so, here's where i'm at with this; i just sent this to my dentist:
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hi.
i got your message this morning, but i'm waiting to finish up some reading before i call you back. i previously indicated i was looking to see a perio about gum recession particularly, but i've called around and it doesn't matter because none of them take disability - unless you know one that does. they've just all told me they don't accept the insurance.
so, i was hoping to see somebody for a consultation and go from there. i think it's clear i should get some grafting asap, and am frustrated by the barrier to care, so i'm happy to come in to talk. the initial thought was: if i need grafting, do i need a planing first, or is it just 100% stains as dr ========= suggested? what i wanted was a battle plan to get my gums back to 100%.
but, after realizing that nobody in town will see me anyways, i started looking at other options, and what i need to talk about now is options regarding collagenase inhibitors and gingival "overgrowth" rather than root planing and gum grafts, for the simple reason that antibiotics that inhibit collagenase are covered and the mechanical operations are not.
i live on disability, but i have a math degree and a pretty deep academic background, so i'm comfortable just browsing through scientific papers and learning on the fly. i have convinced myself that there are two classes of drugs that may be of use for this purpose:
- tetracyclines
- metronidazole
both of these drugs should act as collagenase inhibitors and therefore aid in the regrowth of gum tissue, if i also reasonably increase my vitamin c intake (i already eat a lot of fruit, but i'm looking at taking 100 mg twice daily for the c, which is the maximum absorption level, and which i can of course get at the store. that will make sure i'm getting as much c as i can absorb to maximize collagen production).
the reason i'm writing you this letter is to attach some links to scientific documents.
it is important to understand that i take 8 mg of estrogen per day, orally, because estrogen is a factor in both collagen and collagenase production.
so, this article talks about metronidazole & doxycycline-hcl together as an mmp-3 inhibitor, which should inhibit the production of collagenase and help with gum regrowth:
a gum graft may be preferable, but these drugs are both covered and a gum graft is not.
likewise, this is a review that suggests that the use of these drugs is unnecessary if you have access to root planing. but...i don't. unfortunately. and, remember that i specifically want the anti-collagenase effects because i want to stimulate gum regrowth:
from the above:
(1) Low-dose formulations
A new approach to non-antibacterial periodontal therapy is the administration of specially prepared low-dose capsules containing as low as 20 mg of doxycycline. These specially formulated capsules contain a lower concentration of doxycycline than the regular commercial dosage form, with blood levels reaching around 0.2 to 0.3 [tg/mL. Low-dose doxycycline eliminates the drug's antibacterial function, while allowing the drug to block collagenase activity.
Patients with adult periodontitis were administered either 30 mg doxycycline BID or a placebo for two weeks. Patients received oral hygiene instructions, scaling and root planing, and surgery which included the removal of gingiva and the collection of GCF. A reduction in extracellular collagenase activity by approximately 60-80% was seen in the crevicular fluid of periodontal pockets and in the gingival tissue (Golub et al., 1990). A later study clarified that this effect was due to a direct inhibition of collagenase by therapeutic doxycycline levels (Golub et al., 1995).
In a recent double-blind controlled clinical study, 16 patients with adult periodontitis were administered a "cyclical" regimen over six months of low-dose doxycycline or a placebo after one session of scaling. Results showed a significant reduction in probing depths as measured with a computer-assisted, constant-pressure probe. In addition, there was a 40-45% reduction in GCF collagenase activity (Crout et al., 1996).
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i can only find abstracts of the studies cited online, by golub et al. and, i'm constantly frustrated that i can't get access to anything online through the library at carleton university anymore since i graduated.
but, this is from the 1995 paper:
We conclude that MMPS in inflamed gingival tissue of AP patients, like those in GCF, originate primarily from infiltrating PMNs rather than resident gingival cells (fibroblasts and epithelial cells) or monocyte/macrophages, and that their pathologically-elevated tissue-degrading activities can be directly inhibited by pharmacologic levels of doxycycline.
collagenase inhibition seems to be the same mechanism cited in this paper about gingival overgrowth:
and, without citing the late, great linus pauling on megadoses of vitamin c and their efficacy, or lack thereof, here is a systemic review of vitamin c and oral health:
so, where i'm at with this is that i've convinced myself that i want to do this, but am seeking direction in application. should i utilize a topical? are topicals covered? i stumbled upon this by reading up on corneal regrowth, so i wonder if i want a more general application anyways - taking a collagenase inhibitor orally might also be good for my eyes and my hair, and if my gums are going on me, maybe it's reflective of a broader overproduction of collagenase (and i have recently boosted the folate in my diet out of concern for liver function, oblivious to potential c/b9 equilibrium issues that i'm now going to adjust for by taking oral c pills). are some of these drugs better than others? this is where a doctor's experience becomes useful, even in the face of the most abject nerdiness and careful individual research.
i'm also wondering if you have any direction on the application of topical cysteine on the question of collagenase inhibition, which again comes from studies on corneal regrowth:
...or the use of coffee or tea as a collagenase inhibitor:
i'll give you a call in the morning, but i have another appointment on friday morning at 10:00, and am going to be at the blood lab across the street from your office a little later on that day, so if there's a way to squeeze me in on friday, i'll be right there.
i'll call you tomorrow.
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that's more or less the sum total of the tabs i had open, with the exception of the following two links:
this study also discusses low dosage tetracycline use for collagenase inhibition:
this discuses use of the broader class of drugs that metronidazole is in: