Low Dose Doxycycline 20mg (LDD) - Subantimicrobial Dose Doxycycline  www.periostat.com

"Host Modulated Therapy", or low dose doxycycline 20mg, also known as "subantimicrobial dose doxycycline (SDD)", is one of the most effective ways to control systemic host factors associated with chronic inflammation in periodontal diseases. Host factors may include genetics, smoking, diabetes, AIDS, hormones, medications contributing to periodontitis, and stress.

More about host factors in periodontal disease:

http://www.umm.edu/patiented/articles/who_gets_periodontal_disease_000024_4.htm

Low dose doxycycline, 20mg taken twice daily, slows the progression of the disease by suppressing the "over-production" of a destructive enzyme called collagenase.    

Over-production of collagenase before LDD - the body is out of balance due to host response - chronic inflammation - break down is exceeding repair and bone loss results.

Normal collagenase levels restored by LDD - equal breakdown and repair occuring.  Stability and health is restored. 

LDD puts collagenase levels back into balance.  Although doxycycline 20mg, or PerioStat, is in the tetracycline class of drugs, its use is often misunderstood.

At this very low dose, it is sub-clinical (sub-antimicrobial dose), meaning it has no effect on the bacteria whatsoever; only the production of the destructive enzyme collagenase is suppressed.  The therapeutic benefit has nothing to do with killing bacteria; that is not the goal.  To kill bacteria, doxycycline would have to be at a much higher dose.

This medication is powerfully effective at reducing and/or eliminating chronic periodontal inflammation.  Thus, it is one of the most valuable tools available in the fight against periodontal disease, especially if there are systemic host factors which cannot be controlled.

Other benefits of taking LDD daily include keeping blood sugar levels in check in diabetics, lowering CRP (C-Reactive Protein) levels and cholesterol in patients with chronic periodontitis and cornonary artery disease.  LDD is effective in the successful treatment of rosacea and rheumatoid arthritis.

Preventative periodontal care is about helping a patient to understand what is causing their disease, giving options for treatment, and reasonably predicting long term outcomes.  There are host factors which cannot be controlled with all the best intentions.  Low dose doxycycline (LDD) is one of the most powerful tools available to alter the course of periodontitis safely.

excerpts from Journal of Clinical Periodontology 2004 Sept.;31(9):697-707

Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. A review.

Preshaw PM, Hefti AF, Jepsen S, Etienne D, Walker C, Bradshaw MH.

School of Dental Sciences, University of Newcastle upon Tyne, UK.

Studies have shown that SDD, when prescribed as an adjunct to scaling and root planing (SRP), results in statistically and clinically significant gains in clinical attachment levels and reductions in probing depths over and above those that are achieved by SRP alone. SRP must be thorough and performed to the highest standard to maximise the benefits of adjunctive SDD.

SDD does not result in antibacterial effects, or lead to the development of resistant strains or the acquisition of multiantibiotic resistance. The frequency of adverse events is low, and does not differ significantly from placebo.   

Articles about sub-antimicrobial dose doxycycline (SDD):

http://uuhsc.utah.edu/pharmacy/bulletins/doxycycline.html

http://www.umm.edu/patiented/articles/how_antibiotics_being_used_long-term_prevention_of_periodontal_disease_000024_9.htm 

http://www.natural-hrt.com/artman/publish/article_133.shtml

http://ezinearticles.com/?Low-Dose-Doxycycline-Therapy&id=552971

Published research with low dose doxycycline:

http://www.ncbi.nlm.nih.gov/pubmed/15766366?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus