Teeth, Trends in dentistry

Trends in dentistry - Periostat.

Author	Message
Joel M. Eich #1 / 6	Trends in dentistry - Periostat. Trends in Dentistry Just got this in today. Periodontal and preventive care. Treatment phases: Antimicrobial therapy. 59% of the reporting doctors use it! "Periostat is exciting," Dr. Gutter said. My question is, exciting for whom? Dear Dr. Gutter. Just how thick is a dime anyway? Cheers, Joel Joel M. Eichen, D.D.S. ** Hello Zugumba and others: Periostat I have previously obtained abstracts including graphs and charts detailing the effectiveness of Periostat. The reason why I did this is that their 4-page full color ad in practically every dental journal is slightly misleading. I spent too many years poring over biochemistry research publications to mess up now! When patients ask about efficacy, I like to be able to speak definitely. Periostat (CollaGenex Pharmaceuticals, Inc., Newtown, PA) claims that, 67% reduction in pocket depth seen within 3 months in patients with severe disease (>=7mm) vs. SRP alone. 52% gain in clinical attachment level seen within 3 months in patients with severe disease (>=7mm) vs. SRP alone. Now this is certainly true, however, I had to read and reread this only to find out that I still did not know how effective Periostat really is. What sorts of absolute pocket depth reduction could my patients hope to obtain? This really is the key, isn't it? Look at the numbers, not the percentages! Abstract # 2957 Adjunctive Use of Subantimicrobial Doxycycline Therapy for Periodontitis - J Canton, S Ciancio, R Crout, A Hefti, and A Polson. J Dental Res 1997;76 (abstr 1307). (Multi-institutional study) As example, in this study of 190 patients (94 and 96 patients in respective treatment groups), 9 months out, SRP + placebo (scaling, root planing plus placebo) the mean change in clinical attachment level in tooth sites with severe disease was 1.17 mm while the mean change of SRP + SDD (scaling and root planing plus subantimicrobial dose of doxycyline) was 1.55 mm. I believe this means that SRP plus SDD is 0.38 mm more effective than SRP without SDD. Mean change in pocket depth in tooth sites with severe disease was 1.20 mm (SRP + placebo) versus 1.68 mm (SRP + SDD) which represents 0.48 mm. Recall that in both cases this improvement is around one half the thickness of a dime! This is not a lot to write home about is it? In fact, I do not know how to measure this. What if I press too {filter}e time and not another time? Half the thickness of a dime. Sheesh. The figures for mild-to-moderate disease were somewhat less than those for severe disease. If anyone is interested, I'll post jpgs of the charts at sci.med.dentistry. Cheers, Joel Joel M. Eichen, D.D.S. Where does the 67% improvement (pocket reduction) come from? 67% reduction in pocket depth seen within 3 months in patients with severe disease (>=7mm) vs. SRP alone. ===================================================== In this study SRP + placebo (3 months out) represents pocket reduction of 0.91 mm. SRP + SDD (3 months out) represents 1.38 mm. This is a difference of 0.47 mm which is around half the thickness of a dime. 0.91 mm divided by 1.38 mm equals 67% improvement! Hah! I'm still looking for the magic bullet! -------------------------------------- [background post: Shellah 2/5/99] In reply to Shellah's question. PREVIOUSLY- I just got some prices from my dentist on these. The Perio Chip was $150 per tooth and Antridox treatment was $250 per tooth. Is there any difference is the results of these two methods? Why would one cost that much more? Have these been written up in any dental journal I might read? Can anyone tell me which. Would like to see if I can access it online or the library. I really would like to get some statistics on these treatments as compared to surgery. Are they available from the manufacturers and are they unbiased? As a lay person I'm trying to get some info on these, aside from what a surgery-happy perio (periodontist) is giving me. Thanks! =================================== Reply: Warning: These are prescription medications and should not be administered where contraindicated. Read package insert or literature! ----------------------------------- Atridox --doxycycline hyclate 10.0% Antimicrobial gel. Flows where chips and fibers won't go. In several well-controlled, multicenter studies, (1) {filter}Hygiene and (2) Placebo reduced pocket depth in the first month (0.4 mm reduction). (3) SRP and (4) Atridox reduced pocket depth 0.6 to 0.7 mm in the first month. Atridox did slightly better in subsequent months. (0.4 to 0.6 mm additional pocket reduction). Its placed with a blunt needle. ----------------------- Periostat is doxycycline hyclate capsules - 20 mg. Dosage: 20 mg twice a day for up to 9 months. ---------------------- Perio Chip is chlorhexidine gluconate in a gelatin chip. This of course is the same active ingredient as Hibiclens, antiseptic, antimicrobial skin cleanser. If this therapy becomes popular, competition will drive down the cost of the chip itself. ----------------------
Mon, 24 Dec 2001 03:00:00 GMT

