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Cidr.infoV E T E R I N A R Y M E D I C A L S E R V I C E S i n V e t e r i n a r y M e d i c i n e
Enhance Canine Dentistry
with DOXIROBE™ Gel
by Robert B. Wiggs, DVM, Dipl. AVDC
C R E D E N T I A L S .
is one of the world’s leading veterinary dentists. He has more than 30 years of experience in dental practice, and Animal Clinic, Dallas, Texas, USA, Dental health is fundamental to good, overall pet health. Failure to maintain it can lead to serious disease problems in virtually all a dental referral practice with four of the major body systems, including the heart, kidneys and liver.
Maintaining dental health isn’t automatic.
Signs of dental disease (calculus and gingivitis) have been reportedto be the most common health problems of dogs and cats,1 but, sadly, less than 5% are getting treatment.
That’s one reason every companion animal veterinary clinic today should have a subpractice within the practice—veterinary dentistry.
Dentistry is not merely a lucrative profit center in a successful clinic; American Veterinary Dental College it’s the cornerstone of practicing responsible companion animal veterinary medicine.
credentials• Fellow and president-elect,
One of the most useful and beneficial veterinary dental resources my fellow practitioners and I use in our dental referral practice is DOXIROBE™ Gel (doxycycline). This perioceutic product is • Past president, American Veterinary a flowable polymer gel used to treat and help control infections in periodontal pockets, delivering doxycycline directly to the infectionsite. It is a one-of-a-kind tool that has become a staple in our daily practice.
D U A L A C T I O N M A X I M I Z E S R E S U L T S .
E A S Y T O U S E .
Mixing and administering DOXIROBE Gel has become stage 2 or worse periodontal disease, a condition a routine process in our practice. The steps we follow are: that encompasses approximately 75% of our 1. Thoroughly clean the oral cavity and perform subgingival patients. We administer the product in periodontal curettage and root planing before administration.
pockets that are at least 4 mm deep.
2. Combine the zip-lock seals of Syringes A and B.
Because we chart every patient, we can monitor Syringe A contains the polymer gel; Syringe B contains the doxycycline. Exchange the material back and forth between the 2 syringes for 1 minute (about 100 more than half within 3 months of treatment.
For example, we have treated 8-mm pockets to 3. Push the mixed gel into Syringe A and allow the measure just 3 mm when evaluated 3 months syringe to stand up, pointing downward, for a few minutes to allow all of the gel to flow to the base.
4. Unlock the syringes. Place the blunt cannula on the syringe and remove the cap. Using the cap, we recommend bending the cannula to a 45º angle for more convenient placement of the gel in the 1. Direct bacterial effect – The slowly
dissolving gel allows for binding ofdoxycycline with bacterial protein in the 5. Gently insert the cannula at the bottom of the clean sulcus and in calculus that has formed on periodontal pocket, and inject the gel while slowly the cementum and dentin around the tooth.
withdrawing the cannula. A finger placed against the gingival margin while injecting will help hold the gel 6. Allow the polymer gel to firm before packing. This requires about 3 minutes. However, placing a few drops of water or saline on the gel will usually shorten the waiting time to 30 to 60 seconds.
2. Indirect immune effect – The presence
7. Gently pack the polymer into the sulcus with a W-3 of a high bacterial load in the mouth can beavertail plastic filling instrument, cord packer, or stimulate the animal’s immune system to #7 wax spatula. Once the DOXIROBE sets, pack send neutrophils to the infection site.
the gel below the gumline if possible, but do not be concerned if a small amount protrudes. It is better not to overwork the gel, rather than to displace it while trying to achieve a perfect placement.
maximize results has an anti-collagenase effect that aids in
limiting the impact that an animal’s own DOXIROBE should not be used in dogs less than 1 year of age, because the use of tetracycline during tooth development has been associated with permanent discoloring of teeth. It also should not be used in pregnant bitches, because its use in breeding dogs has not been evaluated.
P A T I E N T , P R A C T I T I O N E R , A N D C L I E N T B E N E F I T .
Since incorporating DOXIROBE in our practice, we have been able toavoid many procedures that are more involved, time-consuming, andcostly. Deep periodontal pockets that once would have required an apical reposition flap procedure or guided tissue regeneration are oftensubstantially improved by the simple administration of DOXIROBE.
Pet owners appreciate this because there is less expense, the procedureis less invasive, and the product requires no pretreatment dosing orpost-treatment removal. The gel simply dissolves over time as it gradually releases doxycycline, which allows high, sustained antibioticconcentration directly at the infection site.
We’ve become so confident in DOXIROBE and use it so regularly that we’ve included it as part of our predental client estimate sheet.
Once we explain what DOXIROBE is and what it does, most clientswant their dogs to receive it if we determine it is necessary. Then, atinvoicing, our computer system automatically triggers the printing of aclient education page on DOXIROBE if it was part of an animal’s care.
Included in this information are instructions to refrain from brushing R E F E R E N C E S .
the dog’s teeth for a week, and, if the gel is visible, to expect gradual discoloration, from yellow to brown to black, of the DOXIROBE gel 1. Lund EM, Armstrong PJ, Kirk CA, Kolar LM, Klausner JS. Health status and population character-istics of dogs and cats examined at private veterinary M U L T I P L E B E N E F I T S .
practices in the United States. JAVMA 1999;214:1336-1341.
