Clinical and microbiological evaluation of one-stage full-mouth disinfection: a short-term study
Avaliação clínica e microbiológica do protocolo one-stage full-mouth disinfection: estudo de curto prazo
Cortelli, José Roberto; Castro, Marcos Vinicius M. de; Balejo, Rodrigo Dalla Pria; Alencar, Camila Oliveira de; Garcioni Filho, Antonio Carlos; Cortelli, Sheila Cavalca; Costa, Fernando Oliveira
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.
Keywords
Resumo
Introdução: Os pacientes parecem aderir melhor ao tratamento periodontal de curto prazo. Além disso, tratamentos de tempo curto possuem melhor custo-benefício. No entanto, os benefícios associados a este tipo de tratamento ainda requerem investigações adicionais. Objetivo: O presente estudo avaliou longitudinalmente indivíduos com periodontite crônica clínica e microbiologicamente tratados pelo protocolo one-stage full-mouth disinfection. Material e método: Dezesseis indivíduos (49,87 ± 8,22), que se enquadraram nos critérios de inclusão/ exclusão foram incluídos. Um examinador calibrado, avaliou índice de placa e gengival, profundidade de bolsa e nível clínico de inserção pré e pós terapia. Amostras subgengivais coletadas dos cinco sítios periodontais mais doentes estabeleceram a carga bacteriana total e níveis de P. gingivalis e S. oralis por qPCR. One-stage full-mouth disinfection foi realizado com instrumentos manuais associado a gel de clorexidina e solução. Após, os indivíduos utilizaram clorexidina 0,12% para bochecho, duas vezes ao dia, durante os dois meses. Dados foram comparados pelo teste pareado t de Student (p<0,05). Resultado: A análise estatística revelou que o tratamento proporcionou melhorias clínicas e microbianas significativas em três meses. A carga bacteriana total evidenciou reduções mais pronunciadas do pré para o pós-tratamento (p=0,0001). Similarmente, P. gingivalis e S. oralis mostraram redução no pós-tratamento. Conclusão: Após 3 meses de monitoramento, indivíduos com periodontite crônica apresentaram melhora clínica e microbiana com o protocolo one stage full-mouth disinfection.
Palavras-chave
References
1. Löe H, Anerud A, Boysen H, Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 16 years of age. J Clin Periodontol. 1986; 13: 431-40. PMid:3487557. http://dx.doi.org/10.1111/j.1600-051X.1986.tb01487.x
2. Lindhe J, Karring T, Lang NP. Tratado de periodontia clínica e implantodontia oral. Rio de Janeiro: Guanabara Koogan; 2005.
3. Zambon JJ. Periodontal diseases: microbial factors. Ann Periodontol. 1996; 1: 879-925. PMid:9118283. http://dx.doi.org/10.1902/annals.1996.1.1.879
4. Kumar PS, Leys EJ, Bryk JM, Martinez FJ, Moeschberger ML, Griffen AL. Changes in periodontal health status are associated with bacterial community shifts as assessed by quantitative 16S cloning and sequencing. J Clin Microbiol. 2006; 44: 3665-73. PMid:17021095 PMCid:PMC1594761. http://dx.doi.org/10.1128/JCM.00317-06
5. Li J, Helmerhorst EJ, Leone CW, Troxler RF, Yaskell T, Haffajee AD, et al. Identification of early microbial colonizers in human dental biofilm. J Appl Microbiol. 2004; 97: 1311-8. PMid:15546422. http://dx.doi.org/10.1111/j.1365-2672.2004.02420.x
6. Adriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000. 2004 Oct; 36(1): 121-45. PMid:15330946. http://dx.doi.org/10.1111/j.1600-0757.2004.03676.x
7. Suomi, JD, Greeme JC, Vermillion JR, Doyle J, Chang JJ, Leatherwood EC. The effect of controlled oral hygiene procedures on the progression of periodontal disease in adults: results after third and final year. J Periodontol. 1971; 42(3): 152-60. PMid:4396693. http://dx.doi.org/10.1902/jop.1971.42.3.152
8. Costa FO, Santuchi CC, Lages EJ, Cota LO, Cortelli SC, Cortelli JR, et al. Prospective study in periodontal maintenance therapy: comparative analysis between academic and private practices. J Periodontol. 2012; 83(3):301-11. PMid:21780903. http://dx.doi.org/10.1902/jop.2011.110101
9. Quirynen M, Bollen CM, Vandekerckhove BN, Dekeyser C, Papaioannou W, Eyssen H. Full-vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations. J Dent Res . 1995; 74: 1459-67. PMid:7560400. http://dx.doi.org/10.1177/00220345950740080501
10. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999; 4: 1-6. PMid:10863370. http://dx.doi.org/10.1902/annals.1999.4.1.1
11. Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral higiene and periodontal condition. Acta Odontol Scand. 1964; 22: 121-35. PMid:14158464. http://dx.doi.org/10.3109/00016356408993968
12. Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963; 21: 533-51. PMid:14121956. http://dx.doi.org/10.3109/00016356309011240
13. Cortelli JR, Cortelli SC, Jordan S, Haraszthy VI, Zambon JJ. Prevalence of periodontal pathogens in Brazilians with aggressive or chronic periodontitis. J Clin Periodontol. 2005; 32: 860-6. PMid:15998269. http://dx.doi.org/10.1111/j.1600-051X.2005.00777.x
14. Nonnenmacher C, Dalpke A, Mutters R, Heeg K. Quantitative detection of periodontopathogens by real-time PCR. J Microbiol Methods. 2004 Oct; 59(1): 117-25. PMid:15325758. http://dx.doi.org/10.1016/j.mimet.2004.06.006
15. Saito T, Inagaki S, Sakurai K, Okuda K, Ishihara K. Exposure of P. gingivalis to noradrenaline reduces bacterial growth and elevates ArgX protease activity. Arch Oral Biol. 2011 Mar; 56(3): 244-50. PMid:20970116. http://dx.doi.org/10.1016/j.archoralbio.2010.09.014
16. Ali RW, Lie T, Skaug N. Early effects of periodontal therapy on the detection frequency of four putative periodontal pathogens in adults. J Periodontol. 1992; 63: 540-7. PMid:1625154. http://dx.doi.org/10.1902/jop.1992.63.6.540
17. Tan BT, Mordan NJ, Embleton J, Pratten J, Galgut PN. Study of bacterial viability within human supragingival dental calculus. J Periodontol. 2004; 75: 23-9. PMid:15025213. http://dx.doi.org/10.1902/jop.2004.75.1.23
18. Bollen CM, Vandekerckhove BN, Papaioannou W, Van Eldere J, Quirynen M. Full- versus partial-mouth disinfection in the treatment of periodontal infections. A pilot study: long term microbiological observations. J Clin Periodontol. 1996; 23: 960-70. PMid:8915027. http://dx.doi.org/10.1111/j.1600-051X.1996.tb00519.x
19. Mongardini C, Van Steenberghe D, Dekeyser C, Quirynen M. One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. I. Long-term clinical observations. J Periodontol. 1999; 70: 632-45. PMid:10397519. http://dx.doi.org/10.1902/jop.1999.70.6.632
20. Quirynen M, Mongardini C, De Soete M, Pauwels M, Coucke W, Van Eldere J, et al. The role of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis. Long-term clinical and microbiological observations. J Clin Periodontol. 2000; 27: 578-89. PMid:10959784. http://dx.doi.org/10.1034/j.1600-051x.2000.027008578.x
21. Sekino S, Ramberg P, Uzel NG, Socransky SS, Lindhe J. The effect of a chlorhexidine regimen on de novo plaque formation. J Clin Periodontol. 2004; 31: 609-14. PMid:15257736. http://dx.doi.org/10.1111/j.1600-051X.2004.00526.x
22. Van Steenbergen TJ, Petit MD, Scholte LH, van der Welden U, de Graff J. Transmission of Porphyromonas gingivalis between spouses. J Clin Periodontol. 1993; 20: 340-5. PMid:8388896. http://dx.doi.org/10.1111/j.1600-051X.1993.tb00370.x
23. Cortelli JR, Aquino DR, Cortelli SC, Nobre Franco GC, Fernandes CB, Roman-Torres CV, et al. Detection of periodontal pathogens in oral mucous membranes of edentulous individuals. J Periodontol. 2008 Oct; 79(10): 1962-5. PMid:18834252. http://dx.doi.org/10.1902/jop.2008.080092
24. Lamont RJ, Jenkinson HF. Life below the gum line: pathogenic mechanisms of Porphyromonas gingivalis. Microbiol Mol Biol. 1998; 62: 1244-63.
25. Dzink JL, Socransky SS, Haffajee AD. The predominant cultivable microbiota of active and inactive lesions of destructive periodontal diseases. J Clin Periodontol. 1988; 15: 316-23. PMid:3292595. http://dx.doi.org/10.1111/j.1600-051X.1988.tb01590.x
26. Van Winkelhoff AJ, Van der Velden U, Winkel EG, de Graff J. Black-pigmented Bacteroides and motile organisms in individuals with and without periodontal breakdown. J Periodontal Res. 1986; 21: 434-8. PMid:2942671. http://dx.doi.org/10.1111/j.1600-0765.1986.tb01477.x
27. Haffajee AD, Uzel NG, Arguello EI, Torresyap G, Guerrero DM, Socransky SS. Clinical and microbiological changes associated with the use of combined antimicrobial therapies to treat "refractory" periodontitis. J Clin Periodontol. 2004; 31: 869-77. PMid:15367191. http://dx.doi.org/10.1111/j.1600-051X.2004.00573.x
28. Davey ME, Costerton JW. Molecular genetics analyses of biofilm formation in oral isolates. Periodontol 2000. 2006; 42: 13-26. PMid:16930303. http://dx.doi.org/10.1111/j.1600-0757.2006.00052.x
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email