Periodontitis is a chronic inflammatory disease that results from complex interactions between bacterial infection and the host response which is modified by behavioural and systemic risk factors. Treatment involves scaling and root planning together with effective oral hygiene measures. Because of the risk of recolonisation hypothesis a full-mouth disinfection approach, which consists of SRP of all pockets in two visits within 24 hours, in combination with adjunctive chlorhexidine treatments of all oral niches, has been proposed with some studies suggesting better outcomes.
The aim of this Cochrane review update was to evaluate the clinical effects of full-mouth scaling or full-mouth disinfection (within 24 hours) for the treatment of periodontitis compared to conventional quadrant subgingival instrumentation (over a series of visits at least one week apart) and to evaluate whether there was a difference in clinical effects between full-mouth disinfection and full-mouth scaling.
Methods
Searches were conducted in the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, the US National Institutes of Health Trials Register (ClinicalTrials.gov) and the WHO International Clinical Trials Registry databases. Randomised controlled trials (RCTs) with at least 3 months follow up were considered. Four reviewers extracted data with 3 reviewers assessing methodological quality. Tooth loss and change in probing pocket depth (PPD) were the primary outcomes, with change in clinical attachment level (CAL), bleeding on probing (BOP) pocket closure and adverse events as secondary outcomes. Standard Cochrane approaches were used for data analyses.
Results
- 20 RCT were included involving a total of 944 patients.
- No studies assessed the primary outcome tooth loss.
- 13 trials compared full-mouth scaling and root planing within 24 hours without the use of antiseptic (FMS) versus control.
- 3 of the FMS trials were at high risk 6 at low risk of bias and 4 at unclear risk of bias
- There was no evidence for a benefit for FMS over control at 6 – 8 months for PPD, CAL or BOP (see table).
| No. of Studies (patients) | Mean difference (95%CI) | |
| PPD | 5 (148) | 0.03 mm (–0.14 to 0.20) |
| CAL | 5 (148) | 0.10 mm (–0.05 to 0.26) |
| BOP | 3 (80) | 2.64% (–8.81 to 14.09) |
- 13 trials compared full-mouth scaling and root planing within 24 hours with adjunctive use of an antiseptic (FMD) versus control.
- 4 FMD trials were judged to be at high risk of bias, one at low-risk CI –8.81 to 14.09
- There was no evidence for a benefit for FMD over control at 6 – 8 months for PPD, CAL or BOP (see table).
| No. of Studies (patients) | Mean difference (95%CI) | |
| PPD | 6 (214) | 0.11 mm (–0.04 to 0.27) |
| CAL | 6 (214) | 0.07 mm (–0.11 to 0.24) |
| BOP | 4 (92) | 9.54% (–2.24 to 21.32) |
- 6 trials compared FMS with FMD.
- 2 trials were at high risk of bias, one at low risk and 3 at unclear risk
- At 6 to 8 months, there was no evidence of a benefit of FMD over FMS for PPD, CAL or BOP (see table).
| No. of Studies (patients) | Mean difference (95%CI) | |
| PPD | 4 (112) | -0.11 mm (–0.30 to 0.07) |
| CAL | 4 (112) | -0.05 mm (–0.23 to -0.13) |
| BOP | 2 (22) | -0.20 (–13.27 to 12.87) |
Conclusions
The authors concluded: –
The inclusion of nine new RCTs in this updated review has not changed the conclusions of the previous version of the review. There is still no clear evidence that FMS or FMD approaches provide additional clinical benefit compared to conventional mechanical treatment for adult periodontitis. In practice, the decision to select one approach to non-surgical periodontal therapy over another should include patient preference and the convenience of the treatment schedule.
Comments
This Cochrane review updates the 2015 version (Dental Elf – 23rd Apr 2015) and includes 9 additional trials. However, there is still no clear evidence that FMS or FMD are more beneficial than conventional scaling and root planing. Limitations in the design of the included studies means that the certainty of the available evidence was low to very low. The review authors’ recommend that future studies should follow the CONSORT statement and should address the patient burden and economic costs.
Links
Primary Paper
Jervøe-Storm PM, Eberhard J, Needleman I, Worthington HV, Jepsen S. Full-mouth treatment modalities (within 24 hours) for periodontitis in adults. Cochrane Database Syst Rev. 2022 Jun 28;6:CD004622. doi: 10.1002/14651858.CD004622.pub4. PMID: 35763286.
Other references
Cochrane Oral Health Blog – Treating all teeth (full mouth) within 24 hours for gum disease in adults
Dental Elf – 23rd Apr 2015
Dental El – 25th Oct 2015
Dental El – 25th Oct 2021
Periodontitis: Adjunctive amoxicillin and metronidazole with full-mouth scaling and root planing
