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Li Y, Xu C, Mao J, Mao L, Li W, Liu Z, Shin A, Wu J, Hou L, Li D, Lin K, Liu J. ZIF-8-based Nanoparticles for Inflammation Treatment and Oxidative Stress Reduction in Periodontitis. ACS APPLIED MATERIALS & INTERFACES 2024; 16:36077-36094. [PMID: 38949426 DOI: 10.1021/acsami.4c05722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Periodontitis, an inflammatory bone resorption disease associated with dental plaque, poses significant challenges for effective treatment. In this study, we developed Mino@ZIF-8 nanoparticles inspired by the periodontal microenvironment and the unique properties of zeolitic imidazolate framework 8, aiming to address the complex pathogenesis of periodontitis. Transcriptome analysis revealed the active engagement of Mino@ZIF-8 nanoparticles in innate and adaptive inflammatory host defense and cellular metabolic remodeling. Through sustained release of the anti-inflammatory and antibacterial agent minocycline hydrochloride (Mino) and the generation of Zn2+ with pro-antioxidant effects during degradation, Mino@ZIF-8 nanoparticles synergistically alleviate inflammation and oxidative damage. Notably, our study focuses on the pivotal role of zinc ions in mitochondrial oxidation protection. Under lipopolysaccharide (LPS) stimulation, periodontal ligament cells undergo a metabolic shift from oxidative phosphorylation (OXPHOS) to glycolysis, leading to reduced ATP production and increased reactive oxygen species levels. However, Zn2+ effectively rebalances the glycolysis-OXPHOS imbalance, restoring cellular bioenergetics, mitigating oxidative damage, rescuing impaired mitochondria, and suppressing inflammatory cytokine production through modulation of the AKT/GSK3β/NRF2 pathway. This research not only presents a promising approach for periodontitis treatment but also offers novel therapeutic opportunities for zinc-containing materials, providing valuable insights into the design of biomaterials targeting cellular energy metabolism regulation.
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Affiliation(s)
- Yaxin Li
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Chenci Xu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Jing Mao
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 201204, China
| | - Lixia Mao
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Weiqi Li
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Ziyang Liu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Airi Shin
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Jiaqing Wu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Lingli Hou
- Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Dejian Li
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201301, China
| | - Kaili Lin
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
| | - Jiaqiang Liu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
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Izidoro C, Botelho J, Machado V, Reis AM, Proença L, Alves RC, Mendes JJ. Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11303. [PMID: 36141577 PMCID: PMC9516975 DOI: 10.3390/ijerph191811303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
Halitosis, or bad breath, is an oral health problem characterized by an unpleasant malodor emanating from the oral cavity. This condition can have different origins and causes a negative burden in social interactions, communication and quality of life, and can in uncommon cases be indicative of underlying non-oral non-communicable diseases. Most cases of halitosis are due to inadequate oral hygiene, periodontitis and tongue coating, yet the remaining proportion of cases are due to ear-nose-throat-associated (10%) or gastrointestinal/endocrine (5%) disorders. For this reason, the diagnosis, treatment and clinical management of halitosis often require a multidisciplinary team approach. This comprehensive review revisits the etiology of halitosis as well as standard and novel treatment that may contribute to higher clinical success.
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Affiliation(s)
- Catarina Izidoro
- Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, 2829-511 Monte de Caparica, Portugal
| | - João Botelho
- Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, 2829-511 Monte de Caparica, Portugal
| | - Vanessa Machado
- Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, 2829-511 Monte de Caparica, Portugal
| | - Ana Mafalda Reis
- Instituto de Ciências Biomédicas Abel Salazar, School of Health and Life Sciences, University of Porto, 4099-002 Porto, Portugal
- Neuroradiology Department, Hospital Pedro Hispano, 4464-513 Matosinhos, Portugal
| | - Luís Proença
- Quantitative Methods for Health Research Unit (MQIS), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
| | - Ricardo Castro Alves
- Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, 2829-511 Monte de Caparica, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, 2829-511 Monte de Caparica, Portugal
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Stein JM, Yekta-Michael SS, Schittenhelm F, Reichert S, Kupietz D, Dommisch H, Kasaj A, Wied S, Vela OC, Stratul SI. Comparison of three full-mouth concepts for the non-surgical treatment of stage III and IV periodontitis: A randomized controlled trial. J Clin Periodontol 2021; 48:1516-1527. [PMID: 34517434 DOI: 10.1111/jcpe.13548] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022]
Abstract
AIM To evaluate the clinical efficacy of full-mouth scaling (FMS), full-mouth disinfection (FMD), and FMD with adjuvant erythritol air-polishing (FMDAP) compared to quadrant-wise debridement (Q-SRP) in patients with periodontitis stage III/IV. METHODS In this four-arm parallel, prospective, randomized, controlled multi-centre study, changes of pocket probing depths (PPDs), clinical attachment level (CAL), bleeding on probing (BOP), and proportion of closed pockets (PPD ≤4 mm without BOP) were evaluated at baseline and after 3 and 6 months. RESULTS From 190 randomly participating patients, 172 were included in the final analysis. All groups showed significant (p < .05) improvements in all clinical parameters over 3 and 6 months. During the study period, FMDAP showed significantly higher reductions of mean PPD in teeth with moderate (PPD 4-6 mm) and deep (PPD > 6 mm) pockets and significantly increased proportions of pocket closure than Q-SRP. Patients treated with FMD had significantly greater PPD reduction in deep pockets and a higher percentage of pocket closure after 3 months but not after 6 months compared to Q-SRP. CAL and BOP changes did not significantly differ among all groups. Efficiency of treatment (time effort to gain one closed pocket) was significantly higher for FMDAP, FMD, and FMS compared to Q-SRP (6.3, 8.5, 9.5 vs. 17.8 min per closed pocket; p < .05). CONCLUSIONS All treatment modalities were effective, without significant differences between full-mouth approaches. FMDAP showed improved clinical outcomes over Q-SRP for moderate and deep pockets after 6 months. Full-mouth protocols were more time-efficient than conventional Q-SRP. CLINICAL SIGNIFICANCE The trial was registered in a clinical trial database (ClinicalTrials.gov: NCT03509233).
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Affiliation(s)
- Jamal M Stein
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH), Aachen, Germany.,Private Practice, Aachen, Germany
| | | | - Florian Schittenhelm
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH), Aachen, Germany.,Private Practice, Aachen, Germany
| | - Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin Luther University, Mainz, Germany
| | - David Kupietz
- Department of Operative Dentistry and Periodontology, Martin Luther University, Mainz, Germany
| | - Henrik Dommisch
- Department of Oral Medicine and Oral Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Adrian Kasaj
- Department of Periodontology and Operative Dentistry, University Medical Center, Mainz, Germany
| | - Stephanie Wied
- Department of Medical Statistics, University Hospital (RWTH), Aachen, Germany
| | - Octavia-Carolina Vela
- Department of Periodontology, Anton Sculean Center for Research and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, Romania
| | - Stefan-Ioan Stratul
- Department of Periodontology, Anton Sculean Center for Research and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, Romania
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Engel Naves Freire A, Macedo Iunes Carrera T, de Oliveira GJPL, Pigossi SC, Vital Ribeiro Júnior N. Comparison between Antimicrobial Photodynamic Therapy and Low-level laser therapy on non-surgical periodontal treatment: A Clinical Study. Photodiagnosis Photodyn Ther 2020; 31:101756. [PMID: 32302705 DOI: 10.1016/j.pdpdt.2020.101756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/11/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alternative antibacterial therapeutic modalities, such as antimicrobial photodynamic therapy (aPDT) and low-level laser therapy (LLLT), have been proposed to improve the effectiveness of periodontal treatment. However, clinical studies evaluating the efficiency of these treatments have been inconclusive, partly due to contradictory results regarding their clinical and microbiological effects. The aim of this study was to evaluate the clinical effects of aPDT and LLLT after a one-stage full-mouth disinfection (OSFMD) protocol during periodontitis treatment. METHODS A split-mouth clinical trial was conducted in 20 patients presenting at least two contralateral teeth with a probing pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) on both sides of the mouth. All patients were submitted to an OSFMD protocol. The selected sites randomly received either (1) aPDT (methylene blue as a photosensitizer activated by red and infrared diode laser) or (2) LLLT (red and infrared diode laser). Clinical parameters were assessed at baseline and at 4 and 12 weeks post-treatment. RESULTS Both treatment protocols promoted significant reductions in PD, number of deep pockets and BOP and an increase in clinical attachment level (CAL) after 4 and 12 weeks, but there were no differences between the two groups. There was no change in the gingival level (GL) of either group for all periods of analysis. A decrease in the number of moderate pockets (4-5 mm) was found in the LLLT group (5.15 ± 4.20) when compared to the aPDT group (7.10 ± 5.24), but only after 4 weeks. CONCLUSIONS In conclusion, both the aPDT and LLLT therapies promoted improvements in periodontal clinical parameters after the OSFMD protocol; however, in general, there were no distinct differences between the two treatment modalities evaluated in this study.
