Reader admires the advantages of Atridox as an option to scaling and root planing.
Connie L. Sidder, RDH
We have entered an exciting age of powered toothbrushes, lasers, and biotechnology develop-ments. Our patients have heard about some or all of these innovations. They question us about them, testing us on how much we know. Many of us feel comfortable suggesting that our patients buy powered brushes. Obviously, our patients trust our judgment. But how many hygienists are familiar with a product for treating periodontal disease, a product recommended by one dental materials expert for auxiliary personnel to apply? Dental hygiene should embrace this product as its own, furthering the cause of a strong dental hygiene department. I am going to share with you my experiences about the new "painless" treatment for gum disease that so many have seen on television reports. It is about the antimicrobial gel called Atridox.
Not all new scientific develop-ments are more expensive to the consumer. In the case of Atridox, it actually costs less to the patient than existing procedures of comparable results. Periodontists have been known to object to the general dental practice of using chemotherapeutic agents. This is because they feel threatened financially, not because the treatment doesn`t work. They use it themselves. But, because it works, it may result in fewer referrals.
How many times have we suggested to our patients to consult a periodontist, only to find out six months later that they didn`t go? What recourse do we have but to do our best and treat them ourselves? Sometimes we are faced with problem of (persistent) pocket areas for which the patient has already received periodontal treatment and does not wish to repeat it. Again, what are our options?
One method of treatment might be to do a prophylaxis, give instructions to patients on yet another approach to home care, and check them at their three or four month recall. Generally, this patient has shown compliance with home care instruction. We know that the 5-6 mm pocket in question is relatively plaque-free, so an immediate recheck is not warranted. Another approach might lead us to scale and root plane (SRP). This patient might have generalized bone loss, maybe two or three pockets per quadrant that need extra attention. We ask them to make an appointment as soon as they can get back into our schedules. Then, we anesthetize one or two quadrants, perform SRP, either by hand or Cavitron, and then recheck them in about two weeks. We are usually heartened by the results, at first, only to realize they underwent the same procedure two years ago.
What if we could do something for both patients that would take 15 minutes of their time, not require anesthesia, nor the pain and discomfort associated with SRP? Also, we could promise the same results, if not better. In most offices, the hygienist is given the power to make decisions about periodontal treatment. It is the hygienist who decides whether the patient should be on a four- or six-month recall. Also, it is traditionally the hygienist who instructs the adult patient on home care.
It is only fair then, that the hygienist - who performs the prophylaxis, takes the pocket measurements, and dispenses home care instructions - be the operator in the patient`s periodontal management. No dentist, unless it is a periodontist, would volunteer to do a root planing! However, a dentist might be inclined to use an easy new product.
This has been my experience using new Atridox. One need only to "squirt" the mixed product, which is an antibiotic gel, into the pocket and instruct the patient not to floss the area for one week. Then, one month later, a recheck reveals better than expected results quite often. The patients have been very appreciative of the new "painless" approach.
In an office where I recently began working, one patient had been treated with four quadrant SRP two years ago. This practice has a strong soft tissue management program. At the patient`s last six-month prophy appointment, no changes in pocket depth was noted by the same hygienist. After reviewing the patient`s home care, we discussed the possibility of using Atridox at his next visit. He was very receptive to trying something "painless."
His appointment can be charged out as a prophylaxis (1110) and the use of a chemotherapeutic agent (4381) for the Atridox. If more time is needed, a second appointment can be scheduled and the charges separated to reflect two appointments. This also gives us time to preauthorize his insurance. I will go into that shortly. We charge $125 per syringe. Each syringe can cover about four pockets. Keep in mind that it doesn`t cost the patient as much to use Atridox as it does to do four quadrant SRP. And it doesn`t take nearly as long to administer either. The biggest payoff for the hygienist is that we have squirted and not scraped. It is user friendly for the hygienist, as well as the patient.
Very often, new procedures are not covered by insurance companies. That was the case when sealants were introduced. Or sometimes we find that one company may pay for a procedure where another will not. To take the guesswork out, we go ahead and preauthorize first. In these cases, all insurance companies have paid for the use of Atridox. We simply include a note.
One example of preauthorization went as follows: "Susan has generally healthy tissue with the exception of #30, which has a 6mm pocket on the mesial. By using a chemotherapeutic agent (4381), specifically Atridox, we expect to clear up the infection and thereby reduce the pocket depth. In so doing, Susan should be able to maintain the area through her home care. We further expect the method will eliminate the need for further periodontal surgery. Thank you for your consideration."
An X-ray was enclosed that clearly revealed the defect. Believe it or not, I do write these notes to insurance companies. But, remember, too, we have never been turned down for payment when we have followed this method.
The problem for hygienists using Atridox, if there is one, lies in its simplicity. A procedure that easily handles four periodontal sites takes only 15 to 20 minutes. Most hygienists are scheduled in 45 minutes to one hour time slots. Fitting a 15-minute appointment into our busy schedules takes cooperation with the receptionist, as well as creativity. I have been known to come in 15 minutes early for those patients who prefer that time. Another option is to make room after a child`s appointment. Yet another idea is to ask the patient to schedule at 11:45 a.m. Then, if we do run over, it goes into the lunch hour.
The advantages of using Atridox over SRP are that it requires less time, it is painless, and one can expect to achieve comparable results. Also, not to be overlooked, is that even with Cavitron scaling, it is wear and tear on a hygienist, as well as a patient`s root surfaces. After 25 years in dental hygiene, I am very enthusiastic about being able to "lighten up."
The product`s active ingredient is doxycyline, so it cannot be used by those allergic to tetracycline. You may also have to fight your employer in applying the gel, because it is so easy to use. But, find a way to get the office staff to assist you in seeing your patients through their periodontal treatment. I worry about the future of our profession. I feel we need to assert ourselves as periodontal specialists in the dental office.
This product, Atridox not only is new and "high tech," but it is painless for our patients. Let us show that we are on top of new developments, and working in their best interests. You will be pleased with the results, too. Your patients will think you are a saint.
For your information, Atridox is available through Block Drug Co. For information, call (800) OK-BLOCK.
Connie L. Sidder, RDH, is based in Fort Collins, Colorado. She can be reached at (970) 482-4649 or [email protected]
The application of Atridox is shown at the beginning of treatment (left) and four months later (right).