What does the dental medical community think of this new drug approved for the treatment of gum disease? My periodontist hasn't even mentioned it to me.

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Periostat, a new drug for the war against gum disease
by Dr. Jerry Gordon
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Periodontal or gum disease is an infection that causes bleeding gums, bad breath, loose teeth, and teeth that fall out. A bacterial film called plaque that continuously forms around the teeth and gums causes gum disease. An estimated 56 million Americans suffer from gum disease, the main reason people lose their teeth.
The leading treatments for gum disease are scaling and root planing (deep cleaning of the gums) and surgical gum treatment in more advanced cases. Antibiotics are sometimes used in conjunction with these other therapies, often with the goal of killing bacteria that is causing the gum disease. Recently, there is a new drug, which instead focuses on controlling our body’s reaction to these bacteria. The new drug is called Periostat.

To understand how Periostat works, we need to have some understanding of how bacteria in the mouth cause the loss of gum tissue and bone around the teeth. Oral bacteria cause a chronic infection in the mouth of people with gum disease. This infection causes the body to release chemical substances called cytokines, which in turn cause a cascade of reactions within the gum and surrounding tissue. One of the substances released is a family of enzymes known as matrix metalloproteinases (MMPs). One of the MMPs is collagenase, an enzyme that breaks down the gum and bone.

Periostat is a new application of a not so new drug, doxycycline. Doxycycline is a derivative of tetracycline. Periostat is a 20mg. capsule of doxycycline that should be taken twice a day over several months. Periostat helps to inhibit the body’s production of the destructive collagenase. Unlike higher doses of doxycycline or tetracycline that can be used to prevent the multiplication of some bacteria associated with gum disease, Periostat protects our body’s "over-reaction" to bacteria, and its lower dose has far fewer side effects.

Periostat is not intended to replace the need for excellent oral hygiene, or other traditional gum treatment. It is a drug that clinical research has shown will modestly improve gum disease when taken in conjunction with professional deep cleaning of the gums and a thorough oral hygiene regimen.
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The technique is not really that new. Why is it that you think you may need it? Is your periodontal disease not under control? Are you not doing your proper oral hygiene as diligently as you were instructed to do so? I have taken minocycline, also another form of tetracycline, but for acne not oral problems. During this time that I was taking it I had the healthiest gums with only brushing once a day. It was amazing. But after taking it for 10 months I started to get chronic vaginal yeast infections. I have not taken it for 2 1/2 years and I am still suffering the reprocussions from taking an antiboitic for such a long period of time. And yes the minocycline was a very low dose.

So feel free to ask your periodontist about the periostat, but chances are...you don't need it. I have seen very few people that will significantly improve with the short term use of an antibiotic. In our office it is one of our last measures to get periodontal disease under control.

I hope this helped, good luck.

I thought it was under control but the dentist feels I need more surgery. He also keeps saying that I have been lucky not to have lost my other teeth. I really feel like the situation is not getting any better. For 4 teeth, he wants me to pay $2800.00 or $700.00 per teeth. The gums don't bleed when I brush them but my dentist said they bleed when he probes them.

I know that long term use of antibiotics is not recommended. I was just wondering should I ask about it.

When I went to my general dentist for a filling, they gave me the mouthwash that you get by prescription only. I didn't really use it because I heard that it stains teeth really badly. They also gave me an interject thing to put the mouthwash directly in the pocket.

My periodontist tells me one minute everything is fine (in fact he said that for the last 5 years). Then, when I asked him about tissue regeneration he said he couldn't do that on my tooth, but on the next visit he said I needed the $2800.00 worth of surgery.