One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. I. Long-term clinical observations.
BACKGROUND
A standard treatment strategy for periodontal infections often consists of 4 consecutive sessions of scaling and root planing (per quadrant, at 1- to 2-week intervals), without proper disinfection of the remaining intra-oral niches for periodontopathogens. This could theoretically lead to a reinfection of previously disinfected pockets by bacteria from an untreated region/niche. This study aimed to investigate, over an 8-month period, the clinical benefits of a one stage full-mouth disinfection in the control of severe periodontitis.


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 standard oral hygiene instructions. A one stage full-mouth disinfection (test group) was sought by scaling and root planing the 4 quadrants within 24 hours in combination with the application of chlorhexidine to all intra-oral niches for periodontopathogens. Besides oral hygiene, the test group also rinsed twice daily with a 0.2% chlorhexidine solution and sprayed the tonsils with a 0.2% chlorhexidine spray, for 2 months. The plaque index, gingival index, probing depth, bleeding on probing, gingival recession, and clinical attachment level were recorded at baseline and at 1, 2, 4, and 8 months afterwards.


RESULTS
The one stage full-mouth disinfection resulted, in comparison to the standard therapy, in a significant (P <0.001) additional probing depth reduction and gain in attachment up to 8 months. For initial pockets > or =7 mm, the "additional" probing depth reduction at the 8 month follow-up was 1.2 mm for single-rooted and 0.9 mm for multi-rooted teeth, with corresponding additional gains in attachment of 1.0 mm and 0.8 mm, respectively. The additional improvements were observed for all subgroups (adult periodontitis, generalized early-onset cases, smokers), with the largest differences in the non-smoking adult periodontitis patients.


CONCLUSIONS
These findings suggest that a one stage full-mouth disinfection results in an improved clinical outcome for the treatment of chronic adult or early-onset periodontitis as compared to scaling and root planing per quadrant at 2-week intervals.
Mongardini
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C
Department of Periodontology, Faculty of Medicine, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Belgium.
van Steenberghe
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D
Dekeyser
C
C
Quirynen
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M
D000328:Adult; D000336:Aerosols; D000368:Aged; D010520:Aggressive Periodontitis / Q000188:drug therapy / Q000628:therapy; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage*; D003774:Dental Plaque Index; D003777:Dental Prophylaxis / Q000379:methods*; D012534:Dental Scaling; D017050:Episode of Care; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage; D017060:Patient Satisfaction; D017622:Periodontal Attachment Loss / Q000175:diagnosis; D010512:Periodontal Index; D010518:Periodontitis / Q000188:drug therapy* / Q000628:therapy; D012044:Regression Analysis; D016745:Root Planing; D016037:Single-Blind Method; D012907:Smoking; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D000336:Aerosols; D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D002710:Chlorhexidine