Helping patients fight gum disease can feel like an uphill battle. Orocidin promises a novel solution in chemotherapeutics for periodontal disease.
By Paige Anderson, RDH
Periodontitis remains one of the biggest challenges in dental care. As dental providers, you're probably all too familiar with the “two steps forward, one step back” struggle of keeping patients on board with ongoing management to prevent tooth loss and systemic complications.
While traditional treatment plans frequently switch from scaling and root planing to surgical interventions, new developments in noninvasive therapies offer promising adjuncts to help patients avoid the potential complications and painful recovery process of periodontal surgery. We may soon have a new addition to the toolkit from Orocidin A/S, a Danish pharmaceutical company specializing in periodontal treatments.
What's It Designed to Do?
Orocidin's new dental gel is called QR-01. The concept is to deliver an antimicrobial and anti-inflammatory agent that will stay in the pocket, delivering an active peptide over a prolonged period.
Like other locally applied chemotherapeutics for periodontitis, administering the gel should be simple. The product starts as a “low-viscosity gel” that should flow easily into the pocket from a syringe.
How Is It Different?
According to the company's recent press release, the gel changes state when it hits oral fluids. Rather than staying in a thin, flowable form, it changes into what the company describes as a “semi-solid bioadhesive crystalline matrix” that slowly releases its active ingredient over time. This controlled release should provide prolonged exposure to the affected areas, potentially improving treatment outcomes compared to irrigating with antimicrobial rinses like chlorhexidine, which don't have the necessary staying power.
Why Gel?
One significant challenge with developing a local medication for periodontal disease is creating a delivery method that will stay in place long enough to be effective. Between gingival crevicular fluid and the regular mechanical disruption between the teeth and gums, keeping medications in place for sustained release can be challenging.
Gels have shown amazing promise in solving this problem. Specifically, oleogels (fat-based gels) and bigels (which have properties of both water-based gels and oleogels) appear to be highly effective in the periodontal environment.
While the company doesn't state exactly what type of gel they're using, QR-01's formulation includes an “optimal balance of triglycerides, monoglycerides, and water.” Based on that information, it's likely that QR-01 is a bigel, which has superior bio-adhesiveness compared to hydrogels and higher drug release than oleogels.
This development in itself makes this gel an exciting prospect. However, what may genuinely set QR-01 apart from existing products like Arestin® is its mechanism of action.
What Is the Mechanism of Action?
QR-01 uses host defense peptides (HDPs) to control periodontal pathogens with bonus immunomodulation effects. In recent years, compelling research has explored HDPs as a potential solution to the ongoing problem of antibiotic resistance.
HDPs are naturally occurring compounds with many structures and effects on pathogens, including Gram-negative and Gram-positive bacteria, fungi, and viruses. The study of antimicrobial proteins and peptides in oral fluids is nothing new. However, isolating the most effective of these peptides as a chemotherapeutic agent will hopefully prove both novel and valuable.
How Will It Compare to Other Medications for Periodontitis?
Orocidin's dental gel must compete with several established locally applied chemotherapeutic agents. Arestin® (minocycline microspheres) is a widely used antibiotic that targets periodontal pathogens. However, minocycline resistance has been an ongoing concern. Its cost versus efficacy has also been somewhat controversial, and many practitioners are not convinced it's worth the risk or investment for patients.
Chlorhexidine gels and chips provide antimicrobial action but may cause staining and other side effects with long-term use. According to a recent meta-analysis, chlorhexidine's results are underwhelming compared to different antibiotics. More recently, alternative formulations like bromelain-quercetin gel and curcumin-based treatments have gained attention for their anti-inflammatory and antimicrobial properties, but their efficacy is unproven.
QR-01's success will depend on its ability to offer superior efficacy, better patient compliance, and fewer side effects than existing options. The concept is promising, and many provide solutions to many significant obstacles in successfully treating periodontal disease.
Preclinical Trials in Progress
QR-01 must pass rigorous testing before it can be used in dental practices. Orocidin A/S recently initiated preclinical toxicity trials, which are expected to conclude by the third quarter of 2025. If successful, the next step will be to pilot efficacy studies in human patients.
These trials will assess the gel's safety and effectiveness in real-world periodontal treatment. While promising, the product remains in the early stages of development, and further research is needed to determine its long-term benefits and clinical applications.
Promising Possibility For Another Tool in the Dental Toolbox
Trends in dentistry and periodontology have increasingly progressed toward minimally invasive therapies, from LANAP to Pinhole® Surgical Technique. Chemotherapeutics that can help control microbial load and reverse inflammation may give us another tool for controlling periodontitis non-surgically.
The product appears to have a lot going for it. One potential perk is its probable appeal to patients who are hesitant about medications and “chemicals.” Since HDPs are part of our body's immune defense system, they may appeal to patients interested in more natural remedies. It's also a significant potential solution to the over-prescription of antibiotics and the serious problems that come with it.
This gel must be at least as effective as other chemotherapeutics already on the market and more affordable than other non-surgical options like LANAP to be truly useful. For patients who are unlikely to follow through with a referral to a periodontist, a locally applied medication of this type can be a game-changer in general dental practice. These adjuncts can give your practice a significant leg up in attracting patients looking for effective and affordable care.
Author: Paige Anderson is a certified registered dental hygienist with eight years of clinical experience and an English degree. She blends her two areas of expertise to create resources for dental providers so they can change lives by giving their patients the highest possible standard of care.