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Affiliation(s)
- Alice Engel Naves Freire
- Department of Clinics and Surgery, School of Dentistry, Alfenas Federal University, Gabriel Monteiro St, 700, Center, 37130-001, Alfenas, MG, Brazil
| | - Thaisa Macedo Iunes Carrera
- Department of Clinics and Surgery, School of Dentistry, Alfenas Federal University, Gabriel Monteiro St, 700, Center, 37130-001, Alfenas, MG, Brazil
| | | | - Suzane Cristina Pigossi
- Department of Clinics and Surgery, School of Dentistry, Alfenas Federal University, Gabriel Monteiro St, 700, Center, 37130-001, Alfenas, MG, Brazil.
| | - Noé Vital Ribeiro Júnior
- Department of Clinics and Surgery, School of Dentistry, Alfenas Federal University, Gabriel Monteiro St, 700, Center, 37130-001, Alfenas, MG, Brazil
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Martelli FS. Author's reply to letter from the SIdP, Italian Society of Periodontology and Implantology on: Long-term efficacy of microbiology-driven periodontal laser-assisted therapy. Eur J Clin Microbiol Infect Dis 2016; 36:399-401. [PMID: 27738854 PMCID: PMC5253142 DOI: 10.1007/s10096-016-2786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 11/24/2022]
Affiliation(s)
- F S Martelli
- Microdentistry, Via dell'Ariento 4, 50123, Florence, Italy.
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The use of platelet-rich fibrin combined with periodontal ligament and jaw bone mesenchymal stem cell sheets for periodontal tissue engineering. Sci Rep 2016; 6:28126. [PMID: 27324079 PMCID: PMC4914939 DOI: 10.1038/srep28126] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/27/2016] [Indexed: 01/05/2023] Open
Abstract
Periodontal regeneration involves the restoration of at least three unique tissues: cementum, periodontal ligament tissue (PDL) and alveolar bone tissue. Here, we first isolated human PDL stem cells (PDLSCs) and jaw bone mesenchymal stem cells (JBMSCs). These cells were then induced to form cell sheets using an ascorbic acid-rich approach, and the cell sheet properties, including morphology, thickness and gene expression profile, were compared. Platelet-rich fibrin (PRF) derived from human venous blood was then fabricated into bioabsorbable fibrin scaffolds containing various growth factors. Finally, the in vivo potential of a cell-material construct based on PDLSC sheets, PRF scaffolds and JBMSC sheets to form periodontal tissue was assessed in a nude mouse model. In this model, PDLSC sheet/PRF/JBMSC sheet composites were placed in a simulated periodontal space comprising human treated dentin matrix (TDM) and hydroxyapatite (HA)/tricalcium phosphate (TCP) frameworks. Eight weeks after implantation, the PDLSC sheets tended to develop into PDL-like tissues, while the JBMSC sheets tended to produce predominantly bone-like tissues. In addition, the PDLSC sheet/PRF/JBMSC sheet composites generated periodontal tissue-like structures containing PDL- and bone-like tissues. Further improvements in this cell transplantation design may have the potential to provide an effective approach for future periodontal tissue regeneration.
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Martelli FS, Fanti E, Rosati C, Martelli M, Bacci G, Martelli ML, Medico E. Long-term efficacy of microbiology-driven periodontal laser-assisted therapy. Eur J Clin Microbiol Infect Dis 2016; 35:423-31. [DOI: 10.1007/s10096-015-2555-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/10/2015] [Indexed: 12/23/2022]
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Fang H, Han M, Li QL, Cao CY, Xia R, Zhang ZH. Comparison of full-mouth disinfection and quadrant-wise scaling in the treatment of adult chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 2015; 51:417-30. [PMID: 26477533 DOI: 10.1111/jre.12326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2015] [Indexed: 11/28/2022]
Abstract
Scaling and root planing are widely considered as effective methods for treating chronic periodontitis. A meta-analysis published in 2008 showed no statistically significant differences between full-mouth disinfection (FMD) or full-mouth scaling and root planing (FMS) and quadrant scaling and root planing (Q-SRP). The FMD approach only resulted in modest additional improvements in several indices. Whether differences exist between these two approaches requires further validation. Accordingly, a study was conducted to further validate whether FMD with antiseptics or FMS without the use of antiseptics within 24 h provides greater clinical improvement than Q-SRP in patients with chronic periodontitis. Medline (via OVID), EMBASE (via OVID), PubMed and CENTRAL databases were searched up to 27 January 2015. Randomized controlled trials comparing FMD or FMS with Q-SRP after at least 3 mo were included. Meta-analysis was performed to obtain the weighted mean difference (WMD), together with the corresponding 95% confidence intervals. Thirteen articles were included in the meta-analysis. The WMD of probing pocket depth reduction was 0.25 mm (p < 0.05) for FMD vs. Q-SRP in single-rooted teeth with moderate pockets, and clinical attachment level gain in single- and multirooted teeth with moderate pockets was 0.33 mm (p < 0.05) for FMD vs. Q-SRP. Except for those, no statistically significant differences were found in the other subanalyses of FMD vs. Q-SRP, FMS vs. Q-SRP and FMD vs. FMS. Therefore, the meta-analysis results showed that FMD was better than Q-SRP for achieving probing pocket depth reduction and clinical attachment level gain in moderate pockets. Additionally, regardless of the treatment, no serious complications were observed. FMD, FMS and Q-SRP are all effective for the treatment of adult chronic periodontitis, and they do not lead to any obvious discomfort among patients. Moreover, FMD had modest additional clinical benefits over Q-SRP, so we prefer to recommend FMD as the first choice for the treatment of adult chronic periodontitis.
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Affiliation(s)
- H Fang
- College & Hospital of Stomatology, Key Lab. of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, China
| | - M Han
- College & Hospital of Stomatology, Key Lab. of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, China
| | - Q-L Li
- College & Hospital of Stomatology, Key Lab. of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, China
| | - C Y Cao
- College & Hospital of Stomatology, Key Lab. of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, China
| | - R Xia
- The 2nd Hospital affiliated to Anhui Medical University, Hefei, China
| | - Z-H Zhang
- Hospital of Anhui Province, Hefei, China
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Nagarakanti S, Gunupati S, Chava VK, Reddy BVR. Effectiveness of Subgingival Irrigation as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Systematic Review. J Clin Diagn Res 2015; 9:ZE06-9. [PMID: 26393230 DOI: 10.7860/jcdr/2015/13862.6210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/02/2015] [Indexed: 11/24/2022]
Abstract
AIM Subgingival applications of various chemotherapeutic agents have been used as an adjunct to nonsurgical periodontal treatment and preventive periodontal therapy. Their use in regular clinical practice, however, is less, perhaps due to concerns about clinical success or probably due to a lack of knowledge of their effectiveness or cost. The aim of this systematic review is to obtain overall quantitative estimate of effectiveness of subgingival irrigation (SI) in the treatment of chronic periodontitis. MATERIALS AND METHODS A literature search of electronic database was performed for articles published through December 31, 2014, followed by manual search of dental journals. Randomized controlled trails (RCTs) assessing the effect of SI as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis evaluated by changes in the clinical and microbiological outcomes were included. RESULTS This literature search yielded only two randomized, placebo-controlled studies that evaluated the efficacy of SI as an adjunct to SRP in patients with chronic periodontitis. The studies were methodologically not perfect (in terms of mediocre quality) with a risk of bias to come to any final conclusions to be reached. These studies didn't clearly mention about randomization, allocation concealment, blinding, dosage and formulation of irrigants, severity of periodontal disease, patient-centered outcomes and results data. CONCLUSION Due to insufficient evidence supporting the efficacy of SI as an adjunct to SRP in treating chronic periodontitis, more rigorous scientific research is required to assess the efficacy of SI as an adjunct to SRP in the treatment of periodontal diseases.
