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

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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). At two months, the same sites harbored singificantly more "beneficial" bacteria (p = 0.02). Moreover, all sites of the test group initially harboring P. gingivalis (6/10) became negative after treatment. These findings suggest that it is possible to achieve a significant improvement of the treatment outcome (both microbiologically and clinically) with a one-stage full-mouth disinfection.