Focus on Inflamation: Party Crashers

June 1, 2005
Planning for a formal dinner festivity takes effort for the host. First, he or she must prepare a guest list and send out invitations early to ensure a well-attended party.

Planning for a formal dinner festivity takes effort for the host. First, he or she must prepare a guest list and send out invitations early to ensure a well-attended party. Once the invitations are sent, the returned response cards will help the host know how many attendees will grace the occasion with their presence. Choosing a theme for the evening makes decorating fun. The host will also want to select food items that will appeal to the guests. Entertainment for the affair will complete the major preparatory plans. A well-planned party becomes a highlight for guests to attend and leaves the host satisfied. Likewise, when party-crashing pathogens become a part of our body, the host response will make or break the successful outcome of any episodic event.

The guest list

When we gaze over the guest list for periodontitis, we may find a targeted listing of destructive enzymes produced as a result of the host inflammatory response. Tissue-destroying enzymes are overproduced in reaction to a chronic bacterial infection. With this lofty level of bacteria, tissue breakdown and pocketing will result. How the host responds to these unintended pathogenic guests will be influenced by the host’s innate risk factors. When one looks carefully at the host guest list, heredity and habits are common factors in disease progression. Look deeper and one will find identifying markers which tend to be elevated in periodontal patients’ systems. These C-reactive proteins and inflammatory mediators have emerged at the forefront as a potential means to discover patients who may be at risk for perio and cardiovascular disease. So, not only are certain markers associated with periodontitis, but they may also be similar predictors of other serious diseases of the heart. For our patients, factors such as smoking, stress, and poor home-care compliance need to be addressed, because these issues may be changeable. However, when genetics, diabetes, or weakened immune systems have a role, the host must react to body imbalances.

Hygienists enter the festivities when we evaluate and treat our patients’ periodontal disease through root planing procedures and adjunctive services. We consider the body’s compromises and plan treatment accordingly. Patients look to the dental professional for guidance as they deal with deteriorating tissues. The care hygienists provide is integral to successfully stabilizing these affected tissues, and to educating patients about their roles in the management of disease. At chairside, we often fight the good fight with our patients’ health in mind, but when factors such as tobacco use, diabetes, and family history limit the healing process, we find ourselves explaining the curative underperformance. We all have had regular recare appointments where we know the patient has been performing plaque removal measures adequately, but we still find the healing to be lackluster. This is discouraging to the patient as well as the clinician, who has incorporated many treatment modalities to try to stabilize the condition. The patient will say, “I have been doing everything the way you told me to. Why is it not improving?”

When desired clinical healing outcomes go awry, consider another approach: Address the patient’s host response through the addition of modulation therapy. Give patients renewed hope with the aim of altering the way their body defends the infection. When the damaging enzymes associated with chronic periodontitis need to be suppressed so healing can take place, please consider writing a prescription for Periostat (doxycycline hyclate) tablets by CollaGenex Pharmaceuticals, for a collaborative effort between the patient’s host response and the hygienist’s skilled care.

In our practice, the dentist writes a prescription for the oral medication when the patient undergoes nonsurgical periodontal therapy. Patients who are faithful Periostat users notice a reduction in bleeding and mention it at recare appointments. The hygienist finds less bleeding upon probing. When used twice daily as prescribed by the dentist, clinical studies show Periostat benefits and even enhances the patient’s host response by suppressing tissue-destroying collagenase enzymes. Successful continuing-care appointments and positive tissue response over time enable the dentist to decide when to continue with the medication or discontinue use. Duration of the therapy then can be determined by the disease progression and healing response of each individual case.

The body’s response to destructive enzymatic forces may be both systemic and environmental in nature. Consider augmenting traditional nonsurgical therapies delivered by the hygienist to include subantimicrobial medication taken as directed for patients at risk for impaired healing. By collaborating with your dentist, a prescription “perio pill” can be prescribed which can boost the patient’s immune response and make that person “the life of the party” through improvement in periodontal tissues and overall health.

The author did not receive compensation from CollaGenex Pharmaceuticals for product support. To learn more, visit