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Affiliation(s)
- Sreenivas Nagarakanti
- Associate Professor, Department of Periodontics, Narayana Dental College & Hospital , Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Sumanth Gunupati
- Senior Lecturer, Department of Periodontics, Narayana Dental College & Hospital , Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Vijay Kumar Chava
- Professor & Head, Department of Periodontics, Narayana Dental College & Hospital , Chinthareddypalem, Nellore, Andhra Pradesh, India
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Clinical and microbiological effects of quadrant versus full-mouth root planing—A randomized study. J Dent Sci 2014. [DOI: 10.1016/j.jds.2013.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bolyarova-Konova T, Dencheva-Garova M, Kisselova-Yaneva A. Application of Diode Laser Fotona XD-2 as Adjunctive Therapy in Non-Surgical Treatment of Periodontal Infections Among Patients on Renal Replacement Therapy. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.5504/bbeq.2012.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cortelli JR, Castro MVMD, Balejo RDP, Alencar COD, Gargioni Filho AC, Cortelli SC, Costa FO. Clinical and microbiological evaluation of one-stage full-mouth disinfection: a short-term study. REVISTA DE ODONTOLOGIA DA UNESP 2013. [DOI: 10.1590/s1807-25772013000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Patients seem to adhere better to short-term periodontal treatment schemes. Besides, time-reduced treatments are more cost-effective. However, the degree of benefits related to this type of treatment still requires additional investigations. AIM: The present short-term study evaluated clinical and microbiological outcomes, from baseline to 3-months, of chronic periodontitis subjects treated by the one-stage full-mouth disinfection protocol. MATERIAL AND METHOD: Sixteen chronic periodontitis subjects (mean-age 49.87 ± 8.22) who met inclusion/exclusion criteria were included. A calibrated examiner measured whole-mouth plaque and gingival indices, periodontal pocket depth and clinical attachment level at baseline and at 3-months. Subgingival samples were also collected from the 5 most diseased periodontal sites to determine total bacterial load and levels of P. gingivalis and S. oralis by real time qPCR. Periodontal treatment consisted of full-mouth manual debridement plus wide intraoral use of chlorhexidine in gel and solution. Additionally, after debridement, individuals rinsed 0.12% chlorhexidine at home twice a day for the following 2 months. Data monitored were compared by paired Student-t test (p<0.05). RESULT: Statistical analysis revealed that, in general, one-stage full-mouth disinfection treatment provided significant clinical and microbiological improvements at 3-months. Total bacterial load showed one of the most pronounced reductions from baseline to 3-months (p=0.0001). Also, subgingival levels P. gingivalis and S. oralis reduced overtime. CONCLUSION: After a short period of monitoring, chronic periodontitis subjects showed clinical and microbial improvements following one-stage full-mouth disinfection treatment.
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Bollen CML, Beikler T. Halitosis: the multidisciplinary approach. Int J Oral Sci 2012; 4:55-63. [PMID: 22722640 PMCID: PMC3412664 DOI: 10.1038/ijos.2012.39] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/16/2012] [Indexed: 12/02/2022] Open
Abstract
Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.
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Affiliation(s)
- Curd M L Bollen
- Department of Periodontology, Universitktsklinikum, Dosseldorf, Germany.
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Thöne-Mühling M, Swierkot K, Nonnenmacher C, Mutters R, Flores-de-Jacoby L, Mengel R. Comparison of two full-mouth approaches in the treatment of peri-implant mucositis: a pilot study. Clin Oral Implants Res 2010; 21:504-12. [DOI: 10.1111/j.1600-0501.2009.01861.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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15
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Stratul SI, Rusu D, Didilescu A, Mesaros-Anghel M, Lala C, Tion L, Sculean A, Jentsch H. Prospective clinical study evaluating the long-time adjunctive use of chlorhexidine after one-stage full-mouth SRP. Int J Dent Hyg 2010; 8:35-40. [PMID: 20096080 DOI: 10.1111/j.1601-5037.2009.00390.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Scaling and root planing are the causal procedure in the treatment of periodontitis. Many attempts have been made to improve the outcome. The aim of this study was to verify the influence of the extended use of chlorhexidine after one-stage full-mouth (FM) SRP in patients with chronic periodontitis on the clinical outcome after 3 months. METHODS Eighty-one patients with pockets > or =5 mm were treated by FM. All patients rinsed additionally with 0.2% chlorhexidine (CHX) twice daily over 3 months. Plaque index, bleeding on probing, probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and after 1 and 3 months. RESULTS In the test group, all variables were significantly improved after 1 and 3 months. Mean reduction of PD and CAL gain was 2.25 +/- 1.08 and 1.67 +/- 1.08 after 1 and 2.99 +/- 1.11 and 2.33 +/- 1.31 after 3 months respectively. CONCLUSIONS Over 3 months of extended use of CHX mouth rinse after SRP showed slightly but statistically significant better results.
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Affiliation(s)
- S-I Stratul
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
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16
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Abstract
The comparison of the efficacy of surgical and nonsurgical procedures revealed that scaling and root planing alone or in combination with flap procedures are effective methods for the treatment of chronic periodontitis. Also, the consistent message is that in treating deep pockets, open-flap debridement results in greater probing pocket depth reduction and clinical attachment gain than nonsurgical modalities. Nonsurgical modalities in shallower pockets consistently involve less post-therapy recession and are clearly recognized as being more conservative. Research is still needed on the clinical benefit of the granulation tissue removal that is a feature of periodontal surgical therapy and, to a lesser extent, occurs through indirect trauma in nonsurgical therapy.
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Affiliation(s)
- Danae A Apatzidou
- Dental School, Department of Preventive Dentistry, Periodontology and Biology of Implants, Aristotle University of Thessaloniki, University Campus, 54124 Greece.
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Teughels W, Dekeyser C, Van Essche M, Quirynen M. One-stage, full-mouth disinfection: fiction or reality? Periodontol 2000 2009; 50:39-51. [PMID: 19388952 DOI: 10.1111/j.1600-0757.2008.00292.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Papaioannou W, Gizani S, Haffajee AD, Quirynen M, Mamai-Homata E, Papagiannoulis L. The microbiota on different oral surfaces in healthy children. ACTA ACUST UNITED AC 2009; 24:183-9. [DOI: 10.1111/j.1399-302x.2008.00493.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Cortelli SC, Cortelli JR, Holzhausen M, Franco GCN, Rebelo RZ, Sonagere AS, Queiroz CDS, Costa FO. Essential oils in one-stage full-mouth disinfection: double-blind, randomized clinical trial of long-term clinical, microbial and salivary effects. J Clin Periodontol 2009; 36:333-42. [DOI: 10.1111/j.1600-051x.2009.01376.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Swierkot K, Nonnenmacher CI, Mutters R, Flores-de-Jacoby L, Mengel R. One-stage full-mouth disinfectionversusquadrant and full-mouth root planing. J Clin Periodontol 2009; 36:240-9. [DOI: 10.1111/j.1600-051x.2008.01368.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lang NP, Tan WC, Krähenmann MA, Zwahlen M. A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis. J Clin Periodontol 2009; 35:8-21. [PMID: 18724838 DOI: 10.1111/j.1600-051x.2008.01257.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To assess the clinical and microbiological effects of full-mouth debridement with (FMD) and without the use of antiseptics [full-mouth scaling and root planing (FMSRP)] in comparison with conventional staged debridement (CSD) in patients with chronic periodontitis after at least 6 months. MATERIAL AND METHODS The search in MEDLINE (PubMed), covering a period of 1975 to October 2007, and hand searching yielded 207 titles. Forty-two abstracts and 17 full-text articles were screened for inclusion. RESULTS Twelve articles allowed a direct comparison of FMD with CSD, FMSRP with CSD and FMD with FMSRP. Probing pocket depth reductions were significantly greater (0.2 mm) with FMD and FMSRP compared with CSD. Moreover, a modest reduction in BOP (9%) favoured FMD. Likewise, clinical attachment levels were improved by 0.2-0.4 mm in favour of FMD and FMSRP, respectively. In all comparisons, single-rooted teeth and deep pockets benefitted slightly from FMD and FMSRP. Limited differences in the changes of the subgingival microbiota were noted between the treatment modalities. CONCLUSIONS Despite the significant differences of modest magnitude, FMD or FMSRP do not provide clinically relevant advantages over CSD. Hence, all three treatment modalities may be recommended for debridement in the initial treatment of patients with chronic periodontitis.
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Affiliation(s)
- Niklaus P Lang
- School of Dental Medicine, University of Berne, Berne, Switzerland.
