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Full-mouth disinfection for the treatment of adult chronic periodontitis

Eberhard J, Jepsen S, Jervøe-Storm P-M, Needleman I, Worthington HV

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Summary

Full-mouth disinfection for the treatment of adult chronic periodontitis

Full-mouth scaling, full-mouth disinfection and quadrant scaling are equally suitable for the treatment of adult chronic periodontitis.
Therapy of chronic periodontitis is based on the mechanical removal of subgingival bacteria from infected root surfaces in order to arrest and control the loss of tooth supporting bone and tissues. Non-surgical periodontal therapy can be carried out either quadrantwise in discrete sessions over a period of several weeks, or within 24 hours in one or two sessions termed full-mouth scaling. The latter can be supplemented with the extended use of an antiseptic agent in the context of full-mouth disinfection. The rationale for full-mouth approaches is to eliminate or reduce pathogenic bacteria from oral habitats that may lead to re-infection of already treated sites. The results of this review have shown that the treatment effects of full-mouth scaling or full-mouth disinfection compared to conventional scaling and root planing are modest and the implications for periodontal care are not profound. In practice the decision to select one approach to non-surgical periodontal therapy over another needs to include patient preferences and convenience of the treatment schedule.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Eberhard J, Jepsen S, Jervøe-Storm PM, Needleman I, Worthington HV. Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004622. DOI: 10.1002/14651858.CD004622.pub2.

This version first published online: January 23. 2008

Abstract

Background

In an attempt to enhance treatment outcomes, alternative protocols for anti-infective periodontal therapy have been introduced.

Objectives

To evaluate the effectiveness of full-mouth disinfection or full-mouth scaling compared to conventional quadrant scaling for periodontitis.

Search strategy

Data sources included electronic databases, handsearched journals and contact with experts. The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information.
Date of most recent searches: December 2006: CENTRAL (The Cochrane Library 2006, Issue 4).

Selection criteria

Randomised controlled trials were selected with at least 3 months follow up comparing full-mouth scaling and root planing within 24 hours with (FMD) or without (FMS) the adjunctive use of an antiseptic (chlorhexidine) with conventional quadrant scaling and root planing (control). The methodological quality of the studies was assessed within the data extraction form, mainly focusing on: method of randomisation, allocation concealment, blindness of examiners and completeness of follow up.

Data collection and analysis

Data extraction and quality assessment were conducted independently by multiple review authors. The primary outcome measure was tooth loss, secondary outcomes were reduction of probing depth, bleeding on probing and gain in probing attachment. The Cochrane Collaboration statistical guidelines were followed.

Main results

The search identified 216 abstracts. Review of these abstracts resulted in 12 publications for detailed review. Finally, seven randomised controlled trials (RCTs) which met the criteria for eligibility were independently selected by two review authors. None of the studies included reported on tooth loss. All treatment modalities led to significant improvements in clinical parameters after a follow up of at least 3 months. For the secondary outcome, reduction in probing depth, the mean difference between FMD and control was 0.53 mm (95% confidence interval (CI) 0.28 to 0.77) in moderately deep pockets of single rooted teeth and for gain in probing attachment 0.33 mm (95% CI 0.04 to 0.63) in moderately deep single and multirooted teeth. Comparing FMD and FMS the mean difference in one study for gain in probing attachment amounted to 0.74 mm in favour of FMS (95% CI 0.17 to 1.31) for deep pockets in multirooted teeth, while another study reported a mean difference for reduction in bleeding on probing of 18% in favour of FMD (95% CI -34.30 to -1.70) for deep pockets of single rooted teeth. No significant differences were observed for any of the outcome measures, when comparing FMS and control.

Authors' conclusions

In patients with chronic periodontitis in moderately deep pockets slightly more favourable outcomes for pocket reduction and gain in probing attachment were found following FMD compared to control. However, these additional improvements were only modest and there was only a very limited number of studies available for comparison, thus limiting general conclusions about the clinical benefit of full-mouth disinfection.

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