Doxycycline (subgingival)

Atridox, which contains doxycycline, is a controlled-release gel applied at the site of gum disease, and can continue delivering medication for up to three weeks.

Overview

Doxycycline is a medication made available by prescription and is used to fight against infection and certain types of bacteria. It is in the class of drugs known as tetracycline antibiotics, and these are considered to be effective at inhibiting both the growth and proliferation of bacteria by reducing the production of protein.

It comes in several forms, among them a capsule and a tablet, but the gel form will be the focus of this particular discussion, and this type of medication will most commonly be administered in a dentist's office by a qualified professional. It will normally be applied directly to areas in the mouth where infection is already in progress, sometimes on or near infected tooth pockets.

When the doxycycline gel comes into contact with saliva in the mouth, it is transformed into a substance which has a waxy consistency, and persists in the mouth for an extended time, all the while releasing medication to fight the infection. This process is generally ongoing for a full seven days before the medication will begin to lose its effectiveness, and at that time a dentist will be able to observe the progress which has been made. A determination can then be made as to whether or not a second application is needed.

Once a treatment of doxycycline gel has been installed in the mouth, you should not brush, floss, or rinse around the area being treated for a full week, so as not to dislodge the semi-hardened material. During this period, the teeth in that area of the mouth should not be used to chew or crunch food, because that may also tend to disturb the waxy medication. It is normal for small pieces of this waxy substance to come loose, so you can either spit them out or swallow them without harm.

If it is deemed necessary to schedule a follow-up treatment of doxycycline, it will not happen immediately, but after a period of several months, at the discretion of your dentist. In the meantime, all dental appointments should be kept faithfully, so your doctor can observe the progress being made in fighting the gum disease or infection.

Condition Treated

  • Malarial infections, other bacterial infections; Gum disease in adults

Type Of Medicine

  • Tetracycline antibiotics

Side Effects

It is fairly common for some patients to experience side effects when having doxycycline gel administered orally. One of the most common kinds of reactions for a patient is to experience pain, soreness, or gum discomfort near the area where the medication has been applied. If this condition gets to the point where it's extremely uncomfortable, you should notify your dentist as soon as possible, although it is normal for at least some amount of discomfort to occur. In rare cases, some patients experience an allergic reaction to doxycycline gel, and this is a situation calling for immediate medical attention. Symptoms typically associated with an allergic reaction are the following:

  • The appearance of hives or rashes on the skin
  • A tightness in the chest, or other difficulty with breathing
  • Dizziness or disorientation
  • Swelling which appears primarily in the facial area, often in the tongue, lips, or throat.

If any of these symptoms are experienced after doxycycline gel has been applied in your mouth, you should notify your dentist immediately, so that appropriate steps can be taken to relieve the symptoms. Some patients have reported experiencing looseness in the teeth around the area where gel has been applied, and other patients have experienced a general pain in the jaw area.

There are a number of other side effects which have been reported by patients, some of which are more severe and some of which are less severe, and the number of patients reporting side effects is not huge in scope. However, since it is possible to develop any of the side effects listed below, they are shown here in the interest of full disclosure. The possible side effects stemming from usage of doxycycline gel are as follows:

  • Tooth looseness
  • Diarrhea
  • Upset stomach, indigestion, or stomach ache
  • Mouth soreness
  • Soft-tissue erythema
  • Canker sores
  • Aphthous ulcers
  • Endodontic abscess
  • Pulpitis
  • Bleeding gums
  • Premenstrual tension syndrome
  • Headaches
  • Coughing or sneezing
  • Tendency toward insomnia
  • Soreness and general body aches
  • Nausea and vomiting
  • Gum discomfort, pain, or soreness
  • Toothaches
  • Increased sensitivity to cold or hot conditions on the teeth
  • Pressure sensitivity in the mouth
  • Periodontal abscess drainage
  • Inflammation of the gums
  • Fevers and/or chills
  • Muscle aches, especially in the back, arms or legs
  • Ear infections
  • Colds or influenza
  • Sore throat
  • Skin infection or inflammations
  • Sinus infections
  • Bronchitis
  • Stuffy head, congestion, or post nasal drip.

Dosage

The dosage of doxycycline gel administered by your dentist will depend on the specific medical condition being treated, as well as your tolerance to the medication itself. If significant soreness or other symptoms develop with usage, a lesser amount of medication will probably be used. If more than one application of doxycycline gel is indicated to manage the symptoms of your medical condition, your dentist will wait between two and four months before scheduling a follow-up treatment.

Interactions

There are a number of other medications which are known to have interactions with doxycycline, so it will be necessary for your doctor or dentist to review a full list of any of the medications which you are currently taking. When you prepare this list, you should include all vitamins, herbal supplements, other prescription drugs, and over-the-counter drugs which you are currently taking, as well as all of the dosages of each of these.

