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Three New Methods to Work Up the Gums

Dental Care: Some promising medicines to fight periodontal disease are now entering the market, but dentists caution that they are not cures.

October 26, 1998|KATHLEEN DOHENY | SPECIAL TO THE TIMES

Never mind that dental floss comes in tasty flavors like mint and cinnamon.

Or that ultrasonic toothbrushes whirl away at an impressive 31,000 brush strokes a minute.

Or even that the wide variety of toothpaste and mouthwash brands takes up half an aisle of display space in many markets.

Gum disease, the major cause of adult tooth loss in the U.S., is still rampant.

Nearly 30 million Americans have gum disease, some of it serious enough to put them on the risk list for dentures.

But three new weapons in the war against gum disease, all approved recently by the Food and Drug Administration, may help make a dent in those statistics.

Periostat, billed as the first pill to fight gum disease and available only by prescription, was approved earlier this month and is due to be available before Thanksgiving. The pill contains the antibiotic doxycycline and is meant to be taken daily after the patient has undergone root planing and scaling, a deep-cleaning procedure to remove plaque. Left unchecked, the sticky plaque inflames gums, causing them to pull away from the teeth. Periodontal pockets then form, where bacteria thrive and can destroy underlying bone and loosen teeth. If the disease progresses too much, gum surgery to reduce the pockets is performed.

PerioChip, approved in May and available now, is a biodegradable chip about the size of a baby's fingernail. It is inserted by a dentist into infected pockets after the scaling and root planing procedure, where it releases the antimicrobial chlorhexidine and is absorbed within 10 days.

Atridox, approved in September and expected to be available nationwide soon, is doxycycline mixed with a liquid polymer that is injected into periodontal pockets. The medicine is slowly released over seven days. It can be used after scaling and planing or as a stand-alone therapy.

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Promising as the new treatments sound, dentists are viewing them with caution. Dr. Marc Waki, a Burbank periodontist, says he will use the new pill, chip and injection on selected patients, along with dispensing this caveat: "It's not a cure for periodontal disease. The idea is to stop bone loss while doing scaling and planing."

"We don't have long-term data on any of them," says Dr. Perry Klokkevold, UCLA clinical director of periodontics, about the treatments.

But the new therapies, Klokkevold and other experts agree, could help.

Until now, treatments aimed at gum disease have emphasized attacking the bacteria that cause it. But Periostat was developed after research demonstrated that the destruction of gum tissue is caused by overproduction of the enzyme collagenase in response to the presence of the bacteria. That, in turn, suggested that treatment should focus on both the bacteria and the body's response to the infection.

Periostat suppresses collagenase, says Brian M. Gallagher, president of CollaGenex Pharmaceuticals in Newtown, Pa., which developed Periostat.

By helping to keep the gum tissues intact and attached to the teeth, Periostat can help slow progression of gum disease, Gallagher says. The pill is expected to cost about 50 cents to $1.

"Periostat can produce up to a 52% enhancement in [gum tissue] attachment levels," Gallagher says, "and up to a 67% reduction in pocket depth, compared to scaling and root planing alone." He bases the results on company-sponsored studies of Periostat in 200 patients.

For instance, a patient who had a 6-millimeter pocket (a depth that makes periodontists scowl) might get a reduction to 4 millimeters with scaling and planing alone, says Gallagher, but with Periostat added could conceivably reduce the pocket depth to 3, considered "at the edge of normal."

The recommended dose of Periostat is 20 milligrams twice a day. Some patients may stay on it long term, Gallagher says, if their disease is severe.

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Some dentists voice concern about patients developing resistance to antibiotics if they stay on Periostat long term, but Gallagher says that does not happen because the levels of doxycycline are too low to produce an antibacterial effect. In a study of 78 patients who took either Periostat or placebo for up to nine months, those on Periostat showed no signs of developing antibacterial resistance, according to researchers who presented their findings from the company-sponsored study at the International Assn. for Dental Research meeting earlier this year.

In company-sponsored studies of Atridox, the injected doxycycline, there was a pocket depth reduction of about 1.2 millimeters, says Vicki Miller, a spokeswoman for Atrix Laboratories in Fort Collins, Colo., the developer.

PerioChip, used in conjunction with scaling and planing, showed a 0.95-millimeter reduction in pocket depth compared with a 0.65-millimeter reduction with the scaling and root planing alone in company studies, says a spokeswoman for Astra Pharmaceuticals in Westborough, Mass., which holds the U.S. marketing rights to the treatment.

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The American Dental Assn. takes no formal stand on the new therapies but recommends that people with symptoms of gum disease such as bleeding gums see their dentist promptly.

The American Academy of Periodontology has issued a statement to its members about each of the treatments. Changes in pocket depth were modest, in the opinion of the academy, and more studies are needed.

And none of these new treatments eliminates the need for seeing a dentist regularly and paying close attention to at-home oral hygiene, warns Dr. Robert Schoor, president of the American Academy of Periodontology and director of the postdoctoral program at the New York University College of Dentistry.

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