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22
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Full-mouth treatment versus quadrant root surface debridement in the treatment of chronic periodontitis: a systematic review. Br Dent J 2008; 205:E18; discussion 496-7. [PMID: 18833208 DOI: 10.1038/sj.bdj.2008.874] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Non-surgical periodontal therapy has been proven to be an effective treatment for patients with chronic periodontitis. Conventional non-surgical therapy by debridement of the root surfaces is performed on a quadrant basis with 1-2 week intervals. This time interval may result in re-colonisation by the bacteria of the instrumented pockets and impair healing. Therefore, a new approach of full-mouth non-surgical therapy to be completed within two consecutive days with (full-mouth disinfection) or without (full-mouth debridement) use of oral antiseptics has been suggested. The aim of this review was to compare the clinical outcomes of the three modalities of non-surgical therapy (full-mouth disinfection [FMD], full-mouth debridement [FRp], quadrant scaling and root planing [Q]). METHODS Standard searches of Medline and Embase databases and appropriate hand searching provided the published studies, which were then assessed against pre-determined inclusion criteria. Meta-analysis was performed wherever possible using Review Manager 4.2 software. RESULTS Seven randomised controlled trials (RCTs) were included in the review and these failed to show any statistically significant differences between the FRp and Q approaches. Further studies are required to reach conclusion regarding the advantages of FMD approach. PRACTICAL IMPLICATIONS Mechanical debridement is an important component of treatment for chronic periodontitis and this review suggests that both the traditional quadrant approach and the newer the full-mouth debridement could be equally effective.
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Cavalca Cortelli S, Cavallini F, Regueira Alves MF, Alves Bezerra A, Queiroz CS, Cortelli JR. Clinical and microbiological effects of an essential-oil-containing mouth rinse applied in the "one-stage full-mouth disinfection" protocol--a randomized doubled-blinded preliminary study. Clin Oral Investig 2008; 13:189-94. [PMID: 18716800 DOI: 10.1007/s00784-008-0219-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 07/25/2008] [Indexed: 11/30/2022]
Abstract
The aim of this randomized double-blinded preliminary study was to evaluate the clinical and microbiological long-term effects of an essential-oil-containing mouth rinse as the active agent utilized in the "one-stage full-mouth disinfection protocol." Probing pocket depth and plaque and gingival indices were evaluated by the same calibrated examiner in all teeth of 20 moderate chronic periodontitis subjects. Presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis were determined by polymerase chain reaction in nonstimulated saliva, tongue dorsum, and pooled subgingival samples. The subjects were randomized into two groups: full-mouth disinfection plus essential oils (Listerine) or full-mouth disinfection plus placebo. Clinical and microbial parameters were evaluated at baseline (T0), 45 (T1) and 180 (T2) days after therapy and analyzed using analysis of variance, Student t, and Wilcoxon tests (p < 0.05). No significant differences were observed between groups regarding clinical measurements at baseline. However, in the later examinations, T1 and T2, the test group always presented higher reductions of pocket depth, plaque index, and gingival index compared to the control group. The essential-oils group revealed significant reduction on occurrence of P. gingivalis in saliva comparing baseline and 45 days; this difference still remain at 180 days. The essential-oil-containing mouth rinse demonstrated beneficial effects on clinical parameters. Microbiological findings were less consistent. The results of this preliminary study suggest further investigations.
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Affiliation(s)
- Sheila Cavalca Cortelli
- Department of Periodontology and Preventive Dentistry, Dental Research Division, University of Taubaté, Taubaté, Sao Paolo, Brazil.
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Guarnelli ME, Franceschetti G, Manfrini R, Trombelli L. Adjunctive effect of chlorhexidine in ultrasonic instrumentation of aggressive periodontitis patients: a pilot study. J Clin Periodontol 2008; 35:333-41. [DOI: 10.1111/j.1600-051x.2008.01199.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ferozali F, Johnson G, Cavagnaro A. Health benefits and reductions in bacteria from enhanced oral care. SPECIAL CARE IN DENTISTRY 2007; 27:168-76. [PMID: 17990475 DOI: 10.1111/j.1754-4505.2007.tb00342.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This investigation assessed the oral cavity and microbiological status of 36 non-verbal persons with developmental disabilities. The authors examined oral hygiene interventions aimed at reducing risk factors linked to bacterial colonization and aspiration pneumonia. The findings indicated a statistically significant decrease of potentially pathogenic bacteria and a reduction in total bacteria counts for people receiving oral care via intermittent suction.
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Affiliation(s)
- Fozia Ferozali
- Porterville Developmental Center, Porterville, Calif., USA.
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26
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Knöfler GU, Purschwitz RE, Jentsch HF. Clinical Evaluation of Partial- and Full-Mouth Scaling in the Treatment of Chronic Periodontitis. J Periodontol 2007; 78:2135-42. [DOI: 10.1902/jop.2007.070010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Albert-Kiszely A, Pjetursson BE, Salvi GE, Witt J, Hamilton A, Persson GR, Lang NP. Comparison of the effects of cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis ? a six-month randomized controlled clinical trial. J Clin Periodontol 2007; 34:658-67. [PMID: 17635245 DOI: 10.1111/j.1600-051x.2007.01103.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effects of an experimental mouth rinse containing 0.07% cetylpyridinium chloride (CPC) (Crest Pro-Health) with those provided by a commercially available mouth rinse containing essential oils (EOs) (Listerine) on dental plaque accumulation and prevention of gingivitis in an unsupervised 6-month randomized clinical trial. MATERIAL AND METHODS This double-blind, 6-month, parallel group, positively controlled study involved 151 subjects balanced and randomly assigned to either positive control (EO) or experimental (CPC) mouth rinse treatment groups. At baseline, subjects received a dental prophylaxis procedure and began unsupervised rinsing twice a day with 20 ml of their assigned mouthwash for 30 s after brushing their teeth for 1 min. Subjects were assessed for gingivitis and gingival bleeding by the Gingival index (GI) of Löe & Silness (1963) and plaque by the Silness & Löe (1964) Plaque index at baseline and after 3 and 6 months of rinsing. At 3 and 6 months, oral soft tissue health was assessed. Microbiological samples were also taken for community profiling by the DNA checkerboard method. RESULTS Results show that after 3 and 6 months of rinsing, there were no significant differences (p=0.05) between the experimental (CPC) and the positive control mouth rinse treatment groups for overall gingivitis status, gingival bleeding, and plaque accumulation. At 6 months, the covariant (baseline) adjusted mean GI and bleeding sites percentages for the CPC and the EO rinses were 0.52 and 0.53 and 8.7 and 9.3, respectively. Both mouth rinses were well tolerated by the subjects. Microbiological community profiles were similar for the two treatment groups. Statistically, a significant greater reduction in bleeding sites was observed for the CPC rinse versus the EO rinse. CONCLUSION The essential findings of this study indicated that there was no statistically significant difference in the anti-plaque and anti-gingivitis benefits between the experimental CPC mouth rinse and the positive control EO mouth rinse over a 6-month period.
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Affiliation(s)
- A Albert-Kiszely
- School of Dental Medicine, University of Berne, Berne, Switzerland
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28
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Casas A, Herrera D, Martín-Carnes J, González I, O'Connor A, Sanz M. Influence of Sampling Strategy on Microbiologic Results Before and After Periodontal Treatment. J Periodontol 2007; 78:1103-12. [PMID: 17539725 DOI: 10.1902/jop.2007.060232] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to test whether different sampling strategies would influence the microbiologic outcomes by assessing the bacterial load and composition of the subgingival microbiota by means of anaerobic culturing before and after periodontal treatment. METHODS The first study (1 versus 4 [1vs4]) included 33 patients with generalized chronic periodontitis. Two sampling strategies were compared, sampling one site from the deepest pocket in the mouth (M1) versus a pooled sample of four sites from the deepest pockets in each quadrant (M4). The second study (2 versus 4 [2vs4]) included 20 patients with generalized chronic periodontitis. The strategy M4 was compared to a pooled sample of two non-adjacent sites in the same quadrant (M2). All samples were processed identically by means of anaerobic culturing. In both studies, a pretreatment sampling was taken. However, in the second study (2vs4), subgingival samples were also taken at 1, 3, and 6 months after periodontal therapy. Quantitative data were compared between strategies by means of t test and signed-rank test; qualitative data were compared by means of 2 x 2 contingency tables. RESULTS Pretreatment samples showed that total anaerobic counts were significantly higher for M4 compared to M1 (P <0.001) and M2 (P = 0.025). However, there were no significant differences in regard to percentage of microbiota and counts for each pathogen. Most of the qualitative differences between strategies were caused by false negatives in M1 and M2. Post-treatment samples showed a reduction in total counts and a limited impact in the frequency of detection of periodontal pathogens. M2 detected a significant decrease in the frequency of detection of Porphyromonas gingivalis, which was not confirmed by the M4 strategy. CONCLUSION The criteria of selection and the number of sites selected when sampling the subgingival biofilm in patients with generalized chronic periodontitis may influence the detection and quantitation of periodontal pathogens when evaluated by culture especially after treatment.
