University of Nebraska Medical Center College of Dentistry researcher
and dentist, Jeffrey B. Payne, D.D.S., has seen many elderly women patients
suffer the loss of teeth because of periodontitis a disease that causes
destruction of bone and gums, the supporting structures of the teeth. Periodontitis
is the number one cause of tooth loss in men and women in the United States.
With the help of a five-year, $2.09 million clinical trial grant from
the National Institutes of Health, National Institute of Dental and Craniofacial
Research, Dr. Payne and other researchers will evaluate the effectiveness
of Dr. Payne and other researchers will evaluate the effectiveness of a
drug called Periostat in reducing oral bone loss and improving bone density
in the hip and spine of women. Researchers know periodontitis results
in collagen being broken down, ultimately destroying bone.
Women are concerned about losing teeth, said Dr. Payne, UNMC assistant
dean for research and F. Gene and Rosemary Dixon Endowed Chair in Dentistry.
They are extremely health conscious. In general, if patients lose teeth,
they want to replace them because of lost function and for aesthetic reasons.
Once a tooth is lost, other teeth start drifting. This compromises chewing
function and a patients quality of life.
Periodontitis, which results in the loss of bone supporting teeth in
the jaws, affects about 36 percent of U.S. adults, Dr. Payne said.
Periostatâ was approved by the FDA in September 1998 and is the
first and only oral drug approved as an additional treatment for periodontitis.
The drug helps prevent the breakdown of collagen, a major structural protein
of the body that is found in bone, skin, gum tissues, ligaments and cartilage.
Before the drug was approved, periodontitis was treated primarily through
teeth cleaning and surgery.
The critical destructive phase in periodontitis is the destruction
of collagen. If you can inhibit that process, then you can inhibit bone
loss and perhaps even enhance bone gain, said Dr. Payne, principal investigator
for the grant. If our hypothesis proves correct, Periostatâ
could be used to prevent the loss of bone and gum support in the mouth,
thus reducing tooth loss, said Dr. Payne, principal investigator of the
study.
Researchers at UNMC and the State University of New York at Stony Brook
School of Dental Medicine will test the effectiveness of Periostatâ
in 120 post-menopausal women, ages 45 to 70 years old, who have periodontitis
and osteopenia. Osteopenia is reduced bone mass in the body and represents
an early stage of osteoporosis.
Osteoporosis, or porous bone, is a disease characterized by low bone
mass and structural deterioration of bone tissue, leading to bone fragility
and an increased susceptibility to fractures of the hip, spine, and wrist.
It is a major public health threat for more than 28 million Americans,
80 percent of whom are women. In the U.S. today, 10 million individuals
already have osteoporosis and 18 million more have low bone mass, placing
them at increased risk for the disease.
In the double-blind study, which means neither researchers nor the participants
will know who received the drug and who received the placebo, women eligible
for the study will receive free screenings, tests, Periostatâ and
a daily dose of 1,200 milligrams of calcium and 400 international units
of vitamin D. Tests, including intraoral X-rays and dual energy X-ray absorptiometry
(DEXA) scans, will be given at the beginning of the study and at one and
two years. A DEXA scan is a fast, simple X-ray that evaluates the density
of the hip and spine to confirm osteopenia or osteoporosis. Art Weaver,
M.D., of the Arthritis Center of Nebraska, who also is a UNMC clinical
professor of internal medicine, will work with UNMC College of Dentistry
researchers on DEXA data generated from this study.
Women will continue to see their periodontists during the study.
In addition to oral bone loss, researchers will also look at the drugs
potential to treat osteopenia.
Dr. Payne said, If you can treat or inhibit oral bone loss, it would
be beneficial at the same time to reduce systemic bone loss. Another important
issue in studying oral bone loss is the compelling scientific evidence
emerging about the relationship between the health of the mouth and the
systemic health of the body.
Last year, the United States Surgeon General, in its first report ever
on oral health, addressed the importance of oral health in maintaining
systemic, or overall, health.
There is more scientific evidence emerging that tells us if a person
doesnt maintain a healthy oral environment, that could place them at risk
for other systemic diseases, Dr. Payne said. We also know that
systemic diseases such as uncontrolled diabetes and osteoporosis place
individuals at greater risk for tooth loss.
Our hypothesis is that this drug will reduce oral bone loss and enhance
bone gain, but we also want to know if it will inhibit bone loss in the
body — specifically in the hip and lumbar spine of post-menopausal women.
If this drug has a positive effect on the hip and spine, it will lead to
another larger study to look at this systemic outcome. Periostatâ
could potentially be a very inexpensive, safe therapy for osteopenia and
osteoporosis.
The outcomes of this study could very well lead to a lot of new areas
of research, which was what the NIH review team was very excited about.
For more information about enrolling in the study, call Julie
Layton, (402) 472-9852. The UNMC College of Dentistry is located in Lincoln.