This list of medications will also be extremely useful if you have to make an unplanned trip to an emergency room locally, or a healthcare clinic setting where your primary care doctor or dentist is not in attendance. By reviewing your list of medications and dosages, any doctor will be able to identify potential drug interactions, so that you can be treated for the medical condition you've come to the clinic or hospital setting for.

The medications which are known to interact with doxycycline include the following:

  • Oral contraceptives
  • Bismuth subsalicylate (Pepto-Bismol)
  • Barbiturates, e.g., phenobarbital
  • Carbamazepine (Tegretol)
  • Phenytoin (Dilantin)
  • Anticoagulants or blood thinners
  • Antibiotics from the penicillin class, for example ampicillin or amoxicillin
  • Methoxyflurane (Penthrane)
  • Antacids which contain magnesium, calcium, aluminum, or iron.

Warnings

Before taking doxycycline, make sure your doctor or dentist knows about all your medical conditions because this medication may have an impact on your current condition. You should especially make your doctor aware if you have had any medical history which includes the following:

  • Kidney or liver disease
  • Type I or type II diabetes
  • Pregnancy and/or breast-feeding
  • Taking blood thinners, carbamazepine, phenytoin, vitamins, antacids, or oral contraceptives
  • Any history of allergic reaction to doxycycline or any kind of tetracycline antibiotics such as minocycline
  • Allergic reactions to pets, foods, preservatives, or fabrics.

It is possible for patients to develop an allergic reaction to doxycycline gel, so if you observe any of the symptoms which indicate an allergic reaction, you should seek medical attention immediately, and alert your doctor to the fact.

Some patients who use doxycycline experience heightened sensitivity to light such as ultraviolet light from tanning beds, or ordinary sunlight. With greater sensitivity to these light sources, it's possible for you to develop sunburns or other negative reactions that you may never have experienced before taking doxycycline. It is therefore advisable for you to wear protective clothing when you're out in the sun, and to have a strong sunscreen applied to any exposed skin surfaces which are not protected by clothing.

Children aged eight or under have been known to experience tooth discoloration when doxycycline gel has been applied orally, so usage of this medication for very young patients should be carefully considered.

Doxycycline is known to decrease the effectiveness of oral contraceptives in some patients, making it more likely for a woman to become pregnant, even while using this method of birth control. It is therefore advisable for a woman who is using oral contraceptives for birth control to consider an alternative method during the time frame where doxycycline is being administered.

There are some types of bacteria which are known to be extremely resistant to doxycycline, and these can proliferate at specific sites, if not immediately identified by a qualified professional. This makes it very important that all dental and doctor appointments are kept, so that any developing conditions can be spotted immediately, and steps can be taken to mitigate them.

Storage

For the most part, it will not be necessary for patients to store their own supply of doxycycline gel, since this is always administered in a clinical setting by qualified professionals. Any storage or handling procedures will be conducted by knowledgeable medical people who have been trained in proper procedures for storage of this medication.

However, for medical people who need to know about storage procedures, this medication should be stored in a refrigerator where the temperature can be maintained at between 36 degrees Fahrenheit and 46 degrees Fahrenheit. It should be kept away from direct lighting and any kind of moisture, and should be kept in its protective pouch right up until the time it is being prepared for administration to a patient.

Doxycycline should not be flushed down a toilet or a sink drain, but should instead be disposed of using proper methods. If a doctor or pharmacist is not available to provide instructions on the best disposal procedure, you can consult the FDA website on safe disposal of medicines, which does contain information on this subject. Some locations also have a medication ‘give-back' program, wherein unused drugs can simply be taken to a specific facility, and it will be disposed of by knowledgeable individuals who work there.

Summary

Doxycycline gel belongs to the class of drugs known as tetracycline antibiotics, and as such it is primarily used to fight infections and gum disease patients have developed. It has a very important time-release capability which allows it to continue delivering medication to an infected area of the mouth for a period of approximately seven days. Once this gel has been applied to the target area of the mouth, it changes from a gel consistency to a waxy kind of consistency.

This waxy substance can then take residence in the area where it has been applied for several days, as long as the patient can refrain from brushing and flossing in that specific area. While some bits of the waxy material may come loose normally, the great majority will stay in place and deliver medication in a time-release fashion. If a second or third application of the drug is deemed necessary by your dentist, this will not be scheduled immediately and will instead take place after several months.

It is normal for a doxycycline patient to experience a certain amount of soreness in the mouth, especially where the medication has been applied. However, if the discomfort should reach an intolerable level, consult with your doctor for some kind of relief strategy.