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Affiliation(s)
- Agustín Casas
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
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29
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Cosyn J, Sabzevar MM. Subgingival chlorhexidine varnish administration as an adjunct to same-day full-mouth root planing. II. Microbiological observations. J Periodontol 2007; 78:438-45. [PMID: 17335366 DOI: 10.1902/jop.2007.060222] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recently, the clinical additive value of a highly concentrated chlorhexidine (CHX) varnish, when applied subgingivally as an adjunct to scaling and root planing, was described. The objective of the present study was to investigate the microbiological impact of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival CHX varnish administration. METHODS A randomized, controlled, single-blind, parallel trial was conducted on 33 non-smoking chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets also were disinfected using a supersaturated CHX varnish. Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 1, 3, and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction-based method for the identification of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Treponema denticola (Td), and Prevotella intermedia (Pi). RESULTS In terms of detection frequency and bacterial levels, significant, mainly temporary, reductions from baseline were found in both groups. When a comparison was made between the control and the test group, significant differences in the detection frequency of Tf (P = 0.024) and Td (P = 0.024), which favored the test group, were found at 1 month. A similar phenomenon was seen for Td (P = 0.031) based on bacterial levels. An important trend toward lower Tf levels in the test group also was found at 1 month (P = 0.052). Compared to baseline levels, microbiological benefits in the test group seemed to be maintained, at least in part, over a 6-month period. In contrast, all microbial levels had relapsed in the control group at study termination. CONCLUSION The microbiological results of the present study promote the subgingival administration of a highly concentrated CHX varnish as an adjunct to same-day full-mouth root planing.
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Affiliation(s)
- Jan Cosyn
- Department of Periodontology, School of Dental Medicine, Free University of Brussels, Brussels, Belgium.
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30
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Faveri M, Gursky LC, Feres M, Shibli JA, Salvador SL, de Figueiredo LC. Scaling and root planing and chlorhexidine mouthrinses in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial. J Clin Periodontol 2006; 33:819-28. [PMID: 16965522 DOI: 10.1111/j.1600-051x.2006.00994.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluation of the clinical and microbiological effects of scaling and root planing (SRP) alone or in combination with 0.12% chlorhexidine (CHX) rinsing. METHODS A blind, placebo-controlled, parallel-design, randomized clinical trial was conducted in 29 subjects with chronic periodontitis. Subjects were assigned to two therapeutic groups: control (SRP+placebo) and test (SRP+CHX during and up to 42 days post-therapy). Clinical and microbiological [N-benzoyl-dl-arginine-2-naphthylamide (BANA test)] examinations were performed at baseline, 42 and 63 days post-therapy. RESULTS Initially, intermediate sites (4-6 mm) in the test group showed less plaque accumulation, gingival bleeding, bleeding on probing and a greater reduction in attachment level and probing depth (PD) at 63 days after treatment. The initially deep sites (>6 mm) in the CHX group also showed a better reduction in plaque accumulation and in PD compared with the control group. Both therapies led to a microbiological improvement; however, the test subjects showed a higher frequency of BANA-negative sites after treatment, which was sustained over time (p<0.001). At 63 days, the control group presented 25 BANA-negative sites and 65 positive sites, and the test group 58 and 26, respectively. CONCLUSION The combination of CHX rinses and SRP leads to clinical benefits and to a better reduction in BANA-positive species.
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Affiliation(s)
- Marcelo Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
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31
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Quirynen M, De Soete M, Boschmans G, Pauwels M, Coucke W, Teughels W, van Steenberghe D. Benefit of “one-stage full-mouth disinfection” is explained by disinfection and root planing within 24 hours: a randomized controlled trial. J Clin Periodontol 2006; 33:639-47. [PMID: 16856902 DOI: 10.1111/j.1600-051x.2006.00959.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The beneficial effects of the one-stage, full-mouth disinfection remain controversial in the scientific literature. This might be due to the fact that an entire mouth disinfection with the use of antiseptics has been confused with a full-mouth scaling and root planing. This parallel, single blind RCT study aimed to compare several full-mouth treatment strategies with each other. MATERIAL AND METHODS Seventy-one patients with moderate periodontitis were randomly allocated to one of the following treatment strategies: scaling and root planing, quadrant by quadrant, at two-week intervals (negative control, NC), full-mouth scaling and root planing within 2 consecutive days (FRP), or three one-stage, full-mouth disinfection (FM) protocols within 2 consecutive days applying antiseptics to all intra-oral niches for periopathogens using as antiseptics: chlorhexidine (FMCHX) for 2 months, amine fluoride/stannous fluoride for 2 months (FMF), or chlorhexidine for 2 months followed by amine fluoride/stannous fluoride for another 6 months (FMCHX+F). At baseline and after 2, 4, and 8 a series of periodontal parameters were recorded. RESULTS All treatment strategies resulted in significant (p<0.05) improvements of all clinical parameters over the entire duration of the study. Inter-treatment differences were often encountered. The NC group nearly always showed significant smaller improvements than the two CHX groups. The differences between the FRP or FM groups, and the two CHX groups only sporadically reached a statistical significance. CONCLUSION These observations indicate that the benefits of the "OSFMD" protocol are partially due to the use of the antiseptics and partially to the completion of the therapy in a short time.
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Affiliation(s)
- Marc Quirynen
- Department of Periodontology, Faculty of Medicine, Catholic University of leuven, Leuven, Belgium.
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32
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Quirynen M, Teughels W, van Steenberghe D. Impact of antiseptics on one-stage, full-mouth disinfection. J Clin Periodontol 2006; 33:49-52. [PMID: 16367856 DOI: 10.1111/j.1600-051x.2005.00868.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol 2005; 32:1096-107. [PMID: 16174275 DOI: 10.1111/j.1600-051x.2005.00814.x] [Citation(s) in RCA: 203] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of this study was to assess the adjunctive clinical effect of the administration of systemic amoxicillin and metronidazole in the non-surgical treatment of generalized aggressive periodontitis (GAP). METHODS Forty-one systemically healthy subjects with GAP were included in this 6-month double-blind, placebo-controlled, randomized clinical trial. Patients received a course of full-mouth non-surgical periodontal treatment delivered over a 24 h period using machine-driven and hand instruments. Test subjects received an adjunctive course of systemic antibiotic consisting of 500 mg amoxicillin and 500 mg metronidazole three times a day for 7 days. Clinical parameters were collected at baseline, and at 2 and 6 months post-treatment. RESULTS In both the test and the placebo groups, all clinical parameters improved at 2 and 6 months. In deep pockets (> or =7 mm), the test treatment resulted in an additional 1.4 mm (95% confidence interval 0.8, 2.0 mm) in full-mouth probing pocket depth (PPD) reduction and 1 mm (0.7, 1.3 mm) of life cumulative attachment loss (LCAL) gain at 6 months. In moderate pockets (4-6 mm), the adjunctive benefit was smaller in magnitude: PPD reduction was 0.4 mm (0.1, 0.7 mm) and LCAL gain was 0.5 mm (0.2, 0.8 mm). In addition, the 6-month data showed LCAL gains > or =2 mm at 25% of sites in test patients compared with 16% in placebo (p=0.028). Similarly, PPD reductions of 2 mm or more were observed in 30% of sites in test and 21% of sites in placebo patients. Seventy-four percent of pockets with PPD > or =5 mm at baseline were 4 mm or shallower at 6 months in the test group. This compared with 54% in the placebo group (p=0.008). Disease progression at 6 months was observed at 1.5% of test and 3.3% of sites in test and placebo, respectively (p=0.072). CONCLUSIONS These data indicate that a 7-day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short-term clinical outcomes of full-mouth non-surgical periodontal debridement in subjects with GAP.
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Affiliation(s)
- Adrian Guerrero
- Department of Periodontology and Eastman Clinical Investigation Centre, Eastman Dental Institute and Hospital, University College London, London, UK
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Wennström JL, Tomasi C, Bertelle A, Dellasega E. Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol 2005; 32:851-9. [PMID: 15998268 DOI: 10.1111/j.1600-051x.2005.00776.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. METHODS Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. RESULTS The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). CONCLUSION The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.
