The role of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis - Long-term clinical and microbiological observations

Background/aims: Recent studies reported significant additional clinical an d microbiological improvements when severe adult periodontitis was treated by means of a "one-stage full-mouth" disinfection instead of a standard tre atment strategy with consecutive root planings quadrant per quadrant. The o ne stage full- mouth disinfection procedure involves scaling and rootplanin g of all pockets within 24 h in combination with an extensive application o f chlorhexidine to all intra-oral niches such as periodontal pockets, tongu e dorsum, tonsils (chairside, and at home for 2 months). This study aims to examine the relative importance of the use of chlorhexidine in the one sta ge full-mouth disinfection protocol. Methods: Therefore, 3 groups of 12 patients each with advanced periodontiti s were followed, both from a clinical and microbiological point of view ove r a period of 8 months. The patients from the control group were scaled and root planed, quadrant per quadrant, at two-week intervals. The 2 other gro ups underwent a one stage full-mouth scaling and root planing (all pockets within 24 h) with (Fdis) or without (FRp=full-mouth rootplaning) the adjunc tive use of chlorhexidine. At baseline and after 1, 2, 4 and 8 months, the following clinical parameters were recorded: plaque and gingivitis indices, probing depth, bleeding on probing and clinical attachment level. Microbio logical samples were taken from different intra-oral niches (tongue, mucosa ; saliva and pooled samples from single- and multirooted teeth). The sample s were cultured an selective and non-selective media in order to evaluate t he number of CFU/ml for the key-periodontopathogens. At baseline, an anonym ous questionnaire was given to the patients to record the perception of eac h treatment (post operative pain, fever, swelling etc.). Results: All 3 treatment strategies resulted in significant improvements fo r all clinical parameters, but the Fdis and FRp patients reacted always sig nificantly more favourably than the control group, with an additional probi ng depth reduction of +/- 1.5 mm and an additional gain in attachment of +/ -2 mm (for pockets greater than or equal to 7 mm). Also from a microbiologi cal point of view both the FRp and Fdis patients showed additional improvem ents when compared to the control group, as well in the reduction of spiroc hetes and motile organisms as in the number of CFU/ml of the key-pathogens, especially when the subgingival plaque samples were considered. The differ ences between FRp and Fdis patients were negligible. Conclusions: These findings suggest that the benefits of a "one-stage full- mouth disinfection" in the treatment of patients suffering from severe adul t periodontitis probably results from the full-mouth scaling and root plani ng within 24 h rather than the beneficial effect of chlorhexidine. The rais e in body temperature the second day after the full-mouth scaling and root planing seems to indicate a Shwartzman reaction.