A Way to Escape The Dentist's Knife?

By Christine Gorman

Gum disease is not something to be ignored. It starts out harmlessly enough, perhaps with just a little blood on the toothbrush. But the bacteria responsible are relentless. If left alone, they eventually produce infected pockets of pus, invade the roots of teeth and put people on the path to being Polident users. As many as 3 of every 4 Americans are somewhere along that path.

If patients don't get to a dentist before the disease gets out of hand, the treatment used to save the teeth is not pleasant. Wielding sharp metal tools, periodontists scrape germ-laden plaque from around the teeth and under the gumline. If that doesn't work, the usual next step is oral surgery that carves away pieces of infected gum.

Is there a way to skip surgery and still avoid dentures? A small group of American researchers thinks so, at least in some cases. They are experimenting with several different techniques designed to control the disease-causing bacteria with drugs instead of knives. Such therapies are already used in some European countries, and advocates question why the Food and Drug Administration has not yet approved the treatments for general use in the U.S.

The new strategy involves implanting into the gums antibiotics or other germ killers so that they can attack bacteria in the pockets where they fester. Standard antibiotic pills, which some specialists have relied on, needlessly expose the entire body to a powerful drug and have not always proved effective. Gum disease "behaves like a chronic type of inflammatory disease," explains Kenneth Kornman, a professor of periodontics at the University of Texas in San Antonio. "We have a hard time eliminating those bacteria." For that reason, dental researchers decided to concentrate the antibiotics' killing power by applying medication directly into infected areas of the gum.

One of the most promising of the new therapies, first available in Italy, is a product called Actisite. It looks something like dental floss but actually consists of an organic fiber coated with the antibiotic tetracycline. Packed deep in the gums, the medicinal thread remains in place for seven to 10 days. Thanks to a time-release formula, the antibiotic slowly diffuses through the infected area, attacking the gum-destroying germs. According to one study, Actisite delivers 300 times as much tetracycline to the crevice where the thread is placed as a gram's worth of pills would.

Another therapy consists of a gel that contains an antimicrobial called metronidazole. Marketed in Denmark, and just approved for use in Sweden, Ireland and Britain, the gel can be squirted into the spaces between teeth and gums. In a U.S. study of 100 patients who had completed a round of oral antibiotics, Walter Loesche of the University of Michigan and James Giordano of the University of Detroit School of Dentistry administered metronidazole on thin patches of an organic material called ethyl cellulose. Preliminary results indicate that the combination treatment saved 94% of teeth scheduled for surgery, and the teeth remained disease-free throughout a three-year follow-up period.

The drug therapies can apparently produce dramatic turnarounds. Rosie New, a 34-year-old Houston resident, was in danger of losing her front teeth when she received Actisite on an experimental basis. Two weeks later, the inflammation had disappeared. Her follow-up treatment included applying the powerful prescription mouthwash Peridex to her dental floss to make sure the bacteria did not reclaim any territory. "It's a major difference in what my gums were like," New says. The deterioration of her jawbone stopped, and her smile was saved. Says she: "It's scary, the thought of losing your front teeth."

So why have Actisite and other new treatments not been approved for general use in the U.S.? "The FDA is burdened with life-or-death priorities like AIDS and cancer," says Michael Newman, a professor of periodontics at the UCLA School of Dentistry. "Dental products are low on the totem pole." Other dental researchers wonder whether acceptance of the therapies is being delayed by periodontists who don't want to lose part of their lucrative oral-surgery practice. "European countries are definitely more receptive," Loesche says. "Part of it is that they don't have a strong periodontal establishment."

Financial considerations aside, there are some real medical issues to resolve. Perhaps the most serious is the concern that widespread use of antibiotics in the mouth could create super-virulent strains of gum-ravaging bacteria that would resist any attempts at treatment. "A lot of the new therapies are just at the tinkering, research stage right now," says Ray Williams, chairman of Harvard University's periodontal department. Until the gum-disease treatments get FDA approval, most people's options will remain the same as always: brush, floss and visit the dentist regularly -- or face the knife.

With reporting by Patrick E. Cole/Los Angeles and Janice M. Horowitz/New York