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Medical Forum / General / Dentistry / December 2008Question about doxycyxline for periodontitis
hi all, I would like to ask my dentist for a prescription, but then I saw this: http://www.drugs.com/mmx/doxycycline-hyclate.html In which it is stated that: ____________________________________________________________________________ Other actions/effects: Although doxycycline is a tetracycline antibiotic, systemic concentrations achieved with this formulation are too low to produce any antibacterial activity {01}{02}. __________________________________________________________________________ So if plaque is caused by bacteria, and most dentists prescribe a very low dose of doxycycline (that is sub- antimicrobial), then how can this eoplow-dose doxycycline be of any use? I know that at 40mg per day, they call it by two other names, and charge a heck of' a lot more for it, and I can't afford those. Do any dentists actually prescribe regular doxycycline that is not geared towards people who can afford to be afraid of super-bugs? If so, how much do they typically prescribe? I can afford those $4 walmart and etc. prescriptions, which are available at 50 mg and 100 mg. Is a dentist likely to work with me on this, or do they j ust stick with the super expensive 40mg doxycycline? I did a google search on "doxycycline dose for perodontitis" and all the results were for sub-anti-microbial only. It just makes no sense to me - plaque is caused by bacteria, oracea and periostat are too low-dose to have any effect on bacteria. hey,what? Your thoughts are appreciated. > hi all, > [quoted text clipped - 40 lines] > > Your thoughts are appreciated. Valid question. The rationale for low-dose doxycycline is NOT based on it's antibacterial action (you're right--this is an insufficient dose for effective antibacterial action), but on this low concentration nevertheless inhibiting the enzyme collagenase, which has a role in the breakdown of periodontal tissue. Nevertheless, most of the periodontists I've spoken to are underwhelmed by the effectiveness of low-dose tetracyclines in periodontal therapy. Most would prefer to use them (if at all) in locally-delivered dosing, such as Atridox, which delivers a high local concentration without a significant systemic dosing. Steve Well, that is trippin'. I did a google search on that. Ok, it also sounds expensive, and can only be applied after one already has an infection, and certainly not to the whole mouth. So if low-dose tetracycline doesn;t really work, why don;t they try higher dose tetracycline, for prevention? Also on that note, if everyone is so afraid of super-bugs, why don;t they take the antibiotics out of the meat supply? I understand I'm far more likely to pick one up from handling raw meat. I don;t see anybody trying to get the anti-biotics out of the meat supply, or warning people not to eat meat because of the bacterial risk. It just seems like there's something missing in the thinking process about this. I read recently that in Europe they did this - they took the anti-biotics out of the meat supply totally, and the incidence of super-bugs went way way down. Ok, so maybe the dentist is not the person to go to for doxycycline. > Well, that is trippin'. I did a google search on that. > [quoted text clipped - 18 lines] > Ok, so maybe the dentist is not the person to go to > for doxycycline. Tetracycline has been used (as well as other antibiotics, such as metronidazole--nasty stuff) mostly short-term. Using for more than a couple of weeks invites superinfection (mostly yeast). Tetracycline is not a first-call antibiotics for most infections (though it has been used extensively for lyme disease), partially because of misuse and overuse. No, you wouldn't use the locally-applied antibiotics all over the mouth. Use is generally selective--many periodontists will use it on periodontal pockets where they are on the fence about doing surgery. In the best case, it will enable enough improvement so that surgery in a given area isn't necessary. Doesn't always work, but selectivity is the key here. Steve On Nov 16, 6:47 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > > Well, that is trippin'. I did a google search on that. > [quoted text clipped - 33 lines] > > Steve I believe locally applied antibiotics are worthless. You want to attack the osteoclasts systemically. Remember osteoclasts destroy the bone by releasing HCl. ONLY osteoclasts destroy bone. Inflammation MAY recruit osteoclasts to the area by mediators. It is ridiculus not to use a cheap, safe medicine to control bone loss. Is good skin as important as good teeth? Dermatologists use it to keep skin healthy. I think good teeth is as important as good skin. Dave On Nov 16, 4:39 pm, oralhea...