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Affiliation(s)
- Jan L Wennström
- Department of Periodontology, Faculty of Odontology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Affiliation(s)
- Noel Claffey
- Dublin Dental School and Hospital, Trinity College, Ireland
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Koshy G, Corbet EF, Ishikawa I. A full-mouth disinfection approach to nonsurgical periodontal therapy - prevention of reinfection from bacterial reservoirs. Periodontol 2000 2004; 36:166-78. [PMID: 15330948 DOI: 10.1111/j.1600-0757.2004.03678.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Geena Koshy
- Department of Hard Tissue Engineering, Tokyo Medical and Dental University Graduate School, JapanDepartment of Hard Tissue Engineering, Tokyo Medical and Dental University Graduate School, Japan
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Hanes PJ, Purvis JP. Local anti-infective therapy: pharmacological agents. A systematic review. ACTA ACUST UNITED AC 2004; 8:79-98. [PMID: 14971250 DOI: 10.1902/annals.2003.8.1.79] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND It is well recognized that periodontal diseases are bacterial in nature. An essential component of therapy is to eliminate or control these pathogens. This has been traditionally accomplished through mechanical means (scaling and root planing [SRP]), which is time-consuming, difficult, and sometimes ineffective. Over the past 20 years, locally delivered, anti-infective pharmacological agents, most recently employing sustained-release vehicles, have been introduced to achieve this goal. RATIONALE This systematic review evaluates literature-based evidence in an effort to determine the efficacy of currently available anti-infective agents, with and without concurrent SRP, in controlling chronic periodontitis. FOCUSED QUESTION In patients with chronic periodontitis, what is the effect of local controlled-release anti-infective drug therapy with or without SRP compared to SRP alone on changes in clinical, patient-centered, and adverse outcomes? SEARCH PROTOCOL MEDLINE, the Cochrane Central Trials Register, and Web of Science were searched. Hand searches were performed of the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. In addition, investigators contacted editors of the above-mentioned journals and companies sponsoring research on these agents for related unpublished data and studies in progress. SELECTION CRITERIA INCLUSION CRITERIA Studies included randomized controlled clinical trials (RCT), and case-controlled and cohort studies at least 3 months long. Therapeutic interventions had to include 1) SRP alone; 2) local anti-infective drug therapy and SRP; or 3) local anti-infective drug therapy alone. Included studies had to report patient-based mean values and measures of variation for probing depth (PD) and/or clinical attachment levels (CAL) for both test and control groups. EXCLUSION CRITERIA Studies were excluded if they: 1) included data from a previously published article; 2) included daily rinsing with chlorhexidine (CHX); or 3) had unclear descriptions of randomization procedures, examiner masking, or concomitant therapies. DATA COLLECTION AND ANALYSIS For the meta-analysis, PD and CAL were expressed as summary mean effects with 95% confidence intervals (CI) for the effect, and analyzed using a standardized difference between SRP alone and experimental agent groups. The results were assessed with both fixed-effects and random-effects models. Studies were ranked according to the York system. MAIN RESULTS 1. Thirty-two studies were included (28 RCT, 2 cohort, and 2 case-control), incorporating a total patient population of 3,705 subjects. 2. Essentially all studies reported substantial reductions in gingival inflammation and bleeding indices, which were similar in both control and experimental groups. 3. A meta-analysis completed on 19 studies that included SRP and local sustained-release agents compared with SRP alone indicated significant adjunctive PD reduction or CAL gain for minocycline (MINO) gel, microencapsulated MINO, CHX chip and doxycycline (DOXY) gel during SRP compared to SRP alone. 4. Use of antimicrobial irrigants or anti-infective sustained-release systems as an adjunct to SRP does not result in significant patient-centered adverse events. REVIEWERS' CONCLUSIONS 1. In some populations, anti-infective agents in a sustained-release vehicle alone can reduce PD and bleeding on probing (BOP) equivalent to that achieved by SRP alone. 2. No evidence was found for an adjunctive effect on reduction of PD and BOP of therapist-delivered CHX irrigation during SRP compared to SRP alone. 3. Additional RCTs are needed which evaluate the effectiveness of these therapies in all forms of periodontitis. 4. The study protocol for future RCTs should include appropriate statistical analyses and complete data sets to facilitate future evidence-based reviews. 5. Alternative surrogate parameters to PD and CAL need to be identified and validated such as microbial, inflammatory, or tissue-destructive markers that could be used in conjunction with clinical parameters to help determine the patient's response to emerging technologies that target the infectious and/or inflammatory aspects of periodontitis. 6. Future Phase IV clinical trials should be designed that evaluate local anti-infective therapies in conjunction with SRP in a manner consistent with current standards of care and evaluate cost-effectiveness. 7. The use of local anti-infective agents in at-risk patient populations and for the treatment of at-risk disease sites needs to be validated in randomized controlled clinical trials. 8. Several local anti-infective agents combined with SRP appear to provide additional benefits in PD reduction and CAL gain compared to SRP alone. The decision to use local anti-infective adjunctive therapy remains a matter of individual clinical judgment, the phase of treatment, and the patient's status and preferences.
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Affiliation(s)
- Philip J Hanes
- Department of Periodontics, Medical College of Georgia, School of Dentistry, Augusta, GA 30912-1220, USA.
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Apatzidou DA, Riggio MP, Kinane DF. Quadrant root planing versus same-day full-mouth root planing. II. Microbiological findings. J Clin Periodontol 2004; 31:141-8. [PMID: 15016040 DOI: 10.1111/j.0303-6979.2004.00462.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that over a period of 6 months, same-day full-mouth scaling and root planing (FM-SRP) resulted in greater reductions in the detection frequency of five putative periodontal pathogens compared with quadrant scaling and root planing (Q-SRP) in chronic periodontitis patients. MATERIALS AND METHODS Forty patients were recruited into this study. Subjects were randomised into two groups. The FM-SRP group received full-mouth scaling and root planing completed within the same day, while the Q-SRP group received quadrant root planing at 2-weekly intervals over four consecutive sessions. Selected-site analyses were performed on the deepest site in each quadrant before and after therapy, at approximately 3 and 6 months from baseline (R1 and R2) and clinical indices were recorded with an electronic pressure-sensitive probe. In addition, subgingival plaque samples were collected from these sites at baseline (BAS), at reassessment 1 (R1), approximately 6 weeks after the completion of therapy and at reassessment 2 (R2), 6 months from baseline. Polymerase chain reaction (PCR) was used to determine the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Treponema denticola and Bacteroides forsythus in plaque. RESULTS Both therapies resulted in significant improvements in all clinical indices both at R1 and R2. A marked reduction in the presence of all candidate periodontal pathogens was noted after both treatment modalities, reaching statistical significance for the majority of the test organisms. These improvements were maintained over a period of 6 months. When the two treatment groups were compared, a significantly higher percentage of Q-SRP patients was positive for P. intermedia at R1 compared with FM-SRP patients (p<0.05). In addition, a greater reduction in the patient prevalence for T. denticola was found for the FM-SRP group than the Q-SRP group at R1 and R2 from baseline (p<0.005), but the significance of this is questionable given the skewed detection frequency of this organism at baseline between the two treatments (p<0.01). CONCLUSION This study failed to confirm that same-day FM-SRP resulted in greater microbiological improvements compared with Q-SRP at 2-weekly intervals over a 6-month period, as determined by PCR.
