The following was published in the Washington Post and addresses "The Pill" and the Gel injection:
New Drug Treatments Target Gum Disease
FDA Approves Antibiotics as Supplement to Basic Dental Hygiene
By Don Colburn
Washington Post Staff Writer
Tuesday, September 22, 1998; Page Z07
With a flurry of new highly touted treatments available for gum disease,
dentists say the best advice for periodontally challenged baby boomers
remains as mundane as ever:
Brush and floss. Regular checkups. Floss and brush.
Periodontal disease, the leading cause of tooth loss in Americans, is an
infection caused by several kinds of bacteria that thrive in the mouth.
The standard treatment, besides brush-and-floss hygiene, is a technique
called scaling and root planing, in which the dentist uses a metal tool
to scrape away the sticky film of bacteria that accumulates on teeth
above and below the gumline. The procedure is done about 15 million
times a year in the United States.
But several new products that may help thwart gum disease by delivering
an antibiotic directly to the infected area have reached the market
recently.
"We don't have a vaccine, a shot or a pill that cures periodontal
disease," said Timothy Rose, a dentist in Appleton, Wis., and
president-elect of the American Dental Association. "So we're not
talking about cure. We're talking control."
The first stage of periodontal disease is gingivitis, or inflammation of
the gums. Left untreated, gingivitis can cause gums to pull away from
the teeth, leaving a pocket that traps more bacteria beyond the reach of
a toothbrush. Eventually, the infection can weaken and erode the bone
and roots that hold teeth in place.
Even people who have never had a cavity filled can lose all their teeth
if periodontal disease weakens the gums and bone.
"If you lose the bone, you can't keep your teeth," said Donald Allen,
chairman of the department of periodontics at Howard University College
of Dentistry.
The latest of the new products aimed at preventing gum disease is a
"drug-delivery system" called Atridox, a fluid that solidifies in the
infected pocket and releases a concentrated week-long dose of
antibiotics before being absorbed by the body.
The Food and Drug Administration approved Atridox this month on the
basis of clinical tests showing that it had a comparable effect to
scaling and root planing against periodontal disease. Another recently
approved product, Periochip, is a tiny, absorbable celluloid chip
saturated with antibiotic that is inserted between the gum and tooth.
Others are under consideration by the FDA.
Such new approaches are no panacea, but they may help some patients
control periodontal infection, dentists said.
"It's very important for the public to realize that these products are
not a cure for periodontal disease," agreed Howard's Allen. While they
add to dentistry's arsenal of weapons for treating gum disease and
halting its progression toward the tooth-loss stage, the primary
responsibility for preventing tooth loss remains with patients, he said.
Just as people control hypertension, or high blood pressure, by taking
daily medication, Allen said, they can keep periodontal disease in check
by brushing and flossing their teeth every day and having routine dental
cleanings.
"People are looking for a cure, but periodontal disease is caused by
germs and bacteria in the mouth," he said. "They're there all the time.
Within hours of brushing your teeth, the plaque starts accumulating
again. It's an ongoing process, 24 hours a day."
Rose, a former president of the American Academy of Periodontology,
called Atridox a supplement to standard periodontal treatment. "Will it
replace scaling and root planing? No," he said.
"The goal is to cleanse the pocket and reduce the load of bacteria or
dental plaque," said David Alexander, director of professional affairs
for Block Drug Corp., which markets Atridox. "You're using a tiny dose
of antibiotic, but you're delivering it just where you want it."
By targeting the time-release antibiotic to the infected gum pocket,
dentists boost the dose while avoiding the possible side effects --
including gastrointestinal upset -- of antibiotics taken by mouth.
Atridox is squirted into the pocket through a blunt syringe.
In two clinical trials, involving 831 patients at 19 dental centers
nationwide for nine months, Atridox was tested against scaling and root
planing and routine dental care. Both approaches achieved comparable
results in reducing periodontal disease, the studies found. Based on
those studies and other data, the FDA approved Atridox for marketing to
dentists Sept. 4.
Atridox gives dentists another tool against periodontal disease in
patients for whom scaling and root planing is not fully effective or
needs a booster or maintenance dose, said Norman Stoller, professor of
periodontics at the University of Colorado School of Dentistry in Denver
and a lead researcher in the Atridox studies.
"What we've been incapable of doing is wiping out the bacteria," Stoller
said. "It's nearly impossible."
More than half of American adults will have some form of periodontal
disease during their lifetime, according to the American Academy of
Periodontology. When gums get infected, they lose their resiliency, pull
away from teeth and bleed easily -- a warning that dentists say should
not be ignored.
"If you brush your teeth and your gums bleed, you've got some
[periodontal disease] going on," Rose said. "It's not normal. You
shouldn't run around with any infection in your body, whether it's
isolated in your little toe or your lower left first molar."
If the 88 million middle-aged American baby boomers heed that warning,
they could become a unique phenomenon in American public health history,
Rose said.
"We've never had a population over 65 whose vast majority still had
their teeth."
GUM DISEASE AT A GLANCE
Periodontal ("around the tooth") disease is an infection that inflames
and wears away tissues holding the teeth in place, including the gums,
bone and surface of the tooth root. The earliest and most common form is
gingivitis, or inflammation of the gums.
Unchecked, periodontal disease can lead to loss of teeth.
SYMPTOMS: Gums become deep red and swollen and bleed easily.
CAUSE: Plaque, a sticky film of bacteria that accumulates on teeth and
gums.
OTHER FACTORS: Smoking, poor nutrition, puberty, pregnancy and some
medications -- including calcium channel blockers -- can worsen gum
disease. People over 35 and those with diabetes, leukemia or AIDS also
are more likely to have it.
TREATMENT: Dentists use a metal instrument to scrape away plaque and
tartar from the teeth (a process called scaling and root planing) and
treat infected areas with targeted antibiotics. In severe cases, surgery
is needed to reduce the gap between gums and teeth or rebuild decayed
bone.
PREVENTION: Daily brushing and flossing; regular dental checkups.
© Copyright 1998 The Washington Post Company