@comcast.net wrote: > On Nov 16, 6:47 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> > wrote: [quoted text clipped - 42 lines] > Remember osteoclasts destroy the bone by releasing HCl. ONLY > osteoclasts destroy bone. Well I don't know what HCI is, or osteoclasts. > Inflammation MAY recruit osteoclasts to the area by mediators. > > It is ridiculus not to use a cheap, safe medicine to control bone > loss. Is good skin as important as good teeth? Dermatologists use it > to keep skin healthy. I think good teeth is as important as good > skin. That actually makes sense to me. > Well I don't know what HCI is, or osteoclasts. No offense, but that's a good reason that you don't understand periodontal disease either. D > > Well I don't know what HCI is, or osteoclasts. > > No offense, but that's a good reason that you don't understand > periodontal disease either. > > D I am not a dentist. yet it seems to me that most of the answers I have gotten, want to address what to do after the infection happens, not prevent it. But that's typical I guess. > I am not a dentist. yet it seems to me that most of the answers > I have gotten, want to address what to do after the infection happens, > not prevent it. But that's typical I guess. I guess that's because most adults have some damage from gum disease, and we are usually playing 'catch-up' since patients don't listen when they are young. Prevention is pretty simple, but you can't wait until you're 40. Brush, floss, and get your teeth cleaned regularly. Have a healthy diet and basically take good care of yourself. DON'T SMOKE!! That does it for 99% of the population. D >>> Well I don't know what HCI is, or osteoclasts. >> No offense, but that's a good reason that you don't understand [quoted text clipped - 5 lines] > I have gotten, want to address what to do after the infection happens, > not prevent it. But that's typical I guess. You prevent it with excellent oral hygiene and regular exams. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Nov 19, 2:40 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > >>> Well I don't know what HCI is, or osteoclasts. > >> No offense, but that's a good reason that you don't understand [quoted text clipped - 7 lines] > > You prevent it with excellent oral hygiene and regular exams. I'm sorry this is too simplistic. For starters, Children who don't brush their teeth don't get bone loss. Why? Why? WHY? Pregnancy may not prevent gingivitis. Leukemia may not prevent gingivitis. Not brushing will cause contact gingivitis. Hard to distinguish systemic vs contact gingivitis. ...David DiBenedetto, DMD , author. On Nov 19, 5:56 pm, oralhea...@comcast.net wrote: > On Nov 19, 2:40 pm, Mark & Steven Bornfeld > [quoted text clipped - 23 lines] > > ...David DiBenedetto, DMD , author. well...not to upset anybody too much but it looks like I'm going to get doxycycline from Mexico anyway. ha! A friend of mine is going. Shh, I won't tell any doctors. I'm going to take it for other things than preventing gingivitis, anyway. >well...not to upset anybody too much but it looks like I'm going >to get doxycycline from Mexico anyway. ha! A friend of mine >is going. Shh, I won't tell any doctors. > >I'm going to take it for other things than preventing gingivitis, >anyway. BTW that's how bacterial resistance is created. Good luck with your future nocosomial infection. >> well...not to upset anybody too much but it looks like I'm going >> to get doxycycline from Mexico anyway. ha! A friend of mine [quoted text clipped - 6 lines] > > Good luck with your future nocosomial infection. First time I went to Mexico it was suggested I take an antibiotic dose of doxycycline. Within an hour I was sick to my stomach. OP stated he/she was taking it for an unrelated reason--could be legit. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Dec 3, 6:36 am, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > New...