One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. II. Long-term impact on microbial load.
BACKGROUND
Recent studies showed the clinical benefits of a one stage full-mouth disinfection, when compared to the worldwide standard treatment strategy of consecutive root planings per quadrant without proper disinfection of the remaining intraoral niches. The purpose of this study was to investigate the microbiological benefits of such a one stage full-mouth disinfection with special attention to all intraoral niches for periodontopathogens and to evaluate the perception by the patients of the new treatment strategy.


METHODS
Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given oral hygiene instructions. The test group received the one stage full-mouth disinfection treatment. At baseline and after 1, 2, 4, and 8 months, microbiological samples were taken from all niches (tongue, mucosa, saliva, and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media. Patient perception of the treatment was evaluated using a questionnaire.


RESULTS
In comparison to the standard therapy, the one stage full-mouth disinfection resulted in significant additional microbial improvements. The test group showed larger reductions in the proportions of spirochetes and motile organisms in the subgingival flora, and more significant reductions in the density of key pathogens, with even the eradication of P. gingivalis. The beneficial effects in the other niches were primarily restricted to the number of colony-forming units/ml of black-pigmented bacteria, especially on the mucosa and in the saliva and to a lesser extent on the tongue. Both treatments were well tolerated by the patients and the overall severity rating for both therapies was comparable, although 4 quadrants were treated within 24 hours in the test group versus only 1 in the control group. The full-mouth disinfection approach resulted more frequently in a slight increase of body temperature, especially after the second day.


CONCLUSIONS
These findings support the benefit of a one stage full-mouth disinfection in the treatment of patients with either chronic adult or early-onset periodontitis.
Department of Periodontology, Faculty of Medicine, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Belgium. Marc.Quirynen@med.kuleuven.ac.be
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Quirynen
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Mongardini
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Pauwels
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Bollen
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Van Eldere
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van Steenberghe
D000328:Adult; D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans / Q000187:drug effects; D010520:Aggressive Periodontitis / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001421:Bacteria, Anaerobic / Q000187:drug effects*; D002710:Chlorhexidine / Q000008:administration & dosage*; D015169:Colony Count, Microbial; D003773:Dental Plaque / Q000382:microbiology; D003774:Dental Plaque Index; D003777:Dental Prophylaxis / Q000379:methods*; D012534:Dental Scaling; D004311:Double-Blind Method; D017050:Episode of Care; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology*; D009067:Mouthwashes / Q000008:administration & dosage; D017060:Patient Satisfaction; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000382:microbiology; D010518:Periodontitis / Q000188:drug therapy* / Q000382:microbiology* / Q000628:therapy; D016966:Porphyromonas gingivalis / Q000187:drug effects; D012044:Regression Analysis; D016745:Root Planing; D012907:Smoking; D013144:Spirochaetales / Q000187:drug effects; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D002710:Chlorhexidine