Atorvastatin Fo

Atorvastatin: a new treatment for periodontal disease?

Oct. 19, 2012
Maria Perno Goldie, RDH, MS, reports on the results of studies that explore the effectiveness of using atorvastatin for the treatment of periodontal disease.
Periodontal disease is a bacterial infection, and tissue destruction occurs as a consequence of the host immune inflammatory response to oral pathogens. Periodontal pathogens produce harmful by-products and enzymes that break down extracellular matrices, such as collagen, as well as host cell membranes and lead to bone resorption creating bony defects that may cause tooth loss.(1) Current techniques to treat bone defects associated with periodontitis or dental implants consist of surgically placing bone particles or substitutes into the defects to stimulate host bone formation.(2) It has also been suggested that statin use has been associated with decreased tooth loss in chronic periodontitis patients.(3) Atorvastatin (ATV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Atorvastatin is marketed by Pfizer as a calcium salt under the trade name Lipitor, and is a member of the drug class known as statins, used for lowering blood cholesterol.(4) It also stabilizes plaque and prevents strokes through anti-inflammatory and other mechanisms. Like all statins, atorvastatin works by inhibiting HMG-CoA reductase, an enzyme found in liver tissue that plays a key role in production of cholesterol in the body.
Recently, statins have shown pleiotropic effects like antiinflammation and bone stimulation. Pleiotropy occurs when one gene influences multiple phenotypic traits.(5) The aim of a recent study was to investigate the effectiveness of 1.2 % ATV, as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects.(6) The study involved 60 individuals who were randomized and categorized into two treatment groups: SRP plus 1.2% ATV and SRP plus placebo gel. Clinical parameters were recorded at baseline and at 3, 6 and 9 months. They included: modified sulcus bleeding index (mSBI); probing depth (PD); clinical attachment level (CAL) at baseline, after 6 months and 9 months; and radiologic assessment of intrabony defect (IBD) fill was done using computer-aided software at baseline, 6 and 9 months.

The results showed that mean probing depth reduction and mean clinical attachment level gain was found to greater in ATV group than placebo group, at 3, 6 and 9 months. As well, significantly greater mean percentage of radiographic bone fill was found in the ATV group (35.49±5.50%) compared to placebo group (1.82±1.32%) after 9 months. The authors concluded that ATV can provide a new direction in the management of intrabony defects as an adjunct to SRP.

The use of inexpensive pharmacologic compounds to stimulate the host to produce autogenous bone growth factors such as bone morphogenetic protein (BMP)-2 could be a cost-effective alternative in the management of osseous defects. Topically applied simvastatin (SMV), a cholesterol-lowering drug without graft matrix, has shown to stimulate BMP-2 and bone growth in animal studies.(7) Long term, multicenter randomized, controlled clinical trial will be required to confirm the findings of this study.

An interesting twist is a post-marketing study of periodontal disease among people who take Lipitor. The study was created by eHealthMe based on 164 reports from FDA and user community. On Oct, 10, 2012: 122,253 people reported to have side effects when taking Lipitor. Among them, 171 people (0.14%) have periodontal disease.(8) Did the Lipitor have an effect? While not a randomized controlled clinical trial (RCT), it is interesting to view the results.

Time on Lipitor when people have Periodontal disease*

*Approximation only. Some reports may have incomplete information.

Sex of people who have Periodontal disease when taking Lipitor*
*Approximation only. Some reports may have incomplete information. One other study investigated the effect of atorvastatin (ATV) treatment on bone loss prevention in subjects with chronic periodontitis. In this small, controlled, double-blind study, 38 subjects with chronic periodontitis were randomized into two groups, paired by age to receive ATV or placebo daily for 3 months. Periodontal mechanical treatment was carried out in both groups at baseline. Clinical and radiographic parameters and bone turnover markers were assessed at baseline and at 3 months. The results showed that periodontal disease conditions improved in both groups. After comparing the figures of change, significant improvements were observed in cholesterol, low-density lipoprotein levels, dental mobility, and the distance from the crestal alveolar bone to the cemento-enamel junction in the ATV group. The authors concluded that the results suggest that ATV might have beneficial effects on bone alveolar loss and tooth mobility in subjects with periodontal disease.(9) As mentioned, long term, multicenter randomized, controlled clinical trials will be required to confirm the findings of these studies.References 1. Kirkwood KL, Cirelli JA, Rogers JE, Giannobile WV. Novel host response therapeutic approaches to treat periodontal diseases. Periodontol 2000 2007; 43: 294-315. 2. Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, Gunsolley JC. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. Ann Periodontol 2003; 8: 227-265. 3. Cunha-Cruz J, Saver B, Maupome G, Hujoel PP. Statin use and tooth loss in chronic periodontitis patients. J Periodontol 2006; 77: 1061-1066. 4. 5. Stearns, F. W. (2010). One Hundred Years of Pleitropy: A Retrospective. Genetics 186(3):767-773. 6. Pradeep AR, Kumari M, Rao NS, Martande SS, Naik SB. Clinical Efficacy of Subgingivally Delivered 1.2% Atorvastatin in Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol. 2012 Oct 2. [Epub ahead of print]. 7. Stein D, Lee Y, Schmid MJ, et al. Local simvastatin effects on mandibular bone growth and inflammation. J Periodontol 2005; 76: 1861-1870. 8. 9. Fajardo ME, Rocha ML, Sanchez-Marin FJ, Espinosa-Chavez EJ. Effect of atorvastatin on chronic periodontitis: a randomized pilot study. J Clin Periodontol 2010; doi: 10.1111/j.1600-051X.2010.01619.x.

Maria Perno Goldie, RDH, MS

To read previous RDH eVillage FOCUS articles by Maria Perno Goldie, go to articles.