Eric #2 / 6	Trends in dentistry - Periostat. Good for you Joel I'm tired of reading of these magic bullets which will eradicate periondontal disease. ie. Periochip with a possible .4 mm. of attachment gain. Emdogain with a possible 1mm. bone regeneration. Periostat with a long term intake of an antibiotic. What kind of superbugs with increased resistance to doxycycline will be produced? The multitude of guided tissue regeneration products with dubious long term substantive results. The next time a detail man comes to your door proclaiming the wonders of some product ask him this question. Can you assure me that I can use this product on a tooth with a 7 mm. intraboney defect and guarantee success so that the tooth can serve as an abutment for a 3 unit bridge. Watch the guy backpedal from his glowing descriptions of the product. Until. we can produce results as good as endodontists, periodontics has a long way to go. Richard Migicovsky Quote: > Trends in Dentistry > Just got this in today. Periodontal and preventive care. > Treatment phases: Antimicrobial therapy. 59% of the reporting > doctors use it! > "Periostat is exciting," Dr. Gutter said. > My question is, exciting for whom? > Dear Dr. Gutter. Just how thick is a dime anyway? > Cheers, > Joel > Joel M. Eichen, D.D.S. > ** > Hello Zugumba and others: > Periostat > I have previously obtained abstracts including graphs and > charts detailing the effectiveness of Periostat. The reason > why I did this is that their 4-page full color ad in > practically every dental journal is slightly misleading. > I spent too many years poring over biochemistry research > publications to mess up now! When patients ask about > efficacy, I like to be able to speak definitely. > Periostat (CollaGenex Pharmaceuticals, Inc., Newtown, PA) > claims that, > 67% reduction in pocket depth seen within 3 months in > patients with severe disease (>=7mm) vs. SRP alone. > 52% gain in clinical attachment level seen within 3 months > in patients with severe disease (>=7mm) vs. SRP alone. > Now this is certainly true, however, I had to read and > reread this only to find out that I still did not know how > effective Periostat really is. What sorts of absolute pocket > depth reduction could my patients hope to obtain? This really > is the key, isn't it? Look at the numbers, not the > percentages! > Abstract # 2957 > Adjunctive Use of Subantimicrobial Doxycycline Therapy for > Periodontitis - J Canton, S Ciancio, R Crout, A Hefti, and A > Polson. J Dental Res 1997;76 (abstr 1307). > (Multi-institutional study) > As example, in this study of 190 patients (94 and 96 patients > in respective treatment groups), 9 months out, SRP + placebo > (scaling, root planing plus placebo) the mean change in > clinical attachment level in tooth sites with severe disease > was 1.17 mm while the mean change of SRP + SDD (scaling and > root planing plus subantimicrobial dose of doxycyline) was > 1.55 mm. I believe this means that SRP plus SDD is 0.38 mm > more effective than SRP without SDD. > Mean change in pocket depth in tooth sites with severe > disease was 1.20 mm (SRP + placebo) versus 1.68 mm (SRP + > SDD) which represents 0.48 mm. > Recall that in both cases this improvement is around one half > the thickness of a dime! This is not a lot to write home > about is it? In fact, I do not know how to measure this. > What if I press too {filter}e time and not another time? Half > the thickness of a dime. Sheesh. > The figures for mild-to-moderate disease were somewhat less > than those for severe disease. If anyone is interested, I'll > post jpgs of the charts at sci.med.dentistry. > Cheers, > Joel > Joel M. Eichen, D.D.S. > Where does the 67% improvement (pocket reduction) come from? > 67% reduction in pocket depth seen within 3 months in > patients with severe disease (>=7mm) vs. SRP alone. > ===================================================== > In this study SRP + placebo (3 months out) represents pocket > reduction of 0.91 mm. SRP + SDD (3 months out) represents > 1.38 mm. This is a difference of 0.47 mm which is around half > the thickness of a dime. 0.91 mm divided by 1.38 mm equals > 67% improvement! Hah! > I'm still looking for the magic bullet! > -------------------------------------- > [background post: Shellah 2/5/99] > In reply to Shellah's question. > PREVIOUSLY- > I just got some prices from my dentist on these. The > Perio Chip was $150 per tooth and Antridox treatment > was $250 per tooth. Is there any difference is the > results of these two methods? Why would one cost that > much more? Have these been written up in any dental > journal I might read? Can anyone tell me which. Would > like to see if I can access it online or the library. I > really would like to get some statistics on these > treatments as compared to surgery. Are they available > from the manufacturers and are they unbiased? > As a lay person I'm trying to get some info on these, > aside from what a surgery-happy perio (periodontist) is > giving me. > Thanks! > =================================== > Reply: > Warning: These are prescription medications and should > not be administered where contraindicated. Read package > insert or literature! > ----------------------------------- > Atridox --doxycycline hyclate 10.0% > Antimicrobial gel. Flows where chips and fibers won't > go. > In several well-controlled, multicenter studies, (1) > {filter}Hygiene and (2) Placebo reduced pocket depth in > the first month (0.4 mm reduction). (3) SRP and (4) > Atridox reduced pocket depth 0.6 to 0.7 mm in the first > month. Atridox did slightly better in subsequent > months. (0.4 to 0.6 mm additional pocket reduction). > Its placed with a blunt needle. > ----------------------- > Periostat is doxycycline hyclate capsules - 20 mg. > Dosage: 20 mg twice a day for up to 9 months. > ---------------------- > Perio Chip is chlorhexidine gluconate in a gelatin > chip. > This of course is the same active ingredient as > Hibiclens, antiseptic, antimicrobial skin cleanser. > If this therapy becomes popular, competition will drive > down the cost of the chip itself. > ----------------------
Thu, 27 Dec 2001 03:00:00 GMT