@bix.nex wrote: > [quoted text clipped - 8 lines] > > > Good luck with your future nocosomial infection. oh, thank you. > First time I went to Mexico it was suggested I take an antibiotic dose > of doxycycline. Within an hour I was sick to my stomach. > OP stated he/she was taking it for an unrelated reason--could be legit. I think I'm in slightly safer position. My friend has been going to this particular pharmacy for a while, and she has to take many different meds, so she's a serious customer. If you saw how this woman, an upper class native Mexican, treats restaurant personnell, you would quake in your boots to imagine how she would react to a pharmacist who gave her bad drugs! Oh Lordy. I'm serious this woman can out-pesky just about anybody. if I was that pharmacist, I would give her the best quality drugs pronto. And she goes back to them, so they must not be giving her bad drugs. I have been in a restaurant with her, and been frightened myself, ok? >I have been in a restaurant with her, and been frightened myself, ok? And what does that have to do with self medicating, and inappropriate use of antibiotics ? Ever heard of MRSA ? Look it up. On Dec 5, 10:38 am, New...@bix.nex wrote: > On Wed, 3 Dec 2008 09:10:41 -0800 (PST), dumb_fishie99 > [quoted text clipped - 3 lines] > And what does that have to do with self medicating, and inappropriate > use of antibiotics ? I was talking about the quality of the pharmacy. You are still not thinking straight. > Ever heard of MRSA ? Look it up. Yeah, I know what it is. PS: Steve: found out this pharmacy is actually part of a laboratory, the laboroatory being the main part of the business, and they actually sell their drugs wholesale to the US market. So it's kind of like: show me the dead Americans. :) >On Dec 5, 10:38 am, New...@bix.nex wrote: >> On Wed, 3 Dec 2008 09:10:41 -0800 (PST), dumb_fishie99 [quoted text clipped - 6 lines] > >I was talking about the quality of the pharmacy. I wasn't. PS: or do I Just have to go to the dentist exactly every three months to make sure? I jsut read an old post on here that said somethign to that effect. Only getting a cleaning every three months has any effect. I can do this only if I can manage to go to the inexpensive dentist, and if the anti-gagging tricks I just learned actually work. I hope they do. I alreayd got kicked out of two dentist offices because of it. I will see how it goes. > PS: or do I Just have to go to the dentist exactly every three months > to [quoted text clipped - 10 lines] > I alreayd got kicked out of two dentist offices because of it. > I will see how it goes. Most periodontists see their patients 3 or 4 times a year, but of course needed frequency should be determined on an individual basis. There are ways of dealing with gagging--topical anesthetics. My brother is experimenting with hypnosis, has been doing extensive reading and course work. I've heard it can be effective for this application for many patients. Steve On Nov 16, 9:23 am, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > > hi all, > [quoted text clipped - 51 lines] > such as Atridox, which delivers a high local concentration without a > significant systemic dosing. Hm, further question: Since perodontitis is caused by bacteria, not by collegenase, Then why not attack the problem, as though dealing with bacteria? I looked it up on wikipedia: http://en.wikipedia.org/wiki/Periodontitis So I found this mention of collagenase: >Deep pockets between the teeth and the gums (pockets are sites >where the attachment has been gradually destroyed by collagen-destroying >enzymes, known as collagenases) You know what, it sounds to me like this idea of using sub- antimicrobial dose levels of doxycycline, is meant for AFTER you already got a big problem! What about BEFORE you already got a big problem??? Could a stronger dose of doxycycline help prevent the big problem, along with all the usual preventions? > On Nov 16, 9:23 am, Steven Bornfeld <dentaltwinm...@earthlink.net> > wrote: [quoted text clipped - 79 lines] > usual > preventions? You should review (1) periodontosis definition in the the free dictionary by farlex, "a degenerative, noninflammatory condition of the periodontium, characterized by destruction of tissue." This very, very destructive NONINFLAMMATORY condition is treated with tetracycline. Why? It helps to prevent osteoclasts from destroying bone. You might also want to review (2) the definition of pneumonia in wikipedia, and see how it could resemble periodontal disease. One of the causes of pneumonia is idiopathic. And, How is pneumonia treated? With drugs. Unfortunately, wikipedia definition of periodontal disease is very simplistic and that is why I wrote my book. You should also review (3) Koch's postulates. Periodontal disease does not follow Koch's postulates. And then you have to ask why? David DiBenedetto, DMD > On Nov 16, 9:23 am, Steven Bornfeld <dentaltwinm...