RESUMO
This study examined the hypothesis of an intra-oral shift, during initial periodontal therapy, from a periopathogenic to a cariogenic flora. Seventy-one patients with periodontitis were randomly allocated to one of the following treatment strategies: (1) scaling and root planing, quadrant by quadrant, at two-week intervals (NC); (2) full-mouth scaling and root planing within 24 hrs (FRP); or (3) full-mouth disinfection within 24 hrs, including antiseptics [chlorhexidine (CHX) or amine fluoride/stannous fluoride (F) for 2 mos, or CHX for 2 mos followed by F for 6 mos (CHX+F)]. At baseline and after 2, 4, and 8 mos, bacterial samples were taken from supra- and subgingival plaque, saliva, and tongue. The detection frequencies and relative proportions of Streptococcus mutans increased in the NC and FRP groups, but decreased in the F group. In the CHX group, these species disappeared temporarily, but they disappeared for the entire 8 mos in the CHX+F group. These observations were similar for all sample locations. The periopathogens decreased in all groups. This finding confirms the abovementioned hypothesis and indicates a need for caries prophylactic regimens.
Assuntos
Anti-Infecciosos Locais/farmacologia , Clorexidina/farmacologia , Placa Dentária/microbiologia , Antissépticos Bucais/farmacologia , Periodontite/terapia , Porphyromonas gingivalis/efeitos dos fármacos , Streptococcus mutans/crescimento & desenvolvimento , Adulto , Idoso , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Contagem de Colônia Microbiana , Raspagem Dentária , Ecossistema , Feminino , Fluoretos Tópicos/farmacologia , Fluoretos Tópicos/uso terapêutico , Humanos , Lactobacillus/crescimento & desenvolvimento , Lactobacillus/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais/uso terapêutico , Periodontite/microbiologia , Streptococcus mutans/isolamento & purificação , Fluoretos de Estanho/farmacologia , Fluoretos de Estanho/uso terapêuticoRESUMO
Most periodontal pathogens colonise different niches such as the oral mucosa, tongue, saliva, periodontal pockets, all hard intra-oral surfaces and the tonsils. Since intra-oral translocation of these pathogens between these niches is possible, a 'one stage' disinfection of the whole mouth in one or two consecutive days as treatment strategy for periodontal infections must be considered. A one stage full-mouth disinfection is achieved by a scaling and root planing of all periodontal pockets within 24 hours, in combination with a chlorhexidine application in all niches (subgingival irrigation, mouth wash, brushing of the tongue, and spray for the pharynx). As such, reinfection by bacteria of recently instrumented sites is inhibited. This approach results in significant additional clinical and microbiological results compared to the classical approach (scaling and rootplaning per quadrant with several days or weeks between each session).
Assuntos
Raspagem Dentária/métodos , Desinfecção/métodos , Boca/microbiologia , Periodontite/terapia , Aplainamento Radicular/métodos , Placa Dentária/microbiologia , Humanos , Mucosa Bucal/microbiologia , Higiene Bucal , Orofaringe/microbiologia , Tonsila Palatina/microbiologia , Periodontite/microbiologia , Saliva , Irrigação Terapêutica , Fatores de Tempo , Língua/microbiologiaRESUMO
BACKGROUND, AIMS: Previous studies indicated that oral hygiene aids can play a rôle in the intra-oral translocation of pathogens. The survival rate of cariogenic and periodontopathogenic species on toothbrushes, with and without toothpaste, and interdental brushes was presently investigated. MATERIAL AND METHODS: 12 periodontitis patients had their interdental spaces professionally cleaned with interdental brushes and their teeth with new toothbrushes with or without different dentifrices. Each time brushes were rinsed with tap water and stored dry at room temperature. At different time intervals an interdental brush or 4 tufts from a toothbrush were processed for vitality staining and selective and non-selective culturing procedures. RESULTS: Immediately after rinsing, a toothbrush without toothpaste harboured 10(7), 10(8) and 10(7) colony forming units (CFU) of respectively aerobic, anaerobic and black pigmented species. An insignificant decrease occurred the first 24 hours and after 48 hours still 10(4) CFU of aerobic and anaerobic species could be cultured. No periodontopathogen remained detectable at 8 hours, except for Fusobacterium nucleatum. The proportion of vital bacteria decreased in 48 hours from 50% to 30%. Comparable results were obtained for interdental brushes. The bacterial survival rate on toothbrushes was significantly reduced by the use of a detergent containing toothpaste by 2 log at baseline, another 2 log at 4 hours and an extra log more at 8 hours for aerobic and anaerobic species. A toothpaste without detergent only had an insignificant bactericidal effect. CONCLUSION: Toothpaste detergents decrease the survival rate of pathogenic species on a toothbrush and can thus limit the risk for bacterial translocation.
Assuntos
Dispositivos para o Cuidado Bucal Domiciliar/microbiologia , Detergentes/farmacologia , Periodontite/microbiologia , Escovação Dentária/instrumentação , Cremes Dentais/química , Cremes Dentais/farmacologia , Adulto , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Aderência Bacteriana/efeitos dos fármacos , Técnicas de Tipagem Bacteriana , Contagem de Colônia Microbiana , Contaminação de Equipamentos , Humanos , Modelos Lineares , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Bactérias/crescimento & desenvolvimento , Desinfecção/métodos , Boca/microbiologia , Periodontite/terapia , Adulto , Idoso , Periodontite Agressiva/microbiologia , Periodontite Agressiva/terapia , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/genética , Bacteroides/efeitos dos fármacos , Bacteroides/crescimento & desenvolvimento , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Doença Crônica , Raspagem Dentária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/microbiologia , Hibridização de Ácido Nucleico , Orofaringe/microbiologia , Tonsila Palatina/microbiologia , Bolsa Periodontal/microbiologia , Bolsa Periodontal/terapia , Periodontite/microbiologia , Porphyromonas gingivalis/efeitos dos fármacos , Porphyromonas gingivalis/crescimento & desenvolvimento , Aplainamento Radicular , Saliva/microbiologia , Língua/microbiologiaRESUMO
BACKGROUND: Although periodontitis has a multi-factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra-oral hard surfaces) and even in the oro-pharyngeal area (e.g., the sinus and the tonsils). METHODS: This review article discusses the intra-oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra-oral translocation. RESULTS AND CONCLUSIONS: Based on the literature, the oro-pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve "a one stage approach" of all pathologic pockets (1-stage full-mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period. For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining dentition. This more global approach offers significant additional clinical and microbiological benefits.
Assuntos
Bactérias Gram-Negativas/fisiologia , Periodontite/microbiologia , Anti-Infecciosos Locais/uso terapêutico , Aderência Bacteriana , Raspagem Dentária , Regeneração Tecidual Guiada Periodontal , Humanos , Mucosa Bucal/microbiologia , Orofaringe/microbiologia , Tonsila Palatina/microbiologia , Bolsa Periodontal/microbiologia , Periodontite/terapia , Aplainamento Radicular , Saliva/microbiologia , Língua/microbiologia , Resultado do Tratamento , CicatrizaçãoRESUMO
BACKGROUND/AIMS: Recent studies reported significant additional clinical and microbiological improvements when severe adult periodontitis was treated by means of a "one-stage full-mouth" disinfection instead of a standard treatment strategy with consecutive root planings quadrant per quadrant. The one stage full-mouth disinfection procedure involves scaling and root planing of all pockets within 24 h in combination with an extensive application of chlorhexidine to all intra-oral niches such as periodontal pockets, tongue dorsum, tonsils (chairside, and at home for 2 months). This study aims to examine the relative importance of the use of chlorhexidine in the one stage full-mouth disinfection protocol. METHODS: Therefore, 3 groups of 12 patients each with advanced periodontitis were followed, both from a clinical and microbiological point of view, over a period of 8 months. The patients from the control group were scaled and root planed, quadrant per quadrant. at two-week intervals. The 2 other groups underwent a one stage full-mouth scaling and root planing (all pockets within 24 h) with (Fdis) or without (FRp=full-mouth root planing) the adjunctive use of chlorhexidine. At baseline and after 1, 2, 4 and 8 months, the following clinical parameters were recorded: plaque and gingivitis indices, probing depth, bleeding on probing and clinical attachment level. Microbiological samples were taken from different intra-oral niches (tongue, mucosa, saliva and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media in order to evaluate the number of CFU/ml for the key-periodontopathogens. At baseline, an anonymous questionnaire was given to the patients to record the perception of each treatment (post operative pain, fever, swelling etc.). RESULTS: All 3 treatment strategies resulted in significant improvements for all clinical parameters, but the Fdis and FRp patients reacted always significantly more favourably than the control group, with an additional probing depth reduction of +/- 1.5 mm and an additional gain in attachment of +/- 2 mm (for pockets > or = 7 mm). Also from a microbiological point of view both the FRp and Fdis patients showed additional improvements when compared to the control group, as well in the reduction of spirochetes and motile organisms as in the number of CFU/ml of the key-pathogens, especially when the subgingival plaque samples were considered. The differences between FRp and Fdis patients were negligible. CONCLUSIONS: These findings suggest that the benefits of a "one-stage full-mouth disinfection" in the treatment of patients suffering from severe adult periodontitis probably results from the full-mouth scaling and root planing within 24 h rather than the beneficial effect of chlorhexidine. The raise in body temperature the second day after the full-mouth scaling and root planing seems to indicate a Shwartzman reaction.