PERIOSTAT is a form of doxycycline hyclate (synthetic tetracycline). It is dispensed in 20mg capsules and the manufacturer, COLLAGENEX, suggests that it be given twice daily. The actual period of administration has not yet been defined.

The fundamental rationale for the use of PERIOSTAT involves the unique property of the tetracycline-like drugs to inhibit the production of an enzyme called collagenase. This enzyme is responsible for the de/~radation of collagen, the primary component of gum tissue. A secondary value of tetracycline-like drugs is that they are released into the gum spaces around the teeth (periodontal pockets) in concentrations five times greater than that found in the blood. This serves to deliver very high concentrations of the drug into the sites where periodontal tissue destruction occurs.

Like all pharmacologic agents, the tetracyclines do have a number of side effects which one should consider prior to prescribing. Gastrointestinal disturbances, sensitivity to sunlight, kidney and liver problems, pigmentation of the skin and oral tissues and permanent discoloration of the developing teeth (in children) have been reported. Interference with the effectiveness of oral contraceptives, yeast infections and dermatitis have also been observed. Because the therapeutic dosage of PERIOSTAT is low, it is expected that many of the side effects typically seen in higher doses will not occur.

Having now given the important facts regarding PERIOSTAT, where does this new drug fit into the scheme of periodontal therapy? Firstly, it is not appropriate to place every patient who domonstrates some periodontal break-down on PERIOSTAT. Studies on the occurrence of periodontal disease have shown that 85% of the population can be effectively stabilized with conventional periodontal care. Scaling and root planing, regular professional cleaning, and adequate daily oral hy. giene measures will enable most patients to keep their dentitions intact. Surgical procedures to correct abnormal bone architecture, or to reduce deep pocket demensions may also be required for some patients. For 15% of the population, however, conventional periodontal therapies will not be totally successful. Unresponsiveness to the usual care strategies may be due to any number of things. Poor patient compliance, poor dental environment ( rough fillings, tight spaces between crowns, etc.) or an abnormal immune response to the presence of certain bacteria are the most likely reasons given for intractable periodontal disease. It is for this population of patients that this new drug therapy appears well suited.

Always check with your doctor for further information.


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