Exploring Alternative Medications for Chronic Periodontitis
The Occurrence of Periodontitis
Periodontitis, a chronic inflammatory disease of the gums, poses a significant threat to oral health, often resulting in bone and tooth loss. This condition is primarily triggered by microorganisms present in the mouth.
According to a study published in the Journal of Infection and Immunity, the occurrence rate of periodontitis varies depending on various factors, such as age, oral hygiene, and systemic health. Research indicates that periodontal disease affects approximately 15 to 35% of the U.S. population, which translates into tens of millions of patients. These numbers highlight the importance of finding new ways to combat the detrimental effects of periodontitis.
While scaling and root planing are the standard of care for periodontitis, researchers have been investigating daily adjunctive therapy that patients can use at home to reduce inflammation without relying on antimicrobial agents. One promising avenue involves disrupting histamine, a key mediator of inflammation in periodontal tissue.
In this blog post, we delve into the research surrounding the use of histamine type 2 (H2) antagonists, particularly cimetidine, as a prescribed, home therapy for chronic periodontitis.
The Limitations of Antibiotics
While antibiotics, such as doxycycline and tetracycline, have been utilized to reduce the growth of microorganisms associated with periodontitis, their use is not without drawbacks. One significant concern is the risk of tooth discoloration and disruption of the beneficial bacteria in the mouth.
Dentists, therefore, limit the use of antibiotics to a maximum of nine months, even though periodontitis is a chronic condition that requires long-term management.
Exploring Histamine Blockade
Researchers have investigated the use of specific histamine type 2 antagonists to disrupt histamine in inflamed periodontal tissue. Histamine, a known contributor to inflammation and subsequent tooth loss, can be disrupted using specific histamine type 2 (H2) antagonists.
Cimetidine, a robust H2 inhibitor first introduced commercially as TAGAMET in 1977 for treatment of stomach ulcers, has been extensively studied due to its safety profile and is now available over the counter (OTC) as per the Food & Drug Administration.
Researchers have examined the impact of histamine blockade using cimetidine and found promising results in reducing periodontal inflammation. A study by Journal of Infection and Immunity found that cimetidine reduced alveolar bone loss in rats with periodontitis, suggesting a potential beneficial role for cimetidine for this gum disease. While another study in the Journal of Periodontology found evidence that topical 0.5% cimetidine oral rinse enhances the antibacterial function of crevicular neutrophils (white blood cells in gum crevices).
Furthermore, a study by Van Dyke et al., showed significant reduction in bone level (P < 0.05) compared to the three cimetidine groups, which showed a marked decrease in inflammation. The studies conducted on cimetidine’s impact on periodontal inflammation demonstrate its potential as a possibly ideal therapy for this chronic condition. Based on this research, dental professionals now have an accessible new option for managing their patient’s periodontal health.
Cimetidine Oral Gel from HDRx Compounding Pharmacy
Health Dimensions Compounding Pharmacy (HDRX) offers an easily accessible oral gel formulation of cimetidine combined with fluoride.
HDRx makes cimetidine available by prescription, for home use by the patient. The prescription is an easy-to-use oral gel combined with fluoride, with or without doxycycline. Our pharmacists recommend doxycycline with cimetidine and fluoride for the first 30 days, followed by continuous therapy of cimetidine/fluoride gel only.
Application is simple; patient’s are instructed to swish the pleasant tasting gel twice daily after oral hygiene. Do not eat or drink for 60 minutes afterward.
Ask your doctor about a prescription for cimetidine and fill your prescription with our compounding experts.
Hasturk H, Kantarci A, Ebrahimi N, Andry C, Holick M, Jones VL, Van Dyke TE. Topical H2 antagonist prevents periodontitis in a rabbit model. Infect Immun. 2006 Apr;74(4):2402-14. doi: 10.1128/IAI.74.4.2402-2414.2006. PMID: 16552070; PMCID: PMC1418940. https://pubmed.ncbi.nlm.nih.gov/16552070/
Longhini R, Aparecida de Oliveira P, Sasso-Cerri E, Cerri PS. Cimetidine reduces alveolar bone loss in induced periodontitis in rat molars. J Periodontol. 2014 Aug;85(8):1115-25. doi: 10.1902/jop.2013.130453. Epub 2013 Nov 28. PMID: 24283656. https://pubmed.ncbi.nlm.nih.gov/24283656/
Van Dyke TE, Cutler CW, Kowolik M, Singer RS, Buchanan W, Biesbrock AR. Effect of topical cimetidine rinse on gingival crevicular neutrophil leukocyte function. J Periodontol. 2005 Jun;76(6):998-1005. doi: 10.1902/jop.2005.76.6.998. PMID: 15948697. https://pubmed.ncbi.nlm.nih.gov/15948697/