Jame #3 / 6	Trends in dentistry - Periostat. These products don't claim to eradicate periodontal disease nor do they claim to be GTR products either, if I am correct. Quote: >Good for you Joel >I'm tired of reading of these magic bullets which will eradicate >periondontal disease. >ie. >Periochip with a possible .4 mm. of attachment gain. >Emdogain with a possible 1mm. bone regeneration. >Periostat with a long term intake of an antibiotic. What kind of >superbugs with increased resistance to doxycycline will be produced? >The multitude of guided tissue regeneration products with dubious long >term substantive results. >The next time a detail man comes to your door proclaiming the wonders >of some product ask him this question. Can you assure me that I can >use this product on a tooth with a 7 mm. intraboney defect and guarantee >success so that the tooth can serve as an abutment for a 3 unit bridge. >Watch the guy backpedal from his glowing descriptions of the product. >Until. we can produce results as good as endodontists, periodontics >has a long way to go. >Richard Migicovsky >> Trends in Dentistry >> Just got this in today. Periodontal and preventive care. >> Treatment phases: Antimicrobial therapy. 59% of the reporting >> doctors use it! >> "Periostat is exciting," Dr. Gutter said. >> My question is, exciting for whom? >> Dear Dr. Gutter. Just how thick is a dime anyway? >> Cheers, >> Joel >> Joel M. Eichen, D.D.S. >> ** >> Hello Zugumba and others: >> Periostat >> I have previously obtained abstracts including graphs and >> charts detailing the effectiveness of Periostat. The reason >> why I did this is that their 4-page full color ad in >> practically every dental journal is slightly misleading. >> I spent too many years poring over biochemistry research >> publications to mess up now! When patients ask about >> efficacy, I like to be able to speak definitely. >> Periostat (CollaGenex Pharmaceuticals, Inc., Newtown, PA) >> claims that, >> 67% reduction in pocket depth seen within 3 months in >> patients with severe disease (>=7mm) vs. SRP alone. >> 52% gain in clinical attachment level seen within 3 months >> in patients with severe disease (>=7mm) vs. SRP alone. >> Now this is certainly true, however, I had to read and >> reread this only to find out that I still did not know how >> effective Periostat really is. What sorts of absolute pocket >> depth reduction could my patients hope to obtain? This really >> is the key, isn't it? Look at the numbers, not the >> percentages! >> Abstract # 2957 >> Adjunctive Use of Subantimicrobial Doxycycline Therapy for >> Periodontitis - J Canton, S Ciancio, R Crout, A Hefti, and A >> Polson. J Dental Res 1997;76 (abstr 1307). >> (Multi-institutional study) >> As example, in this study of 190 patients (94 and 96 patients >> in respective treatment groups), 9 months out, SRP + placebo >> (scaling, root planing plus placebo) the mean change in >> clinical attachment level in tooth sites with severe disease >> was 1.17 mm while the mean change of SRP + SDD (scaling and >> root planing plus subantimicrobial dose of doxycyline) was >> 1.55 mm. I believe this means that SRP plus SDD is 0.38 mm >> more effective than SRP without SDD. >> Mean change in pocket depth in tooth sites with severe >> disease was 1.20 mm (SRP + placebo) versus 1.68 mm (SRP + >> SDD) which represents 0.48 mm. >> Recall that in both cases this improvement is around one half >> the thickness of a dime! This is not a lot to write home >> about is it? In fact, I do not know how to measure this. >> What if I press too {filter}e time and not another time? Half >> the thickness of a dime. Sheesh. >> The figures for mild-to-moderate disease were somewhat less >> than those for severe disease. If anyone