Dental Hygiene Program

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Arestin Policy

The chemotherapeutic agent Arestin is available in the prep-dispense for pre-doctoral dental student and dental hygiene student use. Please read the following to assist you in providing this patient service.

  1. Arestin is available in every prep dispense area. It is not stored in the refrigerator because it is very moisture sensitive and condensation would cause the material to set before placement.
  2. Delivery of the antibiotic requires use of a special syringe, also available in the prep-dispense.
  3. A requisition slip is needed to obtain the material from the prep-dispense. It must be signed by a dentist (usually a Periodontist or GP Manager).
  4. One delivery tip (which includes the medication), to be used on one tooth, will be dispensed per requisition slip. If additional tips are needed, additional forms must be signed by faculty.
  5. The appropriate ADA Code to use when delivering Arestin is D4381. The fee is $50 (fifty dollars) per tooth treated. A complete description of the ADA code is at the end of this memo. Please note that the treatment code is “by tooth, by report”. This means that a written description of the treatment will be needed for insurance reimbursement. A complete progress note should be written in the patient chart and should describe the diagnosis, the tooth and site being treated, and name the dentist prescribing the treatment. As always, supervising faculty should countersign the progress note. Insurance companies may not pay for this treatment without proper documentation in the patient chart.
  6. When entering the ADA code into Axium, you should indicate the surface where Arestin is used (example #30, Buccal). Note that if an additional site is treated on the same tooth, it should be documented accordingly (example #30, Distal). Seek faculty guidance for clarification. Of course, the patient should be appropriately notified of the expected fees for this treatment.
  7. Generally, patients should be instructed not to brush the area of application for 12 hours and not to floss the area for 10 days. Seek faculty guidance for additional information.
  8. If you are using Arestin from our Student Access Program; there is NO CHARGE to the patient and the code should not be entered, however you must note as usual in the EPR notes regarding administration.

ADA CODE and description of procedure according to CDT 2016: D4381 localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report FDA approved subgingival delivery devices containing antimicrobial medication(s) are inserted into periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time.

NOTE ARESTIN STUDENT ACCESS PROGRAM IS IN EFFECT; thus seniors will have arestin via a GRANT from Orapharma and will not need to go to prep dispense or charge out a fee. ASK YOUR FACULTY FOR ARESTIN if using the Student Access program Arestin.