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.