is interested, I'll >> post jpgs of the charts at sci.med.dentistry. >> Cheers, >> Joel >> Joel M. Eichen, D.D.S. >> Where does the 67% improvement (pocket reduction) come from? >> 67% reduction in pocket depth seen within 3 months in >> patients with severe disease (>=7mm) vs. SRP alone. >> ===================================================== >> In this study SRP + placebo (3 months out) represents pocket >> reduction of 0.91 mm. SRP + SDD (3 months out) represents >> 1.38 mm. This is a difference of 0.47 mm which is around half >> the thickness of a dime. 0.91 mm divided by 1.38 mm equals >> 67% improvement! Hah! >> I'm still looking for the magic bullet! >> -------------------------------------- >> [background post: Shellah 2/5/99] >> In reply to Shellah's question. >> PREVIOUSLY- >> I just got some prices from my dentist on these. The >> Perio Chip was $150 per tooth and Antridox treatment >> was $250 per tooth. Is there any difference is the >> results of these two methods? Why would one cost that >> much more? Have these been written up in any dental >> journal I might read? Can anyone tell me which. Would >> like to see if I can access it online or the library. I >> really would like to get some statistics on these >> treatments as compared to surgery. Are they available >> from the manufacturers and are they unbiased? >> As a lay person I'm trying to get some info on these, >> aside from what a surgery-happy perio (periodontist) is >> giving me. >> Thanks! >> =================================== >> Reply: >> Warning: These are prescription medications and should >> not be administered where contraindicated. Read package >> insert or literature! >> ----------------------------------- >> Atridox --doxycycline hyclate 10.0% >> Antimicrobial gel. Flows where chips and fibers won't >> go. >> In several well-controlled, multicenter studies, (1) >> {filter}Hygiene and (2) Placebo reduced pocket depth in >> the first month (0.4 mm reduction). (3) SRP and (4) >> Atridox reduced pocket depth 0.6 to 0.7 mm in the first >> month. Atridox did slightly better in subsequent >> months. (0.4 to 0.6 mm additional pocket reduction). >> Its placed with a blunt needle. >> ----------------------- >> Periostat is doxycycline hyclate capsules - 20 mg. >> Dosage: 20 mg twice a day for up to 9 months. >> ---------------------- >> Perio Chip is chlorhexidine gluconate in a gelatin >> chip. >> This of course is the same active ingredient as >> Hibiclens, antiseptic, antimicrobial skin cleanser. >> If this therapy becomes popular, competition will drive >> down the cost of the chip itself. >> ----------------------
Fri, 28 Dec 2001 03:00:00 GMT

le huar #4 / 6	Trends in dentistry - Periostat. Ouch!!! I think we do damn well with surgery. Sure you can obturate almost any c{filter}but many times the endo is successful and the tooth fails. So there!!! Stick that in your warm gutta percha.
Fri, 28 Dec 2001 03:00:00 GMT

le huar #5 / 6	Trends in dentistry - Periostat. No they don't. What they prey on, however, are peoples' (including dentists') need to have a panacea for avoiding surgery.
Fri, 28 Dec 2001 03:00:00 GMT

Zugumb #6 / 6	Trends in dentistry - Periostat. Quote: >Periostat with a long term intake of an antibiotic. What kind of >superbugs with increased resistance to doxycycline will be produced? Periostat is doxycycline, but it is not given in a dosage sufficient to be an antibiotic. No superresistant bugs form. Also, it's not a magic bullet, it's adjunctive therapy. And, if you read else where in this forum, a small mean increase in a research can actually mean it is having a profound effect. I'll explain again if you didn't see it.
Fri, 28 Dec 2001 03:00:00 GMT

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