M. Quirynen et al., THE EFFECT OF A 1-STAGE FULL-MOUTH DISINFECTION ON ORAL MALODOR AND MICROBIAL COLONIZATION OF THE TONGUE IN PERIODONTITIS PATIENTS - A PILOT-STUDY, Journal of periodontology, 69(3), 1998, pp. 374-382
ORAL MALODOR AFFECTS A LARGE proportion of the population and may be t
he cause of a significant social and psychological handicap. This pilo
t study aimed to examine whether a 1-stage full-mouth disinfection in
periodontitis patients (scaling and root planing of all pockets within
24 hours together with the application of chlorhexidine to all intra-
oral niches followed by chlorhexidine mouth rinsing for 2 months) resu
lted in a significant improvement in malodor when compared to a fracti
onated periodontal therapy (consecutive root planings per quadrant, at
a 1 to 2 week interval). The baseline and outcome data concerning ora
l malodor were linked to the presence of tongue coating and to its rou
ghness (fissures). Twenty-four patients with severe periodontitis were
randomly allocated to test and control groups. At baseline and after
1 and 2 months, the concentration of volatile sulfur compounds (VSC) i
n the mouth was measured and organoleptic ratings (expired air and tot
al mouth air) were given. Plaque samples were collected from the dorsu
m of the tongue to calculate the number of colony forming units (CFU)
per ml (anaerobic culturing) as well as the number of pigmented CFU/ml
. Both the baseline organoleptic ratings and the VSC scores correlated
well with the presence of tongue coating but not with the tongue roug
hness. Because a correlation between tongue coating and its microbial
load could not be detected, it was hypothesized that the tongue coatin
g per se, and not the bacteria, might be responsible for the malodor.
The 1-stage full-mouth disinfection resulted in a faster and additiona
l reduction in the organoleptic ratings of the oral malodor, even afte
r 3, months. This might be explained by the improved periodontal outco
me and/or the more significant reduction in the CFU/ml of pigmented sp
ecies. In contrast to the organoleptic ratings, which were significant
ly reduced in both treatment groups (when compared to baseline), the V
SC levels remained unchanged. This pilot study indicates that a 1-stag
e full-mouth disinfection has, in comparison to a standard periodontal
therapy, additional beneficial effects in the treatment of oral malod
or.