The administration of DOXIROBE Gel considerably improves the 2. Zetner K, Rothmüller G. The treatment of periodontal pockets with the new perioceutic Doxirobe.
microenvironment of canine periodontal infections. In summary, Der Praktische Tierarzt 2002;3:214-225.
we find it to be extremely beneficial because it: • Treats and controls infections directly in the sulcus • Localizes antibiotic concentration at the infection site • Reduces the need for many surgical procedures and oral medications, the latter of which can be helpful for dogs that are difficult to dose • Tremendously improves gingival health and promotes healthy • Improves breath odor by reducing bacteria and their byproducts A recently published study by Prof. Karl Zetner2 of the University of Veterinary Medicine in Vienna, Austria, reinforces my opinion of DOXIROBE Gel. I believe it is an excellent product that yields outstanding effects on pet health. It is a tool that all veterinary dentists should use on a regular basis. I liken it to a computer or other new technology. It takes a bit of experience to learn how to use it, but once you start using DOXIROBE Gel routinely,you’ll wonder what you ever did without it.
The formulation will begin to solidify imme- diately upon application; however, lavage NDC 0009-5193-01
brand of doxycycline gel
facilitate the process. Allow approximately30-60 seconds for the polymer to harden For Periodontal Use in Dogs Only
before beginning to press it into the pocket.
Caution: Federal law restricts this drug to use by or on the order of a licensed
DOXIROBE Gel is provided in a 2-syringe system requiring mixing prior to use.
Syringe A contains the polymer delivery system (N-methyl-2-pyrrolidone and poly (DL-lactide)) and Syringe B contains the active ingredient (doxycycline). Once of a wax spatula or the back of a curette.
mixed, the product is a flowable solution of doxycycline hyclate equivalent to 8.5% doxycycline activity. The formulation is applied subgingivally to the peri- odontal pocket(s) of affected teeth, and doxycycline is slowly released from the polymer providing a local antimicrobial effect. The product is non-irritating and degradable, removal at a subsequent visit CLINICAL PHARMACOLOGY:
Doxycycline is a semi-synthetic tetracycline derivative. Consistent with the tetra-cycline class of antibiotics, it has a wide range of antimicrobial activity against Reconstituted product not used on the day of mixing should be stored in the microorganisms. Upon contact with the aqueous environment (gingival crevicular resealable foil pouch at room temperature (15-25°C or 59-77°F) and used within fluid) the polymer will coagulate, resulting in the formation of a solid, pliable delivery 3 days of reconstitution. Ten additional exchanges between syringes should be system within the treated periodontal pocket(s). Doxycycline is released into the performed if reconstituted product has been stored.
gingival crevicular fluid for a local effect on the microorganisms, particularlygram-negative anaerobic bacteria, involved in periodontal disease.
In a clinical trial, the highest plasma doxycycline concentration was observed at DOXIROBE Gel is indicated for the treatment and control of periodontal disease 6 hours after treatment administration (2-4 affected teeth in each of 6 dogs).
Doxycycline was not detected in plasma samples taken at 24 hours after treatmentadministration or any time point thereafter. All detectable concentrations of doxy- Periodontal pocket probing depths ≥ 4 mm are evidence of disease that may be cycline were well below levels associated with systemic activity or toxicity.
responsive to treatment with DOXIROBE Gel. In clinical trials, use of the productresulted in attachment level gains, periodontal pocket depth reductions and DOSAGE AND ADMINISTRATION:
improved gingival health. Noticeable improvements in these parameters should beevident within 2-4 weeks following treatment. The response in individual animals Teeth should be cleaned and scaled prior to application of the product. If is dependent on the severity of the condition and rigor of adjunctive therapy. This required, root planing and debridement of affected sites should be performed.
product is not intended for use in oronasal fistulas, periapical abscesses, or The product is applied with the animal under sedation or anesthesia. Use as many units as required to fill the periodontal pockets of affected teeth.
Treatment and control of periodontal disease requires a comprehensive program ofroutine scaling and cleaning, home care and dental hygiene (e.g., brushing, rinses Do not use in dogs less than 1 year of age as the use of tetracyclines during tooth or the use of chewing devices) in addition to application of this product. Severe development has been associated with permanent discoloration of the teeth. Do cases may require surgical intervention.
not use in pregnant bitches. The use of the product in breeding dogs has notbeen evaluated.
Clients should be advised to suspend brushing treated teeth for approximately HOW SUPPLIED:
Each unit of DOXIROBE Gel contains Syringe A (polymer delivery system) andSyringe B (doxycycline), which when mixed result in approximately 0.5 ml ofdoxycycline solution. Available as a 3-unit carton (containing 1 additional bluntcannula), NDC 0009-5193-01.
NADA 141-082, Approved by FDA Store in a refrigerator 2° to 8°C (36° to 46°F).
Beginning with Syringe A, use theplungers of Syringes A and B to For Technical Assistance or to report adverse reaction/experience, please call Pharmacia & Upjohn CompanyKalamazoo, MI 49001, USABy:Atrix LabsFort Collins, CO 80525, USA U.S. Pat. No. B1 4,938,763; U.S. Pat. No. 5,077,049; Fully deliver the mixture into Syringe A, U.S. Pat. No. 5,278,201; U.S. Pat. No. 5,324,519; separate the syringes, and lock the supplied blunt cannula onto Syringe A. The cannula 818 214 000
DOXIROBE is a trademark of Pharmacia & Upjohn Company.
2002 Pharmacia & Upjohn Company. All rights reserved.
the gingival margin of an affected tooth.
Express a small amount of the mixture intoeach periodontal pocket 4 mm or deeper.
Ensure that the pockets are filled approx-imately to the gingival margin.
SEDATION DURING TREATMENT FOR RETINOPATHY OF PREMATURITY Background: Surgical intervention in babies with advanced retinopathy of prematurity (ROP) can prevent blindness (1). These babies require sedation and analgaesia for the procedure. They also require ventilatory support because of the sedation, the duration of the procedure and pre-existing lung disease. Neuromuscular paralysis facilita