@earthlink.net> > wrote: [quoted text clipped - 66 lines] > usual > preventions? My periodontists as a group take a fairly dim view of low-dose tetracycline therapy. The amount of improvement cited was not exciting. Yes, bacterial control is the key. But in the absence of ideal oral hygiene, and esp. in the presence of periodontal pockets that are ideal breeding grounds for anaerobic and facultative organisms implicated in periodontal disease, you'd have to be on antibiotics long-term. This is not practical. Makes much more sense to practice excellent oral hygiene. If periodontal pockets are present, pocket elimination therapy will be necessary to make adequate oral hygiene possible. This is an old paradigm; it is very attractive to think there is a magic pill to prevent periodontal disease. I haven't seen one. Steve I prescribe tetracycline and doxycycline routinely to my patients. Many physicians prescribe it for skin problems, arthritis, eye problems. No one has ever died from tetracycline allergy. It is a very safe drug compared to penicillin or aspirin. Look at the number of people who die from aspirin each year. I believe that periodontal disease is caused by the human body. There is a decoupling of osteoblasts and osteoclasts working together that causes bone loss. Some people want to call this the immune response. Tetracyclines inhibit the osteoclasts. Osteoclasts are responsible for bone breakdown Tetracyclines are safe and they prevent bone loss. WHAT IS THE ROLE OF PLAQUE IN PERIODONTAL DESTRUCTION---i.e. BONE LOSS? I am not sure that plaque causes much periodontal disease. This is a powerful statement. Why? (1) Periodontal disease does not follow Koch's postulates and Koch's postulates are the foundation for bacteriology. (2) Periodontal disease is not found in children. Bacteria diseases are indiscriminant with regard to age. (3) In diseases that make you more prone to bacterial infections, e.g.,Sickle cell anemia, periodontal disease is not more common. (4) The teeth that contain the most plaque, the lower anterior teeth, are the last teeth to be lost in the mouth. If they contain the most plaque they should be lost first. (5) Straight teeth would contain less plaque because they are easier to clean. No difference is seen in longevity. (6) Rapid bone loss in young adults is associated with little inflammation and little plaque. (7) Tooth Decay does follows Koch's postulates and is found in children. Are we wrongly associating plaque with periodontal disease because of what we know about tooth decay. Is it guilt by association? (8) Inflammation vs infection. We wrongly confuse infection with inflammation. David DiBenedetto, DMD, author of "Insider's guide to gum disease, orthodontics and dentistry. What is not taught in dental school." You are beneath contempt DiBenedetto. Your "beliefs" are contrary to all available scientific evidence. Truly feel remorse for the patients that allow you to mis-treat them. If there ever was a case for dental malpractice, you are the poster-boy. >No one has ever died from tetracycline allergy. Bet you can't prove that, somewhere someone did. This is a foolish statement that you cannot back up. >I believe that periodontal disease is caused by the human body. Your "beliefs" do not matter one Iota. Scientific evidence says otherwise. What an idiot ! <PLONK> > I prescribe tetracycline and doxycycline routinely to my patients. > Many physicians prescribe it for skin problems, arthritis, eye > problems. No one has ever died from tetracycline allergy. It is a > very safe drug compared to penicillin or aspirin. Look at the number > of people who die from aspirin each year. http://www.ncbi.nlm.nih.gov/pubmed/848727 Steve > I believe that periodontal disease is caused by the human body. There > is a decoupling of osteoblasts and osteoclasts working together that [quoted text clipped - 39 lines] > David DiBenedetto, DMD, author of "Insider's guide to gum disease, > orthodontics and dentistry. What is not taught in dental school." On Nov 16, 6:51 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > oralhea...@comcast.net wrote: > > I prescribe tetracycline and doxycycline routinely to my patients. [quoted text clipped - 6 lines] > > Steve That occurred in 1977 in India. I think it was an injection. Not oral administration. Was the tetracycline contaminated? Dave |
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