With gingivitis, there is an infection of the gum only.

The other kind of gum disease is periodontitis. Periodontitis happens when bacteria penetrate the gum and damage the jawbone beneath it. Bacterial damage to the jawbone is irreversible without surgery. Given enough time, periodontitis can destroy the bone that holds teeth in place, leading to tooth loss.

Simply put, Arestin works. Other things work too, but Arestin has scooped up most of the market share and become synonomous with local antibiotic therapy, much like Clorox with bleach or Kleenex with tissues. Because of this, Arestin enjoys a healthy marketing budget. Unfortunately, it has become a key form of revenue enhancement for some unscrupulous dental offices and chains.

Yes, Arestin has been clinically proven to improve the results of deep cleanings in patients with gum disease. However, Arestin can quickly become an extremely expensive treatment option for patients and a great revenue enhancer for unethical dentists. Good clinicians must weigh the costs / benefits to each patient when deciding whether to use a local antibiotic like Arestin, or a systemic antibiotic like Amoxicillin.

Why Is Arestin So Expensive?

Arestin Cartridges and Syringe
Arestin Cartridges and Syringe

Arestin isn’t cheap, at around $15 per cartridge. Each cartridge treats just 1/6th of a tooth. The material costs for treating an entire tooth can therefore run as high as $90.

Some dentists charge up to $85 per application. Given that every tooth has six potential sites for placement of Arestin, the total cost per tooth may be as high as $510. Subtract the $90 in material costs from that total, and the dental team receives $420 in the form of a placement fee. Add just a few additional teeth and you soon have thousands of dollars of Arestin on the treatment plan.

Treating a couple of teeth with Arestin can be more profitable than doing fillings or even crowns. Furthermore, it can be done by a hygienist, freeing the dentist up to do other profitable procedures. Each application of Arestin takes mere seconds. Thousands of dollars of Arestin therapy may take only minutes to complete. In a world where clinicians are driven to make treatment decisions that maximizes their productivity, Arestin is an easy way to enhance revenue under the facade of good clinical judgment.

Alternatives To Arestin


Although there are a plethora of local antibiotics currently on the market to treat chronic periodontitis, they can all become expensive when they involve multiple teeth. In such cases, it may be best to combine a deep cleaning with systemic antibiotics. One study comparing similar local antibiotics to systemic antibiotics did not shown any statistically significant difference between local and systemic antibiotics when treating periodontitis. However, there is a huge difference in cost.

The key advantage to local antibiotics is the application of high concentrations of antibiotics at targeted sites. This minimizes the side effects we commonly associate with systemic antibiotics. But side effects from systemic antibiotics like amoxicillin are mild in most cases. Given the choice to spend thousands of dollars or endure some potential digestion problems, most patients will opt to save the money.


There is a common saying in dentistry, “don’t diagnose the patient’s pocketbook.” But, in cases where there is no clinically significant improvement over a less expensive option, or where outcomes are only slightly better, then cost to the patient should absolutely be taken into consideration. Would you rather pay $2,000 for a Rolex or $20 for a Casio? Both tell the time. The differences that distinguish the two are only affordable to the wealthy. Sure, some people can appreciate and afford the gold watch, but most people just need something to tell them when their lunch break is over.

Advocate For Yourself

When you receive a pricey treatment plan that includes Arestin, be sure to ask questions. If your dentist is resistant to your questions, that is a red flag. Your dentist should make themselves available to you when you have questions. Office staff and dental assistants are not qualified to answer dental questions.

If you see numerous charges for local antibiotics, ask your dentist what their protocol is for treating periodontitis with antibiotics. In my office, my hygiene team and I have adopted a simple protocol to ensure consistency. We try to maximize outcomes while also being mindful of diminishing returns that can drain pocketbooks.

Your dentist should offer you alternative options. If your dentist refuses to discuss alternative treatments like systemic antibiotics, that is another red flag.

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