Full- vs. Partial-mouth Disinfection in the Treatment of Periodontal Infections: Short-term Clinical and Microbiological Observations

Abstract

In a standard periodontal treatment strategy with consecutive root planings (per quadrant at a one- to two-week interval), re-infection of a disinfected area might occur before completion of the treatment. This study examines, both clinically and microbiologically, whether a full-mouth disinfection within 24 hours significantly improves the outcome of periodontal treatment. Ten patients with advanced chronic periodontitis were randomly allocated to a test and a control group. The patients from the control group received scalings and root planings as well as oral hygiene instructions per quadrant at two-week intervals. Full-mouth disinfection in the test group was sought by the removal of all plaque and calculus (in two visits within 24 hours). In addition, at each of these visits, the tongue was brushed with a 1% chlorhexidine gel for one min and the mouth rinsed with a 0.2% chlorhexidine solution for two min. Furthermore, subgingival chlorhexidine (1%) irrigation was performed in all pockets. The recolonization of the pockets was retarded by oral hygiene and 0.2% chlorhexidine rinses during two weeks. The clinical parameters were recorded, and plaque samples were taken from the right upper quadrant at baseline and after one and two months. The test group patients showed a significantly higher reduction in probing depth for deep pockets at both follow-up visits (p < 0.05). At the one-month visit, differential phase-contrast microscopy revealed significantly lower proportions of spirochetes and motile rods in the test group (p = 0.01). Culturing showed that the test group harbored significantly fewer pathogenic organisms at one month (p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Full-mouth treatment versus quadrant root surface debridement in the treatment of chronic periodontitis: a systematic review

“…Vandekerckhove et al 31 reported eight months' follow up of the Quirynen et al 17 study. Higher reduction in probing depth was reported for the FMD group in initially moderate and deep pockets but this was statistically signifi cant only for the deep (≥7 mm) category (p = 0.01).…”

“…Mongardini et al 1999 36 The clinical data were reported in another study that is included (Quirynen et al 2000) 30 Quirynen et al 1995 17 The duration of the study less than six months. However, the long-term follow-up of the patients was reported in another study that is included 31 Quirynen et al 1998 37 Only microbiological data were reported …”

“…The other sug gested explanation for achieving bet ter outcomes by implementing the FMD approach was the release of more anti gens (LPS) in the blood circulation and the consequent body reaction and there fore acute inflammation and ultimately better healing, which was described as the Schwartzman reaction. 17 This was used to explain the greater rise in body temperature after the second session of scaling and root planing for patients in the test group. 30 According to Quirynen, the time scale of 24h between the start and completion of the debridement is critical to take advantage of this sys temic reaction.…”

“…Thus, the concept of one-stage full-mouth dis infection was introduced in an effort to prevent re-infection of the already treated sites by remaining bacteria from untreated pockets or other intraoral res ervoirs, by completing the treatment in 24 hours and strict use of antimicrobial agents, mainly chlorhexidine (CHX). 17 Additional probing depth reduction of 1 to 1.2 mm has been claimed as a result of this treatment approach. 18 On the other hand, several studies demonstrated an additional but only small clinical improvement when subgingival chlorhex idine irrigation was used as an adjunc tive therapy to scaling and root planing, whereas other studies failed to show even such an effect.…”

“…The original protocol introduced by Quirynen has been modified with regard to the use, type, duration and concentration of the antiseptic agents and, together with dif ferent homecare regimen, may explain the differences. 17 …”