The intra-oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy. A review of the literature.
BACKGROUND
Although periodontitis has a multi-factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra-oral hard surfaces) and even in the oro-pharyngeal area (e.g., the sinus and the tonsils).


METHODS
This review article discusses the intra-oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra-oral translocation.


CONCLUSIONS
Based on the literature, the oro-pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve "a one stage approach" of all pathologic pockets (1-stage full-mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period. For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining dentition. This more global approach offers significant additional clinical and microbiological benefits.
Quirynen
M
M
Catholic University of Leuven, Faculty of Medicine, Department of Periodontology, School of Dentistry, Oral Pathology & Maxillofacial Surgery, Belgium. Marc.Quirynen@med.kuleuven.ac.be
De Soete
M
M
Dierickx
K
K
van Steenberghe
D
D
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001422:Bacterial Adhesion; D012534:Dental Scaling; D006090:Gram-Negative Bacteria / Q000502:physiology*; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D009061:Mouth Mucosa / Q000382:microbiology; D009960:Oropharynx / Q000382:microbiology; D014066:Palatine Tonsil / Q000382:microbiology; D010514:Periodontal Pocket / Q000382:microbiology; D010518:Periodontitis / Q000382:microbiology* / Q000628:therapy; D016745:Root Planing; D012463:Saliva / Q000382:microbiology; D014059:Tongue / Q000382:microbiology; D016896:Treatment Outcome; D014945:Wound Healing
D000891:Anti-Infective Agents, Local