Periostat helps to reduce the over-production of collagenase (enzymes responsible for the destructIon of collagen) and osteoclasts (bone cell responsible for the resorption of bone) that are present in overabundance during a chronic, prolonged and destructive inflammatory response. This exaggerated inflammatory response is common among chronic inflammatory diseases such as periodontitis, cardiovascular disease and rheumatoid arthritis. Therefore, Periostat, when used (BID) for 6 to 9 months, helps to modulate the chronic, prolonged and destructive inflammatory response into a normal and healthy inflammatory response process.
Collagenase inhibitor for periodontal use.
Ideal for these situations :
• Cardiovascular disease14-17
• Diabetes22, 23
• Genotype-positive 25
• Post-menopausal osteoporosis18, 21 24
• Rheumatoid arthritis13
• Severe and rapidly progressing periodontitis cases1-12, 19
Doxycycline Hyclate (20mg)
Twice daily, 1 hour prior to morning and evening meals
Take the capsule with a full glass of water.
Periostat is well tolerated with side effects similar to placebo groups.1-6
Periostat does not cause sun sensitivity, nausea or antibiotic resistance.
• Absorption of doxycycline is impaired by antacids containing aluminum, calcium, or magnesium, and iron-containing preparations.
• Absorption is also impaired by bismuth subsalicylate.
• Barbiturates, carbamazepine and phenytoin decrease the half-life of doxycycline.
• Pregnant or nursing women, children, tetracycline intolerant individuals or liver disease sufferers should not take Periostat.
Consult the product monograph for important information relating to adverse reactions, drug interactions and dosing information which have not been discussed in this piece.
JADA 146(7) http://jada.ada.org July 2015 p. 525-535
A panel of experts convened by the American Dental Association Council on Scientific Affairs presented an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis.*
The Council voted only in favor of two clinical recommendations as nonsurgical treatments for chronic periodontitis:
• Scaling and root planing without adjunct (SRP)
• SRP + subantimicrobial-dose doxycycline (Periostat)
Adding subantimicrobial-dose doxycycline to SRP increases clinical attachment gain by 71 %
• Significantly more effective than SRP + Placebo & NO antibiotic side-effects.1,2,4,10
• 75% fewer teeth lost than patients treated with SRP + Placebo.5
• 90% reduction of “active” pockets (those that get deeper with time).3,5,7,8,9,11,12
• No “rebound” effect.1,6
• 50 to 60% reduction of biologic mediators of tissue breakdown and bone resorption (ie. MMP-8/ collagenase, MMP-9 & IL-1β).1,19
• In quickly progressing periodontitis, adjunctive SDD (versus adjunctive placebo) produced a 73% reduction in “active” pockets, a 2 to 3 times greater mean attachment gain (ie. 2.2 mm vs 0.8 mm) & significant reduction of BOP.2,8
• Rheumatoid arthritis patients (RA) treated with “standard-of-care”, methotrexate, show 3 times greater reduction of RA severity when also treated with SDD for 2 years & NO side-effects due to SDD13
• Improvement in periodontal disease with SDD.14,15,16,17
• Improvement in diagnostic risk-factors for cardiovascular disease (CVD); reduction of blood levels of C-reactive protein, IL-6 & MMP-9 & increase in good cholesterol (HDL)) with SDD.14
• SDD + Periodontal maintenance therapy for 2 years shown reduction of periodontal disease severity assessed clinically, radiologically, and biochemically.18,19,20,21
• SDD for 2 years reduced diagnostic biomarkers of skeletal bone resorption with no effect on biomarkers of bone formation (blood biomarkers) & a reduced risk for osteoporosis.24
• Improvement in periodontal disease with SDD + SRP.
• Reduction in blood levels of Hemoglobin A1C to a near-normal level with SDD + SRP + NO side-effects.22,23
• 50-61% decrease in the IL-1B and MMP-9 was noted after 2 and 4 months compared with SRP + Placebo.25
" Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions. "
I just had a patient return after 2 months of Periostat. He's very compliant with recommendations and has localized severe chronic perio on the max molars. Today, I found that both sites had a significant decrease in bleeding on probing. And the deepest site, a 9mm, decreased to 6mm! I was so excited as I had no expectation of so great a result in an area of severe bone loss! It was terrific!
- Martha, a Registered Dental Hygienist