Retreating Periodontal Pockets with Adjunctive Antimicrobials

Colleen Rutledge, Dental Hygiene Coach & Owner of Perio-Therapeutics & Beyond
Colleen Rutledge, Dental Hygiene Coach & Owner of Perio-Therapeutics & Beyond

Colleen Rutledge, RDH in 2003, provides over-the-shoulder in-office training for various non-surgical periodontal therapies. Her specialty is helping dental practices realize increased production by increasing both the quality and quantity of periodontal services and to positively affect patient clinical outcomes. Thanks Colleen for contributing this great article for DCC readers.

Retreating Periodontal Pockets with Adjunctive Antimicrobials

by Colleen, Rutledge, RDH

Hygienists often ask me how many times to re-treat an unresponsive pocket with an adjunctive antimicrobial product (Periochip, Arestin, Atridox).  Many things affect this decision.  It’s best to use a comprehensive approach and look at the “whole picture” when considering re-treatment.

First and foremost check for any remaining calculus, making sure to rule out burnished calculus.  Evaluate the area for overhangs, food traps or ill-fitting crowns and bridges thoroughly reviewing a current full mouth series of radiographs.

Consider if the patient may clench or grind their teeth.  Bruxing habits can be insidious and often go unrecognized.  However, reoccurring pockets may be a result of occlusal forces, encouraging the bacteria to migrate along the root surfaces of chronically traumatized teeth.

Keep in mind that a whole host of risk factors may be impeding results: smoking, diabetes, history of cardiovascular disease, etc. Often results are positively affected when low-dose doxycycline hyclate is prescribed.

Lastly, consider the technique used when the product was placed. Did the antimicrobial get to the base of the pocket where the red complex of bacteria thrives? Did the patient follow post-operative instructions?

Most importantly, referral to a periodontist is indicated when the patient is unresponsive to non-surgical periodontal therapy.

When considering re-treatment with locally-applied antimicrobials, a comprehensive approach provides better clinical outcomes and ensures that the root cause hasn’t been overlooked.

To get a “Top 10 List for Retreating with Locally-Applied Antimicrobials” email Colleen at

Learn more about Colleen Rutledge, RDH and her consulting services at or call Dental Consultant Connection (727) 447-4756.