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MEDICATIONS FOR PERIODONTAL DISEASE

     Tetracycline antibiotics, which include tetracycline hydrochloride, doxycycline, and minocycline, not only have anti-bacterial actions but also, even in low doses, help block collagenase -- the protein that destroys connective tissue and bone.

    A number of methods have been developed to apply antibiotics to the 
gum areas. Actisite is a thin thread similar to dental floss, which is treated with tetracycline hydrochloride. The treated thread, is temporarily inserted between the tooth and gum,  where it releases a steady concentration of tetracycline to the diseased gum tissue thus there are rarely any side effects.
After 10 days the thread is removed. One study showed that scaling and root planing plus short-term antibiotic-thread therapy reduced the need for gum surgery and tooth extractions by 88%. 

     Other treatments employ metronidazole as a gel (Elyzol) or a strip applied to the gum pocket.  Similar procedures employ minocycline loaded into tiny capsules.

      Atridox is a method for delivering doxycycline; it is applied as a gel that conforms to the gum and then solidifies. Over the next few days, it releases the antibiotics.
      PerioChip is a chip that is placed into the gum pocket after scaling. Overtime, it slowly releases chlorhexidine, a powerful bacteria-killing antiseptic. 

Click here to learn more about periostat

     The first oral antibiotic (Periostat) specifically developed for periodontal disease has been approved and some research suggests that it may improve tooth attachment by 50%. The drug uses doses of the antibiotic doxycycline that are too low to fight bacteria but sufficient to block the actions of collagenase. Doses are also too low to pose a risk for the development of antibiotic-resistant bacteria. 

"Periostat is a subclinical dosage of doxycycline, to suppress the destructive enzyme, collagenase which  destroys gingival tissue and alveolar bone. As a subclinical dosage, 20 mg., it has NO antibiotic activity and will not create any microbial sensitivity . Doxycycline 20  mg = Periostat.  (take 100mg Doxy Hyclate and dilute it in 60cc syringe with 50cc of water and use 10cc BID or 1oz cap and dilutes the capsule in that then in 5 more and take one of the caps BID and  tosses the 4 not used for psoriasis because PD  is the same  disease different end cursor chemical) IDF 10/05

 
     In addition, it is totally safe, with no major side effects other than allergy to the drug. It can be taken long term, with continued benefit, and helps to predictably stabilize a patient's perio condition. It can be used in the high risk patients, and used  with all patients who have active bleeding in multiple sites. It is useful for management of all cases of periodontitis in order too successfully manage perio disease nonsurgically." 
 Source:Dr. Neil R. Gottehrer

Taking a common nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen (Advil), along with the doxycycline may even enhance the effectiveness of this treatment.

     Long-term use of antibiotics is generally advised for the control of juvenile periodontitis, refractory periodontitis, rapidly progressing periodontitis, and prepubertal periodontitis. Recently, a study showed that patients with standard periodontitis required fewer surgical treatments when they were given antibiotics for two weeks and then maintenance cleaning for three months. The most widely used drugs are the tetracyclines and metronidazole (Flagyl).  Amoxicillin is also useful. These medications can also be an effective short-term adjunct to periodontal treatment. One study found that metronidazole was particularly effective in reducing the need for periodontal surgery when it was given for a week after scaling and root planing. Common side effects include allergic reactions, stomach upset, yeast overgrowth, and sensitivity to sunlight (with tetracycline).

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Sodium Hypochlorite Irrigation

     Sodium Hypochlorite 0.05% to 0.10% may be used for oral irrigation as part of a therapeutic regimen for gum disease.

     A fresh solution should be prepared for each use.  Mix:

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1 tsp of plain household bleach or 5.25% Sodium

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Place this bleach in 300 cc reservoir of an oral irrigation device which is 
filled with warm water

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Adjust solution according to taste

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Scented commercial bleach may be more acceptable

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Irrigate 2-3x a week, bacteria in the gum tissue is very susceptible to 
sodium hypochlorite

Metronidazole

Antabuse effect of metronidazole hence the  recommendation of no drinking.  http://www.infomed.org/100drugs/menzadre.html

MMPs.... matrix metalloproteinases chew up collagen which holds it together

Chlorzoin

This solution can be used for wound irrigation and as an antiseptic mouthrinse.
CDA Journal Vol 30, No. 4, April 2002
Dentistry Today pg 42, September 2002

Proxygel - 10% carbamide peroxide

Arestin

Criteria to follow when you should use  place Arestin-Pockets 5mm or greater with bleeding on probing.
How much does one dose of Arestin cost-one box $16 per dose.
Fee per pocket- $25-30 per pocket
Retreat a pocket with Arestin-usage was placement at time of scaling and root planing followed by placement at 3 months and 6 months.
Reimbursement from insurance companies.  Every company has its own protocol, most of which
seem to make little sense. .. bottom line is if you are going to use it the patient needs to expect to pay for it.

Plaque Off

Tea Tree Oil

Tea Tree Oil is an excellent oxidizer of bacterial antigens that cause PD.

Medication Updates

Systemic antibiotics enhance healing for aggressive periodontitis

Aggressive periodontitis is a rare form of gum disease characterized by early onset and severe bone loss that can lead to edentulism at an early age. Researchers at the Eastman Dental Institute in London compared full-mouth instrumentation within 24 hours with and without systemic antibiotics to determine differences in healing.

All subjects received oral hygiene instructions and supragingival instrumentation prior to the start of the study in an attempt to bring each individual's plaque level to 20% or less. The placebo or control group began the study with an average plaque score of 20%, and the test group's average plaque score was higher, at 25.5%. The
test group also started out with higher full-mouth bleeding scores: 61.5% compared to 55% for the control group.
Patients were instructed to rinse twice daily with 0.2% chlorhexidine for two weeks. No subgingival instrumentation was provided during the six-month test period.

All patients were given two bottles of pills and instructed to take one of each, three times daily for seven days. Only the research coordinator knew who received the antibiotics (500 mg of amoxicillin and 500 mg of metronidazole), and who received placebo pills.

Both groups demonstrated good healing at two and six months, with the test group showing a greater average pocket depth reduction, 3 mm in the test group compared to 2 mm in the control group and more deep
pockets being resolved. At two months, 49% of pockets in the test group and 42% of pockets in the placebo group converted from 4 mm or deeper to 3 mm or less. At six months, the figures were 55% for the test group and 37% for the placebo group.

Systemic antibiotics may enhance healing for those with aggressive periodontitis when combined with full-mouth instrumentation.


Guerrero, A., Griffiths, G., Nibali, L., Suvan, J., Moles, D., Laurell, L., Tonetti, M.: Adjunctive Benefits of Systemic Amoxicillin
and Metro-nidazole in Non-Surgical Treatment of Gener-alized Aggressive Perio-dontitis: A Randomized Placebo-Controlled Clinical
Trial. J Clin Perio 32: 1096-1107, 2005. cited PerioReports V17, #11
 

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February 06, 2008

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