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 quadran t, at 1- to 2- week intervals), without proper disinfection of the remainin g intra-oral niches for periodontopathogens. This could theoretically lead to a reinfection of previously disinfected pockets by bacteria from an untr eated region/niche. This study aimed to investigate, over an 8-month period , the clinical benefits of a one stage full-mouth disinfection in the contr ol of severe periodontitis. Methods: Sixteen patients with early-onset periodontitis and 24 patients wi th severe adult periodontitis were randomly assigned to test and control gr oups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given standard oral hygiene instructions. A one stage full-m outh disinfection (test group) was sought by scaling and root planing the 4 quadrants within 24 hours in combination with the application of chlorhexi dine 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 I, 2, 4, and 8 months afterwards. Results: The one stage full-mouth disinfection resulted, in comparison to t he standard therapy, in a significant (P < 0.001) additional probing depth reduction and gain in attachment up to 8 months. For initial pockets greate r than or equal to 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 te eth, 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 la rgest differences in the non-smoking adult periodontitis patients. Conclusions: These findings suggest that a one stage full-mouth disinfectio n results in an improved clinical outcome for the treatment of chronic adul t or early-onset periodontitis as compared to scaling and root planing per quadrant at 2-week intervals.