Gum disease or periodontitis is a chronic inflammatory disease that causes damage to the soft tissue and bone around the teeth. Mild periodontitis is common in adults with severe periodontitis occurring in up to 20% of the population. Non-surgical treatments based on the mechanical removal of bacteria from infected root surfaces are used in order to arrest and control the loss of the bone and tissue that support the tooth in adults suffering from chronic gum disease. These treatments can be carried out in a different area of the mouth in separate sessions over a period of several weeks (SRP), which is the conventional method, or alternatively, can be done within 24 hours in one or two sessions, which is termed ‘full-mouth scaling’ (FMS). When an antiseptic agent (such as chlorhexidine for example) is added to the full-mouth scaling the intervention is called ‘full-mouth disinfection’ (FMD). The rationale for full-mouth approaches is that they may reduce the likelihood of re-infection in already treated sites. This review is an update of one originally published in 2008, and considers the effectiveness of full mouth treatments.
What was the research?
A systematic review of the evidence to consider the effectiveness of full-mouth treatments carried out within 24 hours compared to the more conventional treatment of partial mouth scaling and root planing (SRP) usually done over a number of weeks. The treatments being reviewed are full-mouth scaling (FMS) and full-mouth disinfection (FMD). A secondary aim was to establish if there was a difference in effectiveness between FMS and FMD.
Who conducted the research?
The research was conducted by a team led by Joerg Eberhard from Hannover Medical School, on behalf of the Cochrane Oral Health Group. Soren Jepson, Pia-Merete Jervøe-Storm, Ian Needleman and Helen V. Worthington were also on the team.
What evidence was included in the review?
Data was extracted from 12 randomised controlled trials. A total of 389 people participated in the trials, and were randomly assigned to full mouth scaling or full mouth disinfection, or conventional scaling and root planing. Participants had to have a clinical diagnosis of chronic periodontitis according to the International Classification of Periodontal Diseases. We excluded studies of people with aggressive periodontitis, systemic disorders or who were taking antibiotics.
What did the evidence say?
Treatment effects of FMS and FMD compared to conventional scaling and root planing (SRP) are modest and there are no clear implications for periodontal care. Harms and adverse events were reported in eight studies. The most important harm identified was an increased body temperature after FMS or FMD treatments. In practice, the decision to select one approach to non-surgical periodontal therapy over another can include patient preference and the convenience of the treatment schedule.
How good was the evidence?
The quality of the evidence is low for all treatment comparisons and outcomes. This is due to the small number of studies and participants involved and limitations in the study designs. Future research is likely to change findings.
What are the implications for dentists and the general public?
The inclusion of five additional randomised controlled trials in this updated review comparing the clinical effects of conventional mechanical treatment with full-mouth scaling (FMS) and full-mouth disinfection (FMD) approaches for the treatment of chronic periodontitis has not changed the conclusions of the original review. From the twelve included trials there is no clear evidence that FMS or FMD is more beneficial than conventional scaling and root planing (SRP). In practice, the decision to select one approach to non-surgical periodontal therapy over another can include patient preference and the convenience of the treatment schedule.
What should researchers look at in the future?
The low quality evidence for this review means that future research could change the findings. Studies should follow the CONSORT statement.
Eberhard J, Jepsen S, Jervøe-Storm PM, Needleman I, Worthington HV. Full-mouth treatment modalities (within 24 hours) for chronic periodontitis in adults. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD004622. DOI: 10.1002/14651858.CD004622.pub3.