Host Modulation: Sub-antimicrobial Dose Doxycycline in Periodontal Therapy a Review

A better understanding of the pathogenesis of periodontitis has resulted in pharmacotherapeutic advancements, addressing both the microbes and the host response, leading to improved management of this chronic progressive disease by the dental practitioner. The adjunctive use of host-modulatory agents can enhance therapeutic responses, slow the progression of the disease, and allow for more-predictable management of patients. A number of local host modulatory agents have been investigated for their potential use as adjuncts to surgical procedures not only to improve upon wound healing but also to stimulate regeneration of lost bone, periodontal ligament, and cementum, restoring the complete periodontal attachment apparatus. These have included the systemic (Flurbiprofen) and topical (Ketoprofen) use of nonsteroidal anti-inflammatory drugs, the systemic use of sub-antimicrobial dose doxycycline (Periostat) and the systemic use of bisphosphonates (Fosomax).In addition, a number of local host modulatory agents have been investigated which includes enamel matrix proteins (Emdogain), bone morphogenetic proteins (BMP-2 and BMP-7), growth factors (platelet-derived growth factor and insulin-like growth factor).The only systemic host modulatory agent approved by the FDA (Food and Drug Administration) for adjunctive use in conjunction with nonsurgical periodontal procedures is Periostat.