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Affiliation(s)
- D A Apatzidou
- Periodontal and Oral Immunology Research Group, Glasgow Dental School, Glasgow, UK
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Hallmon WW, Rees TD. Local Anti-Infective Therapy: Mechanical and Physical Approaches. A Systematic Review. ACTA ACUST UNITED AC 2003; 8:99-114. [PMID: 14971251 DOI: 10.1902/annals.2003.8.1.99] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although mechanical non-surgical therapy (scaling and root planing) is the most common means of initial treatment of periodontal diseases, the relative clinical efficacy of various methods, including manual versus machine-driven, with or without adjunctive agents, has not been determined. RATIONALE This systematic review analyzes the literature in an effort to identify the most effective therapies, based on both clinical and patient-centered outcomes. FOCUSED QUESTION In patients with periodontitis, what is the effect of mechanically-driven instrumentation (e.g., power-driven) and/or subgingival irrigation with and without manual instrumentation compared to manual instrumentation alone? SEARCH PROTOCOL Two investigators examined MEDLINE and the Cochrane Oral Health Group specialized registry for clinical trials published in English. Hand searches were performed of the International Journal of Periodontics & Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. Editors of these journals were asked to provide information on articles currently under review. In addition, an electronic discussion group on periodontal diseases and treatment was contacted, as were manufacturers of manual and mechanical instruments and of adjunctive agents. SELECTION CRITERIA INCLUSION CRITERIA Only randomized clinical trials, cohort studies, or case-control studies at least 3 months long were included. All studies had to compare manual instrumentation (MI; scaling and root planing [SRP]) alone with some other form of non-surgical therapy. These included MI versus mechanically-driven instruments (MDI) alone; MI versus MI plus MDI; MI versus MDI plus an agent (e.g., chlorhexidine); and MI versus subgingival irrigation (SGI) delivered in conjunction with MI or MDI. EXCLUSION CRITERIA Studies not meeting the inclusion criteria or those treating periodontal diseases as a manifestation or complication of some other disease or disorder were not included. DATA COLLECTION AND ANALYSIS Probing depth, clinical attachment level, bleeding on probing, and gingival recession were the primary outcomes. Because of the heterogeneity of the patient populations, treatments, and outcome measures, meta-analysis was not appropriate. Only in-study data were compared. Four of the studies required extrapolating data from figures and graphs, resulting in questionable accuracy. MAIN RESULTS 1. Nine studies, representing a study population of 129, were included in the review. 2. Five studies compared MI with MDI alone. The other 4 compared MI alone to MI plus SGI or subgingival tissue treatment. 3. There was comparable efficacy between MI and MDI when treating single-rooted teeth. 4. The use of SGI or subgingival tissue treatment as an adjunct to MI provided no additional benefit compared to MI alone. 5. Findings reported in the review must be interpreted with considerable caution, as lack of study heterogeneity made meta-analysis unfeasible and the need to extrapolate outcomes values from graphs and figures may have resulted in some inaccuracy. REVIEWERS' CONCLUSIONS 1. Manual and mechanically-driven instrumentation appears comparable in affecting improved clinical outcomes. 2. Instrumentation time for MI and MDI were similar, except for 1 study in which MDI was significantly shorter. 3. Adjunctive SGI plus MI and subgingival tissue treatment result in similar clinical outcomes when compared to MI alone. 4. If study data are to be effectively and analytically combined to facilitate meaningful comparisons of treatment outcomes, detailed and standardized study designs must be developed and used consistently in clinical trials.
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Affiliation(s)
- William W Hallmon
- Department of Periodontics, Texas A&M University System Health Science Center-Baylor College of Dentistry, Dallas, Texas, USA.
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Quirynen M, Teughels W, van Steenberghe D. Microbial shifts after subgingival debridement and formation of bacterial resistance when combined with local or systemic antimicrobials. Oral Dis 2003; 9 Suppl 1:30-7. [PMID: 12974528 DOI: 10.1034/j.1601-0825.9.s1.6.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Antibiotics have played a major role in the improvement of life expectancy in the last 50 years and have led many to believe that bacterial infections were about to vanish as a disease entity of any importance. Emerging problems resulting from a widespread use of antibiotics have modified the general perception of the capabilities of antimicrobial agents. Over the years, bacteria have become increasingly resistant to formerly potent antimicrobial agents, including some antiseptics. The use of antimicrobials may also disturb the delicate ecological equilibrium of the body, allowing the proliferation of resistant bacteria or non-bacterial micro-organisms. This shift may initiate new infections that are worse than the ones originally treated. No antimicrobial drug is absolutely non-toxic and the use of an agent carries accompanying risks. This paper discusses the development and occurrence of antimicrobial resistance in the subgingival flora towards antiseptics and local or systemic antibiotics and is focussed on the question: how can the outcome of periodontal therapy with/without antimicrobials be improved?
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Affiliation(s)
- M Quirynen
- Catholic University of Leuven, Faculty of Medicine, Research Group for Microbial Adhesion, Department of Periodontology, School of Dentistry, Oral Pathology & Maxillo-facial Surgery, Leuven, Belgium.
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Rüdiger SG, Ehmke B, Hommens A, Karch H, Flemmig TF. Guided tissue regeneration using a polylactic acid barrier. Part I: Environmental effects on bacterial colonization. J Clin Periodontol 2003; 30:19-25. [PMID: 12702107 DOI: 10.1034/j.1600-051x.2003.300104.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the dynamics of bacterial colonization in intra-osseous defects following guided tissue regeneration (GTR) therapy using a resorbable barrier. PATIENTS AND METHODS In each of 30 patients, one intra-osseous defect was treated with GTR using a polylactic acid membrane (Guidor). Plaque samples were taken from the defect site, other teeth and mucous membranes following initial therapy (baseline), and at 3, 6 and 12 months after periodontal surgery. Additionally, samples were taken from the defect sites at 1, 2 and 4 weeks. Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Bacteroides forsythus (B.f.) were detected by polymerase chain reaction (PCR). Supportive periodontal therapy was performed at 3-month intervals. RESULTS In the 29 patients completing the study, the assessed microflora was detected in 3 (A.a.), 13 (P.g.) and 14 (B.f.) defect sites at baseline, in 2 (A.a.), 2 (P.g.) and 2 (B.f.) following surgical debridement, and in 6 (A.a.), 10 (P.g.) and 22 (B.f.) at 12 months. Defect site colonization following GTR therapy was significantly correlated with presurgical colonization at other assessed teeth (A.a. and P.g.: tau = 0.45 and 0.66, respectively; P < 0.001), or on mucous membranes (B.f.: tau = 0.44, P < 0.001). CONCLUSION The colonization of periodontal pathogens at sites treated by GTR may correlate with the intra-oral presence of these pathogens before surgery. If colonization of GTR sites by periodontal pathogens is to be prevented, intra-oral suppression/eradication of these pathogens may be required before surgery.
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Affiliation(s)
- S G Rüdiger
- Clinic of Conservative Dentistry, University of Tübingen, Germany
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Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol 2002. [PMID: 12010523 DOI: 10.1034/j.1600-051x.29.s2.4.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Analysis of Egyptian hieroglyphics and medical papyri indicate that non-surgical periodontal treatment was common 3000-4000 years ago. Even today, scaling and root planing (SRP) remains an essential part of successful periodontal therapy. The collective evidence from numerous clinical trials reveals a consistency of clinical response in the treatment of chronic periodontitis by SRP using manual, sonic, or ultrasonic instrumentation. Thus, SRP remains the 'gold standard' to which more recently developed therapeutic modalities must be compared. Inherent to the clinical evaluation of SRP are such concerns as manual versus sonic and ultrasonic instrumentation, control of sub-gingival bacterial populations, removal of calculus, root smoothness and changes in various clinical parameters, e.g. probing depth, attachment levels, bleeding on probing and gingival inflammation. Lastly, an abbreviated discussion is presented on a relatively new paradigm of complete mouth 'disinfection' in a compressed time-frame that includes SRP as a significant component of the treatment regimen.
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Affiliation(s)
- Charles M Cobb
- Department of Periodontics, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA.
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Niederman R, Abdelshehid G, Goodson JM. Periodontal therapy using local delivery of antimicrobial agents. Dent Clin North Am 2002; 46:665-77, viii. [PMID: 12436823 DOI: 10.1016/s0011-8532(02)00030-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Antimicrobial agents, systemic and/or local, are thought by some to be effective agents for treating periodontal infections. Here the authors determine the costs and benefits of local delivery agents for treating periodontal disease. Applying this cost-benefit analysis to patient care, however, will depend upon a clinician's expertise and a patient's value system.
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Affiliation(s)
- Richard Niederman
- Center for Evidence-Based Dentistry, Forsyth Institute, 140 The Fenway, Boston, MA 02115, USA.
