One-stage Full-mouth Disinfection to Overcome Intra-oral Transmission of Periodontopathogens

Comparison of Bacterial Contamination and Antibacterial Efficacy in Bristles of Charcoal Toothbrushes versus Noncharcoal Toothbrushes: A Microbiological Study

Background:

Charcoal toothbrushes have been marketed widely claiming lesser bacterial contamination owing to the presence of activated charcoal.

Aim and Objective:

The aim of this study was to evaluate the bacterial contamination and antimicrobial efficacy of charcoal bristles compared to noncharcoal bristles in used toothbrushes.

Materials and Methods:

A total of 50 patients met inclusion criteria which were given standard brushing instructions on the use of a charcoal toothbrush and were asked to return the used brushes after 1 week of usage. After a washout period of 1-week, the participants were then provided with noncharcoal toothbrush and given similar brushing instructions to both groups and were instructed to return the brush after another week of usage. Bristles of the used toothbrushes were sectioned and placed in a 5 ml of saline, and 0.1 ml was inoculated on blood agar plates, which were then placed in a gas pack jar for anaerobic culture. Colony forming units (CFU) were measured after 48 h of incubation. To evaluate the antibacterial efficacy of charcoal bristles, the zone of inhibition was evaluated for charcoal versus noncharcoal after 24 h of incubation. Data collected were analyzed using a paired sample t-test.

Results:

The mean CFU count for noncharcoal bristles was almost double that of charcoal bristles. About 10 mm of the zone of inhibition was found around charcoal bristles as compared to 3 mm for noncharcoal bristles.

Conclusion:

This study shows the statistically significant difference in bacterial counts between bristle types and lower CFUs in the charcoal bristles compared with noncharcoal bristles, after 1 week of use. The zone of inhibition that was found around charcoal tooth bristles supported the antimicrobial properties of the charcoal toothbrush.

Use of the Strength of Recommendation Taxonomy (SORT) to assess full-mouth treatments of chronic periodontitis

Previous studies have not resolved whether scaling and root planing with a full-mouth (with or without antiseptics) or quadrant approach is better for treatment of chronic periodontitis. We identified relevant studies and used Strength of Recommendation Taxonomy (SORT) criteria to critically interpret the results of all relevant studies. A literature search was performed using the PubMed, EMBASE, and Cochrane databases up to July 2015. Selected studies were stratified according to their quality, quantity, and consistency. In total, 377 studies were identified, and 36 articles selected for retrieval were stratified according SORT criteria, as follows: no level 1 studies, 15 level 2 studies, and 21 level 3 studies (which were excluded from subsequent analysis). Among the selected level 2 studies, including seven randomized clinical trials and three systematic reviews, 67% showed no significant difference between scaling and root planing with a full-mouth or quadrant approach. In conclusion, on the basis of the best available data, the strength of evidence is grade B (consistent, low-quality evidence) for full-mouth (with or without antiseptics) and quadrant scaling and root planing for treatment of chronic periodontitis.

Effects of Full-Mouth Scaling and Root Planing in Conjunction With Systemically Administered Azithromycin

BACKGROUND

One-stage full-mouth disinfection (FMD), in which full-mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full-mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full-mouth SRP using azithromycin with conventional SRP.

METHODS

Thirty-four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full-mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment-producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline.

RESULTS

All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks.

CONCLUSION

It was shown that full-mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis.