Full-mouth disinfection revisited

During an election season, voters are often deceived and confused by wild political claims.

by Lynne H. Slim, RDH, BSDH, MSDH
periodent@mindspring.com

During an election season, voters are often deceived and confused by wild political claims. Take my beloved state of Georgia, for example, where we have all types of folks like Georgia Bulldog fans and the hoity toity in-town crowd. One candidate who was running for the state senate claimed that the other candidate, if elected, wanted to impose a 23% sales tax. What the ad didn't say is that the 23% sales tax would be a substitute for federal income tax.

Don't you think that the truth was stretched just a little bit too far in this misleading ad? Some of this year's TV political ads were totally outrageous. So I can understand the growth of a nonpartisan, nonprofit Web site like FactCheck.org.

Do you ever feel the need for a nonpartisan, nonprofit Web site in dental hygiene that checks claims by writers, speakers, and companies about products and procedures? It's easy to feel completely overwhelmed with reams of data from individual studies. That's why systematic reviews of the literature are often helpful because they provide summaries of evidence. They are a quick way of keeping up to date without the effort of having to read and appraise a large body of literature.

I've been following the research on full-mouth disinfection and have read quite a few studies. Quirynen et al. (1995), for example, compared one-stage, full-mouth disinfection to quadrant scaling and root planing at two-week intervals. The rationale for the full-mouth disinfection protocol was to prevent reinfection of treated sites from the untreated pockets and intra-oral niches. Results found a significant reduction in pocket depth for the full-mouth disinfection group when compared to the quadrant group for deep pockets.1

Recently, I found a new systematic review of the literature on full-mouth disinfection for chronic periodontitis, and it's the very first one on this topic.2 The authors systematically reviewed the effectiveness of full-mouth concepts for chronic periodontitis compared to quadrant scaling and searched for randomized, controlled clinical trials. In an extensive search of the literature, 216 abstracts were identified but only seven clinical trials were deemed reliable for a meta-analysis. Reliability is of utmost importance because studies are sometimes flawed and biased for a variety of reasons.

If you've never read a systematic review of the literature, this would be a good one to start with. The question of evidence for 24-hour, full-mouth disinfection (FMD) with and without adjunctive chlorhexidine or povidone iodine compared to a conventional quadrant approach over six weeks showed that the differences were modest and the implications were not profound. All three interventions (FMD with and without adjunctive antimicrobials or quadrant therapy) improved clinical outcomes. The authors concluded that a decision to select one modality over another needs to include patient preferences and convenience of the treatment schedule.

When speakers are presenting data and moving quickly from slide to slide to support their positions on a given topic, raise your hand and challenge their statements. Like the expression, “Show me the money,” you can politely ask the speaker to “show me the studies,” because speakers and writers sometimes pick and choose studies to make their point. Are claims being made that are overstating the evidence, or are they backed by good science?

P.S. Now that the political season in Georgia is over, I've been trying to figure out if a miniature wirehaired dachshund pup stands a chance of landing in the White House. As most of you know by now, I have three of them, and they are among the loves of my life. Let's go presidential and support the presence of a weiner dog running around President Obama's desk in the Oval Office!

References

1 Quirynen M, Bollen CM, Vandekerckhove C, Dekeyser W, Papaioannou W, Eysssen H. Full-vs. partial mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations. J of Dent Res 1995: 74: 1459-1467.

2 Eberhard J, JervØe-Storm P-M, Needleman I, Worthington H, Jepsen S. Full-mouth treatment concepts for chronic periodontitis: a systematic review. J Clin Periodontol 2008: 35: 591-604.

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