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Quirynen M, Teughels W, De Soete M, van Steenberghe D. Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. Periodontol 2000 2002; 28:72-90. [PMID: 12013349 DOI: 10.1034/j.1600-0757.2002.280104.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marc Quirynen
- Department of Periodontology, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Catholic University Leuven, Belgium
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Greenstein G. Full-mouth therapy versus individual quadrant root planning: a critical commentary. J Periodontol 2002; 73:797-812. [PMID: 12146540 DOI: 10.1902/jop.2002.73.7.797] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This commentary compares the abilities of full-mouth disinfection (FDIS), full-mouth root planing (FRP), and partial-mouth disinfection (PDIS) to improve periodontal health. FDIS consists of 4 quadrants of root planing completed within 24 hours with adjunctive chlorhexidine therapies (e.g., rinsing, subgingival irrigation, tongue brushing). FRP denotes 4 quadrants of root planing performed within 24 hours, and PDIS refers to root planing individual quadrants of the dentition, spaced 2 weeks apart. A basic premise of administering full-mouth therapy (FDIS or FRP) is to eliminate or reduce bacterial reservoirs within the oral cavity that could inhibit optimal healing of treated sites or cause periodontal disease initiation or progression. METHODS Controlled clinical trials that compared the abilities of PDIS and full-mouth root planing with and without adjunctive chlorhexidine chemotherapy to alter periodontal status were reviewed. RESULTS Several studies conducted at one treatment center indicated that FDIS and FRP attained greater therapeutic improvements than PDIS with respect to decreasing probing depths (PD), gaining clinical attachment (CAL), diminishing bleeding upon probing, and reducing the subgingival microflora. However, the magnitude of PD reductions and gains of clinical attachment must be carefully interpreted, because initial PD measurements were usually determined after scaling and root planing, which may have caused the results to be overstated. Furthermore, in studies that addressed the utility of FDIS, it was not possible to determine if benefits induced beyond PDIS were due to FRP or administration of multifaceted intraoral chlorhexidine treatments ora combination of both therapies. One investigation that had protocol limitations indicated that similar results were attained by FRP with and without adjunctive chemotherapy. In contrast, recent studies from 2 other treatment centers indicated that there were no significant differences when the efficacy of quadrant-by-quadrant root planing was compared to FRP or FDIS with regard to PD reduction, gains of clinical attachment, and impact on the magnitude and quality of the immune response. POSSIBLE CLINICAL IMPLICATIONS: Conceptually, full-mouth therapy (FRP or FDIS) could reduce the number of patient visits and facilitate more efficient use of treatment time. In addition, there appears to be no major adverse reactions to full-mouth root planing with or without adjunctive chemotherapy. However, small study populations and non-corroborating data from different treatment centers indicate that additional randomized clinical trials are needed to determine if full-mouth therapy provides clinically relevant improvements beyond PDIS.
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Affiliation(s)
- Gary Greenstein
- Department of Periodontology, University of Medicine and Dentistry of New Jersey, Newark, USA.
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Abstract
Dentistry is a relatively new field in veterinary medicine, despite the fact that dental disease is common in dogs and cats. Obstacles to the development of dental treatments in animals include the diversity of the dentition among the species, the difficulty in administration of oral treatments, the different presentations of oral disease, and the cost of regulatory approval for each species. Mechanical removal of plaque and calculus has been the mainstay of periodontal disease treatment in animals and humans. New adjunctive therapies, as well as new applications for older drugs, are being introduced for periodontal therapy.
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Affiliation(s)
- W P Cleland
- Heska Corporation, 1613 Prospect Parkway, Fort Collins, CO 80525, USA.
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De Soete M, Mongardini C, Peuwels M, Haffajee A, Socransky S, van Steenberghe D, Quirynen M. One-stage full-mouth disinfection. Long-term microbiological results analyzed by checkerboard DNA-DNA hybridization. J Periodontol 2001; 72:374-82. [PMID: 11327066 DOI: 10.1902/jop.2001.72.3.374] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent studies reported significant, additional clinical and microbiological improvements when severe adult periodontitis was treated via the one-stage full-mouth (OSFM) disinfection approach, instead of a standard treatment scheme with staged instrumentation per quadrant. The OSFM disinfection involves dealing with the remaining oropharyngeal niches such as tonsils, saliva, tongue, and mucosa. The OSFM disinfection procedure involves scaling and root planing of all pockets within 24 hours in combination with chlorhexidine application to all oropharyngeal niches (chairside and at home for 2 months). This study aimed to compare the microbiological shifts with the OSFM approach versus standard therapy. METHODS Nineteen patients with advanced chronic periodontitis (AP) and 12 patients with early-onset periodontitis (EOP) were randomly assigned to the test and control groups. The control group (9 AP patients, 6 EOP patients) was scaled and root planed, per quadrant, with 2-week intervals. The test group (10 AP patients and 6 EOP patients) underwent OSFM disinfection treatment. At baseline and after 2, 4, and 8 months, pooled subgingival plaque samples were taken from single- and multi-rooted teeth. The presence and levels of 30 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization. RESULTS Both treatments resulted in important reductions of the pathogenic species up to 8 months after therapy, both for their detection level and frequency. The OSFM disinfection resulted in an additional improvement, especially in the AP group. P. gingivalis and B. forsythus were reduced below detection level. The number of beneficial species remained nearly unchanged. CONCLUSIONS The OSFM disinfection results in supplementary reductions of periodontal pathogens even after 8 months in the treatment of patients with advanced or early-onset periodontitis.
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Affiliation(s)
- M De Soete
- Catholic University of Leuven, Faculty of Medicine, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Department of Periodontology, Belgium
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Abstract
The primary etiology of periodontal disease is bacterial infection. Bacteria exist as a biofilm (plaque) on the tooth and soft-tissue surfaces of the mouth. Biofilm is extremely resistant to antimicrobial activity. To effectively treat periodontal disease, the bacterial load must be reduced to allow healing of the inflamed tissues. Reduction of the bacterial load can be accomplished by surgical methods, nonsurgical methods, or a combination of the two. This article focuses on the nonsurgical treatment of periodontal disease. A thorough oral examination, which includes visual inspection and the use of a periodontal probe, is needed to determine the best therapy. Supragingival cleaning with power and hand scalers is the first step in the therapy process. The next step, subgingival scaling, is necessary to remove bacteria that are in direct contact with the periodontium. Effective subgingival plaque removal is time intensive and requires motivation, manual dexterity, and meticulous technique. Most veterinarians and veterinary technicians lack the training, instruments, and time to remove subgingival plaque effectively. To improve therapeutic results, adjunctive therapy in the form of oral systemic antibiotics or a locally applied doxycycline-containing polymer may be used. The success of periodontal therapy also is dependent on dental home care that takes place after professional treatment. The veterinarian and staff must be willing to educate and reinforce the dental home care efforts of the pet owner.
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Abstract
BACKGROUND New research is demonstrating that a person's total health is indeed related to his or her oral health. Elimination of all oral infections, including gingivitis and periodontis, is important to overall health. CLINICAL IMPLICATIONS This article reviews recent evidence on the systemic and oral connection and discusses these findings as they relate to patient care. The article examines trends in nonsurgical and surgical therapy that will successfully arrest periodontal infections. Opportunities for early diagnosis and prevention will play an increasing role in dental practice in the future as patients understand the importance of oral health to overall health.
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Affiliation(s)
- C H Drisko
- Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville School of Dentistry, KY 40202, USA
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Loesche WJ. The antimicrobial treatment of periodontal disease: changing the treatment paradigm. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2000; 10:245-75. [PMID: 10759408 DOI: 10.1177/10454411990100030101] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last 100 years, methods of surgical periodontal treatment have enjoyed a history of success in improving oral health. The paradigm of care is based on the "non-specific plaque hypothesis"--that is, the overgrowth of bacterial plaques cause periodontal disease, and the suppression of this overgrowth reduces disease risk. The central feature of this approach to care is the removal of inflamed gingival tissue around the teeth to reduce periodontal pocket depth, thereby facilitating plaque removal by the dentist and by the patient at home. Over the last 30 years, with the recognition that periodontal disease(s) is caused by specific bacteria and that specific antimicrobial agents can reduce or eliminate the infection, a second paradigm has developed. This new paradigm, the "specific plaque hypothesis", focuses on reducing the specific bacteria that cause periodontal attachment loss. The contrast between the two paradigms can be succinctly stated as follows: The antimicrobial therapy reduces the cause, while the surgical therapy reduces the result of the periodontal infection. The specific plaque hypothesis has two important implications. First, with the increasing attention to evidence-based models for prevention, treatment, outcome assessment, and reimbursement of care, increasing attention and financial effort will be channeled into effective preventive and treatment methods. Second, the recent observations that periodontal infections increase the risk of specific systemic health problems, such as cardiovascular disease, argue for the prevention and elimination of these periodontal infections. This review highlights some of the evidence for the specific plaque hypothesis, and the questions that should be addressed if antimicrobial agents are to be used responsively and effectively.
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Affiliation(s)
- W J Loesche
- University of Michigan School of Dentistry, Ann